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Objective: to assess the effectiveness of immunonutrition (IN) compared to standard nutritional formulas in patients undergoing gastric cancer surgery. Material and Methods: this is a real-life, observational retrospective cohort study. It included 134 patients, all of whom underwent gastrectomy at Montecelo Hospital between December 2019 and December 2022. Group A (n = 79 patients) received standard nutrition, and Group B (n = 55 patients) received formulas containing arginine, nucleotides, omega-3 fatty acids, and extra virgin olive oil. This protocol was carried out both pre and postoperatively for an average period of 10 days. The study evaluated hospital stay, the need for parenteral nutrition (PN), postoperative complications, as well as anthropometric and laboratory variables. Statistical analyses were performed using Stata 16.1.® Results: in the IN group compared to the standard nutrition group, the hospital stay was reduced by 34 % (p < 0.001). The number of patients requiring PN decreased by 21.1 % (p = 0.022), and its duration also decreased by 33.2 % (p < 0.001). The risk of infectious complications was lower with IN, specifically 70.1 % less (p < 0.001). As for other postoperative complications, IN reduced the risk of intestinal obstruction by 84 % (p < 0.002), suture dehiscence by 90.9 % (p < 0.001), blood transfusion by 99.8 % (p < 0.001), pleural effusion by 90.9 % (p = 0.021), acute renal failure by 84.02 % (p = 0.047), and surgical re-intervention by 69.93 % (p < 0.011). In the IN group, there was less weight loss (p = 0.048) and a smaller decrease in postoperative albumin (p = 0.005) and cholesterol (p < 0.001). Conclusion: immunonutrition reduces postoperative complications, decreases hospital stay, and optimizes nutritional outcomes. [ABSTRACT FROM AUTHOR]

Los trastornos autoinmunes representan una familia de al menos 80 condiciones diferentes que surgen de una respuesta aberrante del sistema inmunológico resultando finalmente en la destrucción de tejidos y órganos específicos del cuerpo. Es importante destacar que durante las últimas tres décadas los estudios epidemiológicos han proporcionado evidencia de un aumento constante en la incidencia y prevalencia de trastornos autoinmunes. En los últimos años, varios estudios han demostrado que la vitamina D y los ácidos grasos poliinsaturados (AGPs) omega-3 ejercen propiedades inmunomoduladoras y antiinflamatorias sinérgicas que pueden aprovecharse positivamente para la prevención y el tratamiento de trastornos autoinmunes. En este sentido, el reciente ensayo clínico denominado VITAL (ensayo de vitamina D y omega 3); un estudio a gran escala, aleatorizado, doble ciego, controlado con placebo encontró que la suplementación conjunta de vitamina D y AGPs omega-3 (VIDOM) puede reducir la incidencia de enfermedades autoinmunes. En esta revisión de la literatura, resumimos los mecanismos moleculares detrás de las propiedades inmunomoduladoras y antiinflamatorias de la vitamina D y los AGPs omega-3, así como la posible interacción bidireccional entre el metabolismo de la vitamina D y el metabolismo de los AGPs omega-3 que justifica la co- suplementación VIDOM en trastornos autoinmunes.

Introducción: los bioderivados propuestos como candidatos a ingredientes alimentarios suelen requerir ciertas evaluaciones para las aplicaciones inmunonutricionales Los hongos comestibles-medicinales son un surtidor de compuestos con estas potencialidades. Entre ellos, las setas Pleurotus ostreatus contienen metabolitos bioactivos, con importantes usos en la industria alimenticia y en la práctica terapéutica de la industria médico-farmacéutica. Los ensayos de citotoxicidad in vitro constituyen métodos valiosos para evaluar productos de origen natural, como los extractos fúngicos. Objetivo: evaluar la citotoxicidad de dos extractos obtenidos de la seta Pleurotus ostreatus en diferentes líneas celulares. Método: se obtuvieron extractos hidrosolubles a partir del micelio y de los cuerpos fructíferos de Pleurotus ostreatus en laboratorios del Centro de Estudios de Biotecnología Industrial de la Universidad de Oriente. Se evaluó la citotoxicidad de los bioproductos por el ensayo de reducción del colorante resazurina sobre tres líneas celulares en el Laboratorio de Microbiología, Parasitología e Higiene (LMPH) de la Universidad de Amberes, Bélgica. Se utilizaron células no adherentes THP-1 (pre-monocitos de leucemia humana), células adherentes Caco-2 (epitelio de adenocarcinoma de colon humano) y células adherentes RAW 264.7 (macrófagos murinos). Resultados: los extractos de Pleurotus ostreatus no resultaron citotóxicos para ninguna de las líneas celulares estudiadas humanas o murina, ya que no ocasionaron daños sobre la viabilidad de las células epiteliales del sistema gastrointestinal, ni sobre las células del sistema inmune empleadas. Conclusiones: este resultado demuestra que ambos bioderivados fúngicos pueden ser aplicados con seguridad en estudios inmunonutricionales.

