Immunonutrition

Usefulness of immunonutrition

Immunonutrition can contribute to the significant reduction of the risks related to the complications of acute post-operative inflammation. Surgery (in oncology , traumatology , etc.) often determines a HYPERmetabolic – CATABOLICAL response responsible for:

• Weight loss
• Reduction of muscle mass and tone
• Impaired immune system
• Slowing down of the healing processes
• Difficulty in weaning from mechanical respiration (when applied)
• Increased risk of infections
• In the worst case scenario, multiorgan failure and increased risk of mortality.

In such cases, the only MINIMAL administration of nutrients by ENTERAL route is able to prevent intestinal villous atrophy and mucosal atrophy , to increase the intestinal immune barrier and to reduce bacterial translocation . However, let us remember that ADEQUATE (and not minimal) nutritional support is able to prevent both malnutrition and the various repercussions on the immune system.

Immunonutrition was born on the basis of these assumptions and aims to optimize the body’s own resources.

Immunonutrition molecules – immunonutrients

In immunonutrition the most useful and used molecules are:

• L- arginine
• L- glutamine ( amino acid )
•  Omega3 fatty acids (ω3 – essential fatty acid )
• Nucleotides
• Taurine (amino acid)
• Tocopherols (vitamin E)
• Inulin and fructo- oligosaccharides (FOS – water soluble dietary fiber)

Arginine has a stimulating action on the secretion of some hormones , including somatotropin [GH] and this is particularly valid (and demonstrated) precisely for debilitated and/or poly-traumatized subjects. It is also a precursor of nitric oxide (NO) and helps to enhance the activation of T lymphocytes and macrophages ( white blood cells ).

Glutamine , among its numerous functions, constitutes 60-70% of the energy used by enterocytes ( cells of the intestinal mucosa ) and has a primary action on lymphocyte and macrophage activation. Its administration proves to be useful in wound healing and in reducing hospitalization times. Taurine is an amino acid derivative which contributes to the regulation of osmotic balance , intracellular calcium homeostasis , composition and stabilization of cell membranes , antioxidant protection ,
blood sugar regulation etc. Its administration allows to maintain normal concentrations of platelets , erythrocytes ( red blood cells ), granulocytes (white blood cells) and lymphocytes .
ω3 fatty acids are typically anti-inflammatory; they also act on the metabolism of lipids favoring the increase of HDL and the reduction of LDL and triglycerides . They also act positively on the reduction of blood pressure and on the immune response and have no side effects.
The FOSsthey favor the selection of the correct intestinal bacterial flora , reduce the transit time of food, modulate the absorption of glucose and reduce that of cholesterol ; not least, they help maintain the integrity of the intestinal mucosa.

Immunonutrition: yes or no?

In conclusion, although the therapeutic effects of immunonutrition are by now ascertained, there is still little use of this nutritional practice among doctors and within clinical hospitalization structures. Obviously, even immunonutrition has very specific limits:

• It is possible to derive a significant benefit from it provided that first of all the basic nutritional needs are met
• It is not advisable to administer immunonutrients indiscriminately and each case should have a separate formulation.

These are secondary aspects and are easily managed through the intervention of a specialized professional, the latter being an indispensable figure in clinical nutrition and an integral part of medical therapy.