Perioperative Immunonutrition Modulates Inflammatory Response after Radical Cystectomy: Results of a Pilot Randomized Controlled Clinical Trial.

Autor:	Hamilton-Reeves JM; Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas; Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas. Electronic address: jhamilton-reeves@kumc.edu., Stanley A; Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas., Bechtel MD; Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas., Yankee TM; Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas., Chalise P; Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas., Hand LK; Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas., Lee EK; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas., Smelser W; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas., Mirza M; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas., Wyre H; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas., Hull H; Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas., Carlson SE; Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas., Holzbeierlein JM; Department of Urology, University of Kansas Medical Center, Kansas City, Kansas.
Jazyk:	angličtina
Zdroj:	The Journal of urology [J Urol] 2018 Aug; Vol. 200 (2), pp. 292-301. Date of Electronic Publication: 2018 Mar 06.
DOI:	10.1016/j.juro.2018.03.001
Abstrakt:	Purpose: Poor preoperative nutritional status is associated with a higher complication rate after radical cystectomy in patients with bladder cancer. Given the short interval between diagnosis and radical cystectomy, we compared the effect of short-term specialized immunonutrition to that of a standard oral nutritional supplement on the acute inflammatory response and arginine status in patients treated with radical cystectomy. Materials and Methods: In this prospective, randomized study in 29 men 14 received specialized immunonutrition and 15 received oral nutritional supplement. Each group drank 3 cartons per day for 5 days before and 5 days after radical cystectomy. The Th1-Th2 balance, plasma interleukin-6 and plasma amino acids were measured at baseline, intraoperatively and on postoperative days 2, 14 and 30. Body composition was measured by dual energy x-ray absorptiometry at baseline and on postoperative days 14 and 30. Differences in outcomes were assessed using the generalized linear mixed model. Results: In the specialized immunonutrition group there was a 54.3% average increase in the Th1-Th2 balance according to the tumor necrosis factor-α-to-interleukin-13 ratio from baseline to intraoperative day, representing a shift toward a Th1 response. In the oral nutritional supplement group the Th1-Th2 balance decreased 4.8%. The change in the Th1-Th2 balance between the specialized immunonutrition and oral nutritional supplement groups significantly differed (p <0.027). Plasma interleukin-6 was 42.8% lower in the specialized immunonutrition group compared to the oral nutritional supplement group on postoperative day 2 (p = 0.020). In the specialized immunonutrition group plasma arginine was maintained from baseline to postoperative day 2 and yet the oral nutritional supplement group showed a 26.3% reduction from baseline to postoperative day 2 (p = 0.0003). The change in appendicular muscle loss between the groups was not statistically significant. Conclusions: Th1-to-Th2 ratios, peak interleukin-6 levels and plasma arginine suggest that consuming specialized immunonutrition counteracts the disrupted T-helper balance, lowers the inflammatory response and prevents arginine depletion due to radical cystectomy. (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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