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Immunonutrition is a science that encompasses aspects related to nutrition, immunity, infection, inflammation and tissue damage. Immunomodulatory formulas have shown benefits in a wide variety of clinical situations. The objective of this work was to review the available evidence in immunonutrition (IN). For this, a bibliographic search has been carried out with the keywords: immunonutrition, arginine, glutamine, nucleotides, omega-3 fatty acids, ERAS, fast-track. Clinical trials, reviews and clinical practice guidelines have been included. IN has been shown to reduce postoperative fistulae in head and neck cancer patients and in gastric and esophageal cancer patients, infectious complications and hospital stay. Other clinical situations that benefit from the use of IN are pancreatic cancer surgery, colorectal cancer surgery and major burns. More controlled, prospective, and randomized studies are necessary to confirm the potential benefits of IN in other clinical situations such as non-esophageal thoracic surgery, bladder cancer, gynecological surgery, hip fracture, liver pathology and COVID-19, among others. [ABSTRACT FROM AUTHOR]

La desnutrición en el paciente con cáncer que es sometido a un procedimiento quirúrgico es uno de los problemas nutricionales mayormente asociado con desenlaces clínicos adversos, como aumento en el riesgo de las infecciones, mayor riesgo de formación de fístulas e incremento en los días de estancia hospitalaria y en el riesgo de mortalidad. La inmunonutrición (IMN) se refiere al uso de diversos nutrimentos en dosis mucho más altas de los requerimientos diarios, con la finalidad de lograr una modulación en la respuesta del sistema inmune del huésped en el proceso inflamatorio y una mejoría en el estado de nutrición en pacientes quirúrgicos. Es importante conocer el estado actual del uso de la IMN en el paciente con cáncer sometido a una cirugía, con la finalidad de aplicar correctamente la terapia nutricional y disminuir los desenlaces clínicos adversos, así como aumentar la supervivencia. El objetivo de esta revisión es conocer el estado actual del arte de la IMN en el paciente oncológico quirúrgico para llegar, de forma puntual, a recomendaciones en la práctica clínica basadas en la mejor evidencia científica disponible en la actualidad.

Las infecciones de las vías respiratorios altas (IVRA), son debilitantes para el potencial deportivo de los atletas de élite. El ejercicio físico activa múltiples vías moleculares y bioquímicas relacionadas con el sistema inmune, sensibles a influencias nutricionales. Sobre este contexto, la inmunonutrición está adquiriendo una nueva dirección orientada a conseguir el equilibrio inmunológico, contraponiéndose con algunas de las teorías que han sentado las bases de la inmunología del ejercicio durante las últimas décadas. Objetivo. Investigar los aspectos nutricionales que puedan mejorar la respuesta inmunológica en deportistas de elite. Estudiar los posibles beneficios del equilibrio inmunológico para mejorar el rendimiento, analizar los factores nutricionales que contribuyan al equilibrio de la respuesta inmunológica y extrapolar la evidencia actual en recomendaciones prácticas de alimentación/suplementación para mejorar la homeostasis de la respuesta inmunológica en atletas de élite, teniendo en cuenta las limitaciones existentes.Resultados. La evidencia científica apunta que se puede potenciar el equilibrio inmunológico y la respuesta inmune a través de la modificación de factores nutricionales. Dentro de los cuales, la vitamina D, los probióticos, la vitamina C y el cinc son los que cuentan con mayor evidencia. Conclusión. Los avances científicos resultan prometedores y de interés para los atletas de élite, debido a que pueden disminuir la incidencia de IVRA, mejorando el éxito deportivo de los mismos. Se requieren más estudios para su validación y aplicación.

Copyright of ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M. is the property of Knowledge E DMCC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Surgical stress predisposes patients to have immune dysfunction and an increased risk of infection. Malnourished surgical patients have higher postoperative morbidity and mortality rates, higher readmission rates, and higher hospital costs. The use of an immunomodulatory formula is associated in the ESPEN guidelines with a reduction in wound healing problems, suture failure, and infectious and global complications. Several authors have suggested that, since most clinical trials evaluating the efficacy of immunonutrition have been carried out in a traditional perioperative setting, it would be interesting to investigate its efficacy in a more controlled setting, such as in the ERAS (Enhanced Recovery after Surgery) protocol. The objective of this work was: a) to define the role that immunonutrition should play in ERAS protocols based on the best scientific evidence available; b) to analyze the difficulties that continue to exist in real-life clinical practice to screen the nutritional risk of patients; c) to make a proposal of algorithms adapted to the characteristics of our environment regarding the screening, assessment, and nutritional treatment of surgical patients in fast-track surgery. [ABSTRACT FROM AUTHOR]

Los pacientes quirúrgicos a menudo tienen un alto riesgo nutricional y esto se asocia con resultados posoperatorios deficientes, poniendo la supervivencia en riesgo.La identificación precoz de este tipo de pacientes es esencial para las intervenciones nutricionales tempranas con el objetivo de atenuar el catabolismo y preservar los procesos de respuesta al estrés quirúrgico que promueven la recuperación e inmunoprotección, reducen la morbimortalidad perioperatoria y mejoran los resultados quirúrgicos.En los últimos años, se han estudiado diversas estrategias nutricionales durante el período perioperatorio que han mostrado beneficios.El objetivo de la presente revisión es analizar la evidencia más reciente sobre la terapia nutricional en pacientes quirúrgicos no críticos; para ello se han consultado bases de datos electrónicas como PubMed, y revistas de las principales sociedades científicas competentes en la materia.

Copyright of Archivos Latinoamericanos de Nutrición is the property of Sociedad Latinoamericana de Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La inmunonutrición es una alternativa en pacientes quirúrgicos por sus ventajas clínicas. Se pretende unificar conceptos y desarrollar un documento de acceso y consulta fácil en relación con el uso de inmunonutrición en pacientes quirúrgicos en Colombia.

