Efficacy of Early Enteral Nutrition on Immune Function Using Immuno-enhancing Diet in Patients with Stroke

DOI 1 Citations 20 References
  • Ebihara Takayuki
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine
  • Kinoshita Kosaku
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine
  • Noda Akihiro
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine
  • Ishii Mitsuru
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine
  • Kitahata Yuji
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine
  • Utagawa Akira
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine
  • Tanjoh Katsuhisa
    Department of Emergency and Critical Care Medicine, Nihon University School of Medicine

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Other Title
  • 脳卒中患者に対するｉｍｍｕｎｏ‐ｅｎｈａｎｃｉｎｇ　ｄｉｅｔを用いた早期経腸栄養が免疫機能へ及ぼす影響

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Abstract

Background and Purpose: The efficacy of early enteral feeding using an immuno-enhancing diet (IED) in patients with stroke is indeterminate. The purpose of this study is to elucidate the immune modifying effect of early enteral nutrition using an IED in patients with severe stroke. Method: Eighteen severe stroke patients having a Glasgow Coma Scale (GCS) score of 8 or less were randomly divided into two groups: an IED group of 8 patients, who were given an IED in the early enteral nutrition, and a control group of ten patients, who were given no IED. Both groups were tested as follows. Resting energy expenditures were measured by indirect calorimetry and target levels for nutritional administration were determined. Early enteral nutrition was administered until the nutritional target levels were reached, at which point in time was designated “day 1.” Enteral nutrition levels were then maintained for 14 days (the final day being day 14). Lymphocyte counts, natural killer (NK) cell activity (percentage cytotoxicity; cytotoxicity test), cluster of differentiation (CD) 4 values, CD8 values, and serum eicosapentaenoic acid (EPA) and serum arachidonic acid (AA) concentrations were measured from blood samples taken on admission and on day 14. Results: Scores for acute physiology, chronic health evaluation II and GCS revealed no significant difference in severity between the two groups at the initial stage. In the IED group, lymphocyte counts (p<0.05), NK cell activity (p<0.05) and CD4 values (p<0.01) were significantly increased on day 14 compared to the admission day. The group also showed significantly increased EPA (p<0.01) concentrations and decreased AA (p<0.05) concentrations on day 14 compared with admission day. There were no significant differences over time in the control group. Conclusions: Considering that lymphocyte counts, NK cell activity, CD4 values and EPA increased while AA decreased after early enteral IED feeding when compared to the pre-feeding period (admission day). We conclude that early enteral IED feeding in patients with severe stroke improves cellular immunity, although clinical validity remains unsubstantiated.

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