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Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: a systematic review and meta-analysis.
Clin Nutr 2014; 33(6):951-7CN

Abstract

INTRODUCTION

Arginine improves healing and modulates inflammation and the immune response. A systematic review and meta-analysis were conducted to assess whether arginine-enriched enteral formulas reduce complications (fistulas, wound infections, other infections) and hospital length of stay (LoS) in patients undergoing surgery for head and neck cancer.

METHODS

Medline, CENTRAL, and Trip Database were searched using the search strategy "Head and Neck Neoplasms" AND "Enteral Nutrition" AND "Arginine" OR "Immunonutrition". Inclusion criteria comprised: type of study (RCT), language (English, Spanish), outcomes (complications of surgery, LoS), and methodological quality (Jadad scale). The odds ratio (OR) and confidence intervals (95% CI) were calculated using the Mantel-Haenszel method, and the mean difference (MD) with the random effects method. Heterogeneity was assessed using Cochran's Q.

RESULTS

Six studies were included, with 397 patients receiving peri/postoperative enteral nutrition with different doses of arginine (6.25-18.7 g/L). Enteral formulas containing arginine were associated with a reduction in fistulas [OR = 0.36 (95% CI 0.14-0.95), p = 0.039; Q = 3.93, p = 0.269], and LoS [MD = -6.8 (95% CI -12.6 to -0.9) days, p = 0.023; Q = 2.44, p = 0.486]. There were no reductions in wound infections [OR = 1.04 (95% CI 0.49-2.17), p = 0.925; Q = 1.60, p = 0.809] or other infections [OR = 0.79 (95% CI 0.48-1.31); p = 0.369; Q = 7.94, p = 0.094]. Arginine administration did not increase the occurrence of diarrhoea [OR = 1.80 (95% CI 0.50-6.52), p = 0.375; Q = 0.16, p = 0.691].

CONCLUSIONS

The administration of arginine-enriched enteral nutrition led to a significant reduction in fistulas and hospital stay in patients undergoing surgery for head and neck cancer.

Authors+Show Affiliations

Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain. Electronic address: avcyo@hotmail.com.Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain.Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain.Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain.Clinical Nutrition and Dietetics Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava SN, 24008 León, Spain.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

24844870

Citation

Vidal-Casariego, Alfonso, et al. "Efficacy of Arginine-enriched Enteral Formulas in the Reduction of Surgical Complications in Head and Neck Cancer: a Systematic Review and Meta-analysis." Clinical Nutrition (Edinburgh, Scotland), vol. 33, no. 6, 2014, pp. 951-7.
Vidal-Casariego A, Calleja-Fernández A, Villar-Taibo R, et al. Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: a systematic review and meta-analysis. Clin Nutr. 2014;33(6):951-7.
Vidal-Casariego, A., Calleja-Fernández, A., Villar-Taibo, R., Kyriakos, G., & Ballesteros-Pomar, M. D. (2014). Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: a systematic review and meta-analysis. Clinical Nutrition (Edinburgh, Scotland), 33(6), pp. 951-7. doi:10.1016/j.clnu.2014.04.020.
Vidal-Casariego A, et al. Efficacy of Arginine-enriched Enteral Formulas in the Reduction of Surgical Complications in Head and Neck Cancer: a Systematic Review and Meta-analysis. Clin Nutr. 2014;33(6):951-7. PubMed PMID: 24844870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: a systematic review and meta-analysis. AU - Vidal-Casariego,Alfonso, AU - Calleja-Fernández,Alicia, AU - Villar-Taibo,Rocío, AU - Kyriakos,Georgios, AU - Ballesteros-