Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact

Crit Care Med. 1995 Apr;23(4):652-9. doi: 10.1097/00003246-199504000-00012.


Objective: To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies.

Design: Prospective, randomized, placebo-controlled, double-blind study.

Setting: Surgical intensive care unit (ICU) in a German university hospital.

Patients: Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer.

Interventions: Patients were randomized to receive either the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5.

Measurements and main results: Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p < .05). Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p < .05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p < .05).

Conclusions: Supplementation of enteral diet with arginine, RNA, and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arginine / administration & dosage*
  • Double-Blind Method
  • Enteral Nutrition*
  • Fatty Acids, Omega-3 / administration & dosage*
  • Female
  • Food, Formulated*
  • Gastrointestinal Neoplasms / immunology*
  • Gastrointestinal Neoplasms / surgery
  • HLA-DR Antigens / analysis
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Intensive Care Units
  • Interferon-gamma / blood
  • Lymphocyte Activation
  • Lymphocyte Count
  • Lymphocyte Subsets
  • Male
  • Postoperative Care*
  • Prospective Studies
  • RNA / administration & dosage*


  • Fatty Acids, Omega-3
  • HLA-DR Antigens
  • Immunoglobulin G
  • Immunoglobulin M
  • RNA
  • Interferon-gamma
  • Arginine