Introduction: Objective: the aim of the study is to evaluate the effect of preoperative and postoperative oral nutritional therapy in the prevention of malnutrition and postsurgical complications in colorectal cancer Patients and methods: patients who underwent oncological colorectal surgery between June 2014 and December 2015 are included. An evaluation of preoperative nutritional status is performed. Patients received IMPACT® (2/day) for 5-10 days previous surgery. In the postoperative period, patients received IMPACT®/24h from 3rd to 7th postoperative day. Patients with low rates of albumin (< 2.5) or postoperative ileus received parenteral nutrition. Data were analyzed with the statistical package SPSS 21.0. Results: two hundred and twenty colorectal cancer patients were included. Twenty-eight patients did not take the preoperative oral supplements. Following the intake of nutritional supplements, an improvement of prealbumin and transferrin was noticed. One hundred and twenty-one patients received oral nutrition and 41 received parenteral nutrition in the postoperative period. There were more postoperative complications among patients without preoperative nutritional supplements (50% vs 28.1%; p = 0.019), and hospital stay was higher 14.64 ± 11.86 vs 9.36 ± 5.5; p < 0.005). There were more complications among patients without postoperative oral nutritional supplements (24% vs 18.2%; p < 0.005), with more wound infection (1.9% vs 0.8%) and leaks (1.9% vs 0.8%). They also had a higher average stay (9.15 4.6 vs 7.57 2.5 days; p = 0.021). Conclusion: in our study, patients that received oral nutritional supplements prior and following colorectal surgery had a lower rate of complications and a shorter hospital stay. [ABSTRACT FROM AUTHOR]

La inmunonutrición enteral en el paciente con cáncer gástrico puede tener efectos benéficos sobre los resultados clínicos en el postoperatorio.

Purpose: Assess the efficacy of preoperative administration of oral immunonutrition in patients with resectable colorectal cancer, in terms of reducing the incidence of postoperative infectious complications. Material and methods: Prospective randomized study. A total of 84 patients were recruited. To the group YES IN, Impact© Oral was preoperatively administered for 8 days (3 bricks a day), whereas the NOT IN group only received normal diet, without supplements. Results: Of all patients, 40.5% (17) in the NOT IN group suffered infectious complications against 33.3% (14) in the YES IN group. Among patients with rectal cancer in the NOT IN group, 50% (8) suffered minor infectious complications, compared with 13.6% (3) among those in the YES IN group (P = .028). Using logistic regression, the variable total protein on the fifth postoperative day [OR: 2.8 (95% CI: 1.3 to 6.3) (P = .012)] showed a statistically significant relationship with the occurrence of infectious complications. Specifically, anastomotic leak variable behaved as a risk factor in the development of surgical site infection, with an OR of 4.5 (95% CI: 1.3 to 16.1) (P = .033). Discussion: Malnutrition in cancer patients suitable for surgery results in an increase in postoperative morbidity and mortality. The use of enteral formulas with immunonutrients in these subjects can attenuate this morbidity, decreasing infectious complications. Conclusion: In our analysis, the NOT IN group suffered more postoperative infectious complications, particularly the subset of patients with rectal cancer. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. Objectives: Some studies of patients receiving immuno-nutrition in the perioperative period in head and neck cancer have shown beneficial effects on clinical outcome and inmune status. The authors carried out a systematic review of randomised control trials to determine whether perioperative immunonutrition has a role in the treatment of head and neck cancer. Methods: 14 trials of polymeric nutritional supplementation with immunonutrition were identified. Two studies compared two types of immunonutrition. Results: A reduction in the length of postoperative hospital stay was seen in some trials, but the reason for this reduction is not clear. Some studides showed statistical differences with less complications in arginine-enhanced group and also showed a significant decrease of fistula complications in patients treated with a high arginine dose enhanced formula, if compared with a medium dose of arginine. Conclussion: Those planning future studies face challenges. A suitable powered clinical trial is required before firm recommendations can be made on the use of immunonutrition in head and neck cancer patients posto-peratively.Introducción: Un alto porcentaje de pacientes con cáncer de cabeza y cuello presentan un importante grado de malnutrición. Esta malnutrición está asociada defectos de la función inmune. Tanto la malnutrición como la inmunosupresión hacen a estos pacientes susceptibles de padecer complicaciones infecciosas en el postoperatorio. Objetivos: Algunos trabajos de pacientes que han recibido inmunonutrición en el postoperatorio de cirugía por cáncer de cabeza y cuello han mostrado un efecto beneficioso en la evolución clínica y el estado inmune. Los autores han llevado a cabo una revisión sistemática de los ensayos clínicos realizados hasta la fecha, para determinar el papel que tiene la inmunonutrición enteral postoperatoria en el tratamiento del cáncer de cabeza y cuello. Métodos: Se identificaron 14 trabajos en los que se habían utilizado fórmulas de inmunonutrición. Dos trabajos compararon dos tipos de inmunonutrición. Resultados: En algunos trabajos se observó una disminución en los días de estancia hospitalaria, aunque la razón para ello no está clara. Algunos estudios mostraron diferencias significativas con menos complicaciones en los grupos que recibieron nutriciones enriquecidas, presentando una disminución significativa en el número de fístulas en pacientes tratados con nutriciones con altas dosis de arginina, si se compara con una nutrición con una dosis media de arginina. Conclusión: Los futuros trabajos presentan retos. Es necesario un ensayo clínico extenso, para poder realizar recomendaciones firmes sobre el uso de la inmunonutrición en el postoperatorio de pacientes intervenidos de cáncer de cabeza y cuello.

