Effect of preoperative immunonutrition and other nutrition models on cellular immune parameters

Table 1 Distribution of patients by nutrition models

	Patients (n)	Nutrition model	Nutritional products1
Group 1	n = 16	Immunonutrition	Enteral product with addition of arginine, omega-3 fatty acids and RNA (IMPACT®)
Group 2	n = 13	Normal nutrition	Normal feeding planned by a dietitian
Group 3	n = 13	Standard enteral nutrition	Standard enteral product without RNA or Omega-3 fatty acids (FRESUBIN®)

¹One liter of Impact (Novartis Nutrition, Bern, Switzerland) contains 780 non-protein calories, 43 g of protein, 12.5 g of arginine, 3.3 g of ω-3 fatty acids and 1.2 g of RNA.

Table 2 Patient characteristics and distribution (mean ± SD)

	IM	NN	SE	P
Number of patients	16	13	13
F/M ratio	(8/8)	(9/4)	(8/5)
Age	64.56 ± 16.16	64.38 ± 11.67	61.31 ± 12.13	> 0.05
BMI	24.11 ± 3.67	23.02 ± 5.66	22.24 ± 4.87	> 0.05
Malnutrition index	7.96 ± 1.36	7.25 ± 0.79	8.40 ± 1.68	> 0.05
Muscle circumference	22.34 ± 3.01	21.11 ± 4	20.41 ± 2.31	> 0.05
Strength of hand grasping	0.46 ± 0.20	0.40 ± 0.15	0.41 ± 0.18	> 0.05
Albumin	3.6 ± 0.59	3.46 ± 0.57	3.26 ± 0.51	> 0.05
Prealbumin	13.64 ± 8.83	15.71 ± 6.97	17.72 ± 8.39	> 0.05
Number of lymphocytes	1454 ± 462	1281 ± 779.2	1277 ± 546.4	> 0.05
Subjective global assessment (SGA)1
Moderate malnutrition	9	7	6
Severe malnutrition	7	6	7

¹No statistical evaluation was made for subjective global assessment; IM: Immunonutrition; NN: Normal nutrition; SE: Standard enteral nutrition.

Table 3 Changes in prealbumin values with repeated measurements (mean ± SD)

Prealbumin1	IM	NN	SE	P
Baseline	13.64 ± 8.83	17.72 ± 8.39	15.71 ± 6.97	0.414
Day 4	17.12 ± 9.13	18.34 ± 6.71	16.24 ± 7.20	0.792
Day 8	15.98 ± 8.66	18.13 ± 6.76	16.41 ± 7.81	0.750
P	0.037	0.834	0.876

¹Normal value of prealbumin: 20-40 mg/dL; IM:Immunonutrition; NN: Normal nutrition; SE: Standard enteral nutrition.

Table 4 Percentage of lymphocyte subgroups in the peripheral blood of patients before nutritio

	IM	NN	SE	P
CD4 (n = 32%-54%)	46.13 ± 10.69	41.46 ± 9.11	49.92 ± 7.30	< 0.05
CD8 (n = 34%-37%)	36.81 ± 7.08	46 ± 11.34	42.08 ± 10.4	< 0.05
CD4/8 (n = 0.8-1.8)	1.32 ± 0.44	1.01 ± 0.54	1.26 ± 0.38	< 0.05
CD69	4.25 ± 5.6	1.40 ± 1.09	2.02 ± 2.01	> 0.05
CD69F	12.95 ± 13.05	2.70 ± 1.73	17.31 ± 10.69	< 0.001
CD16/56 (n = 8%-22%)	4.45 ± 3.74	7.30 ± 5.54	5.81 ± 6.38	> 0.05
CD4+, CD8+ (n = ≤ 1%)	4.26 ± 2.03	3.61 ± 1.80	4.08 ± 2.43	> 0.05

IM: Immunonutrition; NN: Normal nutrition; SE: Standard enteral nutrition.

Table 5 Percentage of lymphocyte subgroups in the peripheral blood of patients after nutrition (mean ± SD)

	IM	NN	SE	P
CD4	44.5 ± 10.09	41.62 ± 10.97	48.08 ± 12.98	> 0.05
CD8	41.5 ± 10.02	46.08 ± 12.77	40.23 ± 14.95	> 0.05
CD4/8	1.33 ± 0.56	1.04 ± 0.63	1.54 ± 1.34	> 0.05
CD69	9.22 ± 24.36	1.73 ± 1.06	3.02 ± 4.41	> 0.05
CD69F	23.11 ± 27.74	3.23 ± 1.68	14.3 ± 13.16	< 0.001
CD16/56	5.63 ± 5.05	7.52 ± 3.98	6.15 ± 8.68	> 0.05
CD4, CD8	4.58 ± 2.62	4.96 ± 3.44	3.02 ± 1.62	> 0.05

IM: Immunonutrition; NN: Normal nutrition; SE: Standard enteral nutrition.

Table 6 Data on the operation and postoperative follow-up (mean ± SD)

	IM n = 13	NN n = 9	SE n = 11	P
Duration of operation (min)	303.8 ± 160.1	248.9 ± 87.67	288.6 ± 71.28	> 0.05
Blood transfusion (U)	2.84 ± 2.85	3 ± 2.20	2.54 ± 1.80	> 0.05
Wound infection	5	3	2	> 0.05
Pneumonia	2	1	4	> 0.05
Urinary infection	-	-	1	> 0.05
Sepsis	-	-	1	> 0.05
Non-infectious complications	5	3	2	> 0.05
Duration of hospital stay (d)	16.54 ± 14.83	12 ± 3.69	14.22 ± 9.12	> 0.05

IM: Immunonutrition; NN: Normal nutrition; SE: Standard enteral nutrition.