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Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients.
Am J Clin Nutr. 2001 Feb; 73(2):323-32.AJ

Abstract

BACKGROUND

Malnourished head and neck cancer patients are at increased risk of postoperative complications.

OBJECTIVE

We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss >10% of body weight) head and neck cancer patients undergoing major surgery.

DESIGN

Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding.

RESULTS

Patients in both prefed groups received approximately 9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1, 2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6) at the start of the study than did patients who died.

CONCLUSIONS

Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.

Authors+Show Affiliations

Department of Dietetics, the Nutrition Support Team, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. m.vanbokhorst@azu.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

11157331

Citation

van Bokhorst-De Van Der Schueren, M A., et al. "Effect of Perioperative Nutrition, With and Without Arginine Supplementation, On Nutritional Status, Immune Function, Postoperative Morbidity, and Survival in Severely Malnourished Head and Neck Cancer Patients." The American Journal of Clinical Nutrition, vol. 73, no. 2, 2001, pp. 323-32.
van Bokhorst-De Van Der Schueren MA, Quak JJ, von Blomberg-van der Flier BM, et al. Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. Am J Clin Nutr. 2001;73(2):323-32.
van Bokhorst-De Van Der Schueren, M. A., Quak, J. J., von Blomberg-van der Flier, B. M., Kuik, D. J., Langendoen, S. I., Snow, G. B., Green, C. J., & van Leeuwen, P. A. (2001). Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. The American Journal of Clinical Nutrition, 73(2), 323-32.
van Bokhorst-De Van Der Schueren MA, et al. Effect of Perioperative Nutrition, With and Without Arginine Supplementation, On Nutritional Status, Immune Function, Postoperative Morbidity, and Survival in Severely Malnourished Head and Neck Cancer Patients. Am J Clin Nutr. 2001;73(2):323-32. PubMed PMID: 11157331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. AU - van Bokhorst-De Van Der Schueren,M A, AU - Quak,J J, AU - von Blomberg-van der Flier,B M, AU - Kuik,D J, AU - Langendoen,S I, AU - Snow,G B, AU - Green,C J, AU - van Leeuwen,P A, PY - 2001/2/7/pubmed PY - 2001/3/17/medline PY - 2001/2/7/entrez SP - 323 EP - 32 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 73 IS - 2 N2 - BACKGROUND: Malnourished head and neck cancer patients are at increased risk of postoperative complications. OBJECTIVE: We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss >10% of body weight) head and neck cancer patients undergoing major surgery. DESIGN: Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding. RESULTS: Patients in both prefed groups received approximately 9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1, 2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6) at the start of the study than did patients who died. CONCLUSIONS: Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses. SN - 0002-9165 UR - https://www.unboundmedicine.com/medline/citation/11157331/Effect_of_perioperative_nutrition_with_and_without_arginine_supplementation_on_nutritional_status_immune_function_postoperative_morbidity_and_survival_in_severely_malnourished_head_and_neck_cancer_patients_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/73.2.323 DB - PRIME DP - Unbound Medicine ER -