Profound changes in perioperative management, namely "fast track surgery" have been recently proposed. This is a bundle of various techniques used for subjects undergoing elective operations that allows an improved well-being, faster recovery, shorter hospitalization and better outcome. From a nutritional point of view this new approach translates into a more rapid return of bowel function and thus to safely tolerate oral re-feeding within 1-3 days even after major operations. Nevertheless, the classic indications for perioperative artificial nutritional support remain valid but they should now apply only to a minority of patients. Extensive research in the last 20 years has clearly shown that modifying the composition of standard nutritional feeds by adding supernormal doses of specific substrates that have immuno-modulatory, anti-inflammatory, anabolic, and tissue protective ability often translates into improved surgical outcome. The most convincing and reproducible results were obtained on the reduction of infectious complication by the perioperative use of enteral formulas enriched with arginine and omega-3 fatty acids.Recientemente, se han propuesto cambios notables en el manejo perioperatorio, denominado «cirugía du curso rápido». Esto es un conjunto de técnicas diversas empleadas en individuos sometidos a cirugías programadas que permiten una mejora del bienestar, una recuperación más rápida, una hospitalización más corta y mejores resultados. Desde un punto de vista nutricional, este nuevo abordaje se traduce en una recuperación más rápida de la función intestinal y, por lo tanto, tolerar de forma segura la realimentación n 1-3 días, incluso después de intervenciones mayores. Sin embargo, las indicaciones clásicas del soporte nutricional artificial perioperatorio siguen siendo válidas pero serían aplicables hoy en día a una minoría de pacientes. La extensa investigación de los últimos 20 años ha demostrado claramente que la modificación de la alimentación nutricional estándar añadiendo dosis supranormales de sustratos específicos que poseen propiedades inmunomoduladoras, antiinflamatorias, anabólicas y protectoras de los tejidos a menudo se traduce en una mejora del resultado quirúrgico. Los resultados más convincentes y reproducibles se obtuvieron con la reducción de las complicaciones infecciosas mediante el uso perioperatorio de fórmulas enterales enriquecidas con arginina y ácidos grasos omega-3.

Background: Patients with head and neck cancer undergoing surgery have a high incidence of ambulatory postoperative complications. Objective: The aim of our study was to investigate the influence of an oral immunoenhanced supplement (arginine and glutamine) on nutritional and biochemical parameters in postsurgical ambulatory patients with head and neck tumor. Design: A population of 39 ambulatory postsurgical patients with oral and laryngeal cancer was enrolled. At Hospital discharge postsurgical head and neck cancer patients were asked to consume two units per day of a specially designed enhanced supplement for a twelve week period. Results: The mean age was 60.2+/-13.1 years (9 female/30 males). Duration of supplementation was 90.8+20 days. A significant increase of albumin (3.1±0.6 g/dl vs 4.12+0.7g /dl;pAntecedentes: Los pacientes con tumores de cabeza y cuello sometidos a cirugía presentan una alta incidencia de complicaciones ambulatorias. Objetivo: El principal objetivo de nuestro trabajo fue evaluar la influencia de un suplemento oral inmunoenriquecido con arginina y glutamina en pacientes postquirúrgicos ambulatorios con tumores de cabeza y cuello. Diseño: Una muestra de 39 pacientes postquirúrgicos ambulatorios con tumores de cabeza y cuello fue evaluada. Tras el alta hospitalaria, los pacientes recibieron dos bricks al día de un suplemento inmunoenriquecido durante 12 semanas. Resultados: La edad media fue de 60,2+/-13,1 años (9 mujeres/30 varones). La duración media de la suplementación fue de 90,8+20 días. Se detectó un aumento significativo en los niveles de albúmina (3,1±0,6 g/dl vs 4,12+0,7 mg/dl;p

Los ácidos grasos de naturaleza poliinsaturada ω-3 han recibido una gran atención en los últimos años como componentes de la dieta supresores de las funciones inmunes y por ello han sido aplicados en la resolución de diferentes desórdenes de naturaleza inflamatoria. Aunque la inhibición de algunas funciones inmunes por la acción de estos ácidos grasos ejerce efectos beneficiosos en la disminución de la respuesta inflamatoria del individuo, este estado puede conducir a una reducción significativa de la protección del individuo frente a microorganismos de naturaleza infecciosa (virus, bacterias, hongos y parásitos). Sin embargo, el aceite de oliva (constituido principalmente por ácidos grasos monoinsaturados y uno de los componentes principales de la dieta Mediterránea) modula también algunas de estas funciones, sin reducir de forma tan severa la resistencia inmune del individuo frente a agentes de naturaleza infecciosa. Bajo estas premisas podemos afirmar que la administración de aceite de oliva puede contribuir a la reducción de la actividad inflamatoria observada en algunas enfermedades crónicas caracterizadas por desórdenes inmunes, sin agravar la susceptibilidad del individuo a agentes patógenos. Por lo tanto, la aplicación del aceite de oliva en emulsiones lipídicas puede tener efectos beneficiosos sobre la salud y particularmente sobre el sistema inmune de individuos inmunocomprometidos, adquiriendo una gran importancia en nutrición clínica. El presente trabajo de revisión contribuye a clarificar la interrelación existente entre la administración de dietas constituidas por aceite de oliva y el sistema inmune, así como a determinar el efecto que este componente esencial de la dieta Mediterránea juega en la inmunomodulación en los estados de infección.Polyunsaturated fatty acids contribute to the suppression of immune system functions. For this reason, n-3 polyunsaturated fatty acids have been applied in the resolution of inflammatory disorders. Although the inhibition of several immune functions promotes beneficial effects on the human health, this state may lead to a significant reduction of immune protection against infectious microorganisms (viruses, bacteria, fungi and parasites). Nevertheless, less attention has been paid to the action of olive oil in immunonutrition. Olive oil, a main constituent of the Mediterranean diet, is capable of modulating several immune functions, but it does not reduce host immune resistance to infectious microorganisms. Based on these criteria, we corroborate that olive oil administration may exert beneficial effects on the human health and especially on immune system, because it contributes to the reduction of typical inflammatory activity observed in patients suffering from autoimmune disorders, but without exacerbating the susceptibility to pathogen agents. The administration of olive oil in lipid emulsions may exert beneficial effects on the health and particularly on the immune system of immunocompromised patients. Therefore, this fact acquires a crucial importance in clinical nutrition. This review contributes to clarify the interaction between the administration of diets containing olive oil and immune system, as well as to determine the effect promoted by this essential component of Mediterranean diet in the immunomodulation against an infectious agent.

La Nutrición Enteral es una técnica que aunque utilizada desde tiempos inmemoriales, ha sido en los últimos 25 años cuando ha experimentado un desarrollo considerable, pasando de ser un elemento terapéutico secundario, destinado exclusivamente a alimentar al paciente, a ocupar en la actualidad un papel importante que va mucho más allá del simple acto de nutrir. La composición cuantitativa pero sobre todo la cualitativa, es objeto de un interesante debate en el que se busca un perfil que permita modular determinados aspectos de la respuesta del organismo mediante el enriquecimiento con distintos nutrientes. Ello incluye desde el mantenimiento del trofismo intestinal y de la "barrera intestinal" antibacteriana, tan importante para prevenir el temido fracaso multiórgánico, hasta la atenuación del Síndrome de la Respuesta Inflamatoria Sistémica, pasando por los conceptos de alimentación inmunomoduladora, alimentación organoespecífica, farmaconutrientes o econutrición. En ésta nueva dinámica han adquirido importancia determinados nutrientes como la glutamina, arginina, nucleótidos, ácidos grasos de la serie ω-3 y antioxidantes diversos, así como la manipulación de otras moléculas de naturaleza no nutricional, como hormonas, factores de crecimiento, citoquinas y bloqueantes. Estos aspectos que suponen para el futuro unas apasionantes vías de investigación, nacen del mejor conocimiento que se va teniendo de la fisiopatología de procesos tan graves como la sepsis, y de la reacción del organismo ante el ayuno y la agresión grave, de modo que se está intentando modular dicha respuesta a través de cambios en la composición cuantitativa y cualitativa de las fórmulas.Enteral nutrition is a technique that even though it was used in times immemorial, in the last 25 years has suffered a considerable development, from being considered a secondary therapeutic weapon destined only to feed the patient, to occupying an important status that goes beyond the single act of nourishing. The quantitative composition but overall the qualitative one, is object of an interesting argument in which a profile allowing the modulation of certain aspects of the organism response through the supplementation with different nutrients is searched. That includes from the keeping of the intestinal trophism and of the anti-bacteria intestinal barrier, so important to avoid the frightening multiple organ dysfunction, up to the lessening of the Systemic Response Inflammatory Syndrome (SRIS), going through the immuno-modulative feeding concepts, specific- feeding, pharmaco-nutrient or eco-nutrition. In this new dynamic not only certain nutrients such as glutamine, arginine, nucleotides, ω-3 fatty acids and many antioxidants have acquired importance, but also the manipulation of other molecules of a non- nutritional nature, such as hormones, cytokines and blockers. These aspects that imply passionate ways of investigation for the future are born from the better knowledge that is being acquired from such a severe pathophysiology processes such as sepsis and the organism response before fast and severe aggression; therefore, the modulation of that response through changes in the quantitative and qualitative formulas composition is being attempted.

Objetivo: Valorar el estado nutricional en el perioperatorio, de pacientes afectos de cáncer esofágico o gástrico, tratados mediante esofaguectomía y gastrectomía total respectivamente, y analizar la repercusión de la dieta enteral inmunomoduladora con las complicaciones postquirúrgicas. Ámbito: Pacientes ingresados en el Servicio de Cirugía del Hospital Clínico Universitario de Salamanca. Pacientes y métodos: Pacientes sometidos a esofaguectomía yo gastrectomía total a los que se le aporta nutrición enteral (NE) precoz con una dieta inmunomoduladora. Intervenciones: A todos los pacientes se les pautaba una dieta inmunomoduladora de 1000 kcal/día por vía oral más dieta normal por turmix que iniciaban en el 5º día preoperatorio y continuando en el postoperatorio inmediato (en las primeras 24 h) con NE por catéter de yeyunostomía, de forma progresiva hasta conseguir 25Kcal/Kg/día al 4º-5º día. La NE se mantuvo al menos los primeros diez días del postoperatorio y se realizaron controles analíticos en el preoperatorio en el quinto y décimo días postoperatorios. También realizamos una ecuación de predicción con la variable dependiente morbi-mortalidad y como independientes con el resto de las variables. Resultados: Se estudiaron 68 pacientes de los cuales 36 (35 varones y 1 mujer) padecían cáncer esofágico y 32 (21 varones y 11 mujeres) que padecían cáncer gástrico. La media de edad de los pacientes con cáncer esofágico era de 60 ± 9,68 años con una estancia media postoperatoria de 36,97 ± 62,37 días y las cifras de pacientes con cáncer gástrico eran 69,41 ± 11,53 años y 24,41 ± 13,77 días respectivamente La comparación de medias de los parámetros nutricionales bioquímicos, puso de manifiesto una disminución de las cifras de casi todas las variables, en la determinación del 5º día postoperatorio respecto de la determinación preoperatoria y posterior aumento en la determinación del 10º día postoperatorio respecto del 5º día. Las diferencias son en la mayoría de los casos estadísticamente significativas. Resultaron ser partícipes en la ecuación de predicción de la morbimortalidad las variables, colesterol, enfermedades asociadas, PCR, IgM y sexo varón. Conclusiones: Las variables analizadas, excepto el sexo, parecen ser indicadores adecuados para el estudio de la respuesta a la agresión quirúrgica y así mismo a la nutrición enteral. La nutrición perioperatoria inmunomoduladora creemos que recupera las cifras de parámetros nutricionales postoperatorios.La nutrición enteral por yeyunostomía es bien tolerada y con morbilidad baja y poco severa.Objective: To assess the nutritional peri-surgical status of patients suffering from esophageal or gastric cancer, treated with esophagectomy and total gastrectomy, respectively, and to analyze the impact of an enteral immunomodulating diet on postsurgical complications. Setting: Patients admitted to the Surgery Department of Hospital Clínico Universitario of Salamanca. Patients and methods: Patients submitted to esophagectomy and/or total gastrectomy to whom early enteral nutrition (EN) is provided with an immunomodulating diet. Interventions: All patients were prescribed an immunomodulating diet of 1000 Kcal/day p.o. plus a normal grinded diet that they started on the 5th presurgical day and pursued during the immediate postsurgical period (within the first 24 hours) with EN through a jejunostomy catheter, in a progressive way until reaching 25 kcal/kg/day at days 4-5. EN was kept in place for at least the first 10 days after surgery and laboratory checkups were done before surgery and at days 5 and 10 after surgery. We also performed a prediction equation, with morbidity as the dependent variable and the remaining as independent variables. Results: Sixty-eight patients were studied of whom 36 (35 men and 1 women) suffered from esophageal cancer and 32 (21 men and 11 women) from gastric cancer. Mean age of patients with esophageal cancer was 60 ± 9.68 years, with a mean postsurgical stay of 36.97 ± 62.37 days, and for gastric cancer patients mean age was 69.41 ± 11.53 years and mean stay 24.41 ± 13.77 days. The comparison of the means of the biochemical nutrition parameters showed a decrease in almostall values at the 5ht post-surgery day in relation to the presurgical determination, and an increase in the measurement at the 10th postsurgical day as compared to the 5th day values. In most of the cases, the differences are statistically significant. For morbimortality prediction, the variables cholesterol, related diseases, CRP, IgM, and male gender, were contributors. Conclusions: All the analyzed variables, but gender, seem to be appropriate indicators for the study of response to surgical aggression as well as of enteral nutrition. We believe that peri-surgical immunomodulating nutrition recovers the values of postsurgical nutrition parameters. Enteral nutrition through jejunostomy is well tolerated, and has a low and mild morbidity.

Algunas dietas lipídicas están implicadas en la reducción de ciertas funciones inmunes. Sin embargo, la acción inmunosupresora de estas dietas puede tener efectos adversos sobre la resistencia inmune del individuo frente a enfermedades de naturaleza infecciosa. En el presente estudio tratamos de valorar el estado inmune de ratones alimentados con dietas lipídicas e infectados experimentalmente con una cepa virulenta de Listeria monocytogenes. Ratones de la raza Balb/c fueron divididos en cuatro grupos alimentados cada uno de ellos con su respectiva dieta: dieta baja en lípidos (control, 2,5%), dieta rica en aceite de oliva (AO, 20%), dieta rica en aceite de pescado (AP, 20%) y dieta rica aceite de coco (AC, 20%). Los animales fueron alimentados durante un mes y posteriormente infectados con L. monocytogenes por vía endovenosa. Los resultados han mostrado una reducción de la supervivencia en animales alimentados con AP, así como un incremento significativo en el número de bacterias viables aisladas a partir de bazo. Además hemos podido observar un aumento de la capacidad bactericida de células peritoneales procedentes de ratones alimentados con AO, aunque la invasividad de L. monocytogenes en este grupo fue mayor que en el resto. Finalmente, una reducción significativa de la linfoproliferación fue observada en el grupo alimentado con AP, mientras que la actividad de células natural killer (NK) no se ha visto modificada. Estos resultados indican que dietas lipídicas constituidas por ácidos grasos poliinsaturados de la serie n-3 reducen la resistencia inmune de los ratones, mientras que una dieta constituida por AO no produce un efecto inmusupresor tan relevante y por consiguiente no reduce drásticamente la resistencia inmune siendo más eficiente en la eliminación de L. monocytogenes.Several dietary lipids are capable of exerting an immunosupressor effect. This action may have undiserable effects on the host immune resistance to infectious diseases. The purpose of the present study was to determinate the immune status of mice fed dietary lipids and experimentally infected with a virulent strain of Listeria monocytogenes. Balb/c mice were divided into four groups and were fed with their respective diet: low fat diet (LF, 20%), olive oil diet (OO, 20%), fish oil diet (FO, 20%) and hydrogenated coconut oil (HCO, 20%). Mice were fed for four weeks and infected with L. monocytogenes by endovenous route. Results have shown a survival reduction in mice fed a diet containing FO, as well as a significant increase in the number of viable bacteria from spleen. In addition, we have observed an increase in the bactericidal activity in peritoneal cells from OO group, although the invasion of L. monocytogenes in cells from this group was larger. Finally, a significant reduction of lymphocyte proliferation was observed in the group fed an FO diet, whereas natural killer (NK) cell activity was not modified. These results indicate that dietary lipids constituted by polyunsaturated n-3 fatty acids reduce the murine immune resistance, whereas a diet constituted by OO-does not exert an immunosuppressor effect as relevant as FO diet, and it does not reduce the immune resistance leading to an efficient L. monocytogenes elimination.

The clinical trials of immunonutrition that we have undertaken have often been small, single centre studies. They have often been of limited statistical power and have often included patients with a variety of underlying disease states and at different points in the disease process. Three meta-analysis and a consensus statement in conjunction with a systematic review, have been performed in an attempt to overcome many of these limitations and understand further the clinical place for immunonutrition. However, there are still many questions regarding the place of immunonutrition in clinical practice that we still do not understand or have definitive answers to. For example, do we really know what is the optimal combination of nutrients and in what quantities they should be provided? Do we understand any potential interactions that might occur between these nutrients? What is the effect of the patients nutritional state? When and for how long should immunonutrition provided? What is the impact of the patients´ underlying disease process and how does this interact with the provision of immunonutrition? At the present time whilst there is some indication and evidence as to which patients might benefit most, and as to those who may not benefit or even suffer detrimental effects from immunonutrition, we still can not answer these questions with any definitive authority. It is essential now that we undertake large well designed, well controlled multicentre studies with adequate statistical power to answer these questions. The indications are that immunonutrition has the potential to help patients but its place must be more clearly defined before its widespread acceptance into clinical practice is based on sound scientific evidence.Los ensayos clínicos sobre inmunonutrición que se han realizado han sido en general pequeños y unicéntricos. Su poder estadístico se ha visto limitado y con frecuencia se han incluido pacientes con situaciones patológicas subyacentes múltiples y en diferentes puntos del proceso de la enfermedad. Se han realizado tres meta-análisis y una valoración de consenso, junto con una visión sistemática en un intento de superar muchas de las limitaciones y para entender mejor las situación clínica de la inmunonutrición. Sin embargo, hay todavía gran número de incógnitas en relación con el papel de la immunonutrición en la práctica clínica, que todavía no entendemos y para los que no tenemos contestaciones definitivas. Por ejemplo, ¿conocemos en realidad cuál es la combinación óptima de nutrientes y qué cantidades deben ser administradas? ¿Entendemos las interacciones potenciales que pudieran suceder entre estos nutrientes? ¿Cuál es el efecto sobre el estado nutritivo del paciente? ¿Cuándo y durante cuánto tiempo debe ser administrada inmunonutrición? ¿Cuál es el impacto de la enfermedad subyacente y cómo interactúa ésta con la de immunonutrición? En el momento actual, hay alguna indicación y evidencia en relación con los pacientes que se benefician más y en relación con cuales no se benefician o incluso puedan sufrir efectos detrimentales de la immunonutrición, pero aún no podemos responder a estas preguntas con una autoridad definitiva. Es esencial que se lleven a cabo estudios multicéntricos controlados, bien diseñados con poder estadístico adecuado para responder a estas preguntas. La inmunonutrición tiene potencial para ayudar a los pacientes pero su lugar deberá ser clarificado aún más antes de su aceptación universal en la práctica clínica basada sobre una evidencia científica sólida.

Background: malnutrition is a common complication in patients with cancer and is associated with immunosuppression and alterations with inflammatory response.Objective: the aim of our study was to evaluate the effect of enteral nutrition supplemented with two enteral formulas on inflammatory markers (CRP, IL-6 and FNTα) in cancer patients undergoing chemotherapy.Design and Methods: randomized control trial, conducted at the Hospital Juarez of Mexico in patients with cancer undergoing chemotherapy with IRN < 97.5 and SGA B/C. Patients were randomly allocated to two groups: group I (immunomodulatory), group II (high ω3). The intervention began on the first day of chemotherapy until day 10 after. We evaluated nutritional status and an inflammatory marker on days 0, +5, +10 QT. Statistical analysis was performed with T Student, x2 and analysis of variance for repeated measurements. P < 0.05 was considered statistically significant.Results: a total of 29 patients were analyzed, 27 (62.8%) females and 16 (37.2%) males. Mean age 43.91 + 11.3 years old. Malnutrition prevalence was 48.8% moderate and 51.2% severe. Prealbumin levels significantly increase in group II vs group I (p < 0.05). Both groups maintenance body weight, lean mass and fat mass. No decrease levels of CRP, IL-6 and FNTα.Conclusions: enteral supplementation during chemotherapy inhibits nutritional deterioration and maintenance body weight and lean mass. No decreased levels of inflammatory markers. [ABSTRACT FROM AUTHOR]

Profound changes in perioperative management, namely "fast track surgery" have been recently proposed. This is a bundle of various techniques used for subjects undergoing elective operations that allows an improved well-being, faster recovery, shorter hospitalization and better outcome. From a nutritional point of view this new approach translates into a more rapid return of bowel function and thus to safely tolerate oral re-feeding within 1-3 days even after major operations. Nevertheless, the classic indications for perioperative artificial nutritional support remain valid but they should now apply only to a minority of patients. Extensive research in the last 20 years has clearly shown that modifying the composition of standard nutritional feeds by adding supernormal doses of specific substrates that have immuno-modulatory, anti-inflammatory, anabolic, and tissue protective ability often translates into improved surgical outcome. The most convincing and reproducible results were obtained on the reduction of infectious complication by the perioperative use of enteral formulas enriched with arginine and omega-3 fatty acids. [ABSTRACT FROM AUTHOR]

Background: Patients with head and neck cancer undergoing surgery have a high incidence of ambulatory postoperative complications. Objective: The aim of our study was to investigate the influence of an oral immunoenhanced supplement (arginine and glutamine) on nutritional and biochemical parameters in postsurgical ambulatory patients with head and neck tumor. Design: A population of 39 ambulatory postsurgical patients with oral and laryngeal cancer was enrolled. At Hospital discharge postsurgical head and neck cancer patients were asked to consume two units per day of a specially designed enhanced supplement for a twelve week period. Results: The mean age was 60.2+/-13.1 years (9 female/ 30 males). Duration of supplementation was 90.8+20 days. A significant increase of albumin (3.1±0.6 g/dl vs 4.12+0.7g /dl;p<0.05), prealbumin (21.4±6.3 mg/dl vs 22.4+5.9 mg/dl;p<0.05) and transferrin (198.8±45.2 mg/dl vs 253.8+60.7 mg/dl; p<0.05)levels were observed. No differences were detected in weight and other anthropometric parameters. Ten patients (41.3%) received radiotherapy along the enhanced supplementation period and only 5 (20% of patients with radiotherapy) developed a clinical oral mucositis. Conclusions: At dose used, arginine and glutamine enhanced formula improved seric protein levels in ambulatory postoperative head and neck cancer patients with a low rate of oral mucositis in the subgroup with radiotherapy. [ABSTRACT FROM AUTHOR]

Polyunsaturated fatty acids contribute to the suppression of immune system functions. For this reason, n-3 polyunsaturated fatty acids have been applied in the resolution of inflammatory disorders. Although the inhibition of several immune functions promotes beneficial effects on the human health, this state may lead to a significant reduction of immune protection against infectious micro-organisms (viruses, bacteria, fungi and parasites). Nevertheless, less attention has been paid to the action of olive oil in immunonutrition. Olive oil, a main constituent of the Mediterranean diet, is capable of modulating several immune functions, but it does not reduce host immune resistance to infectious microorganisms. Based on these criteria, we corroborate that olive oil administration may exert beneficial effects on the human health and especially on immune system, because it contributes to the reduction of typical inflammatory activity observed in patients suffering from autoimmune disorders, but without exacerbating the susceptibility to pathogen agents. The administration of olive oil in lipid emulsions may exert beneficial effects on the health and particularly on the immune system of immunocompromised patients. Therefore, this fact acquires a crucial importance in clinical nutrition. This review contributes to clarify the interaction between the administration of diets containing olive oil and immune system, as well as to determine the effect promoted by this essential component of Mediterranean diet in the immunomodulation against an infectious agent. [ABSTRACT FROM AUTHOR]

Enteral nutrition is a technique that even though it was used in times immemorial, in the last 25 years has suffered a considerable development, from being considered a secondary therapeutic weapon destined only to feed the patient, to occupying an important status that goes beyond the single act of nourishing. The quantitative composition but overall the qualitative one, is object of an interesting argument in which a profile allowing the modulation of certain aspects of the organism response through the supplementation with different nutrients is searched. That includes from the keeping of the intestinal trophism and of the anti-bacteria intestinal barrier, so important to avoid the frightening multiple organ dysfunction, up to the lessening of the Systemic Response Inflammatory Syndrome (SRIS), going through the immuno-modulative feeding concepts, specific-feeding, pharmaco-nutrient or eco-nutrition. In this new dynamic not only certain nutrients such as glutamine, arginine, nucleotides, ω-3 fatty acids and many antioxidants have acquired importance, but also the manipulation of other molecules of a non- nutritional nature, such as hormones, cytokines and blockers. These aspects that imply passionate ways of investigation for the future are born from the better knowledge that is being acquired from such a severe pathophysiology processes such as sepsis and the organism response before fast and severe aggression; therefore, the modulation of that response through changes in the quantitative and qualitative formulas composition is being attempted. [ABSTRACT FROM AUTHOR]

MELAS syndrome (Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes) is one of the most frequent mitochondrial pathologies. Its diagnosis is based on the classic triad of symptoms its acronym stands for and the presence of ragged red fibres. There is currently no curative therapy for MELAS, and treatment focuses on managing complications that affect specific organs and functions. However, some immunonutrients can be used as a therapeutic alternative in patients with MELAS. We present a scientific literature review accompanied by the clinical case of a patient with dementia and seizures admitted to the intensive care unit., (Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Background: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs., Objective: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program., Methods: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis., Results: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition., Conclusion: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients., (Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Se trata de una revisión bibliográfica sistemática sobre la nutrición. Se clasifican los nutrientes como las proteínas, carbohidratos y grasas además de los oligoelementos (vitaminas y minerales), necesarios en la dieta para el buen funcionamiento del organismo. Se revisaron artículos relacionados con el tema de los últimos 10 años, en Inglés y Español, disponibles en la red telemática de Infomed. Se realiza un análisis sobre los principales antioxidantes que se ingieren con la dieta, debido al efecto dañino que provocan los radicales libres en el organismo; por otro lado, se explica cómo la manipulación nutricional de la inmunidad puede tener implicaciones clínicas (inmunodeficiencia celular, humoral y déficit fagocítico), biológicas y terapéuticas, además de abordar el efecto que tiene una adecuada nutrición sobre los principales mecanismos de defensa del organismo. De esta revisión bibliográfica, se deduce la importancia de conocer y establecer una terapia nutricional adecuada no solamente para mantener una apariencia física saludable, sino para lograr disminuir los mecanismos de estrés oxidativo y mejorar nuestras defensas.It is a systematic bibliographic review about nutrition. Nutrients are classified as proteins, carbohydrates, fat, vitamins and minerals, needed in diet for the well functioning of the human being. These last decade’s articles were reviewed, all related to the topic and written in English and Spanish, well available at the Infomed intranet. An analysis is done about the main antioxidants ingested by diet, due to the harmful effect that free radicals cause in the organism ; on the other hand it is explained how nutritional manipulation of immunity may have clinical ( cellular immunodeficiency, humoral and phagocitic weakness), biological and therapeutic implications. Besides, it is approached the effect that an adequate nutrition may have on the main defense mechanisms of the organism. Out of this bibliographic review, it is deductible the importance of an adequate nutrition to maintain a proper physical appearance and to diminish the oxidative stress mechanisms and improve our defenses.

MELAS syndrome (Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes) is one of the most frequent mitochondrial pathologies. Its diagnosis is based on the classic triad of symptoms its acronym stands for and the presence of ragged red fibres. There is currently no curative therapy for MELAS, and treatment focuses on managing complications that affect specific organs and functions. However, some immunonutrients can be used as a therapeutic alternative in patients with MELAS. We present a scientific literature review accompanied by the clinical case of a patient with dementia and seizures admitted to the intensive care unit., (Copyright © 2021 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs., Objective: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program., Methods: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis., Results: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition., Conclusion: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients., (Copyright © 2021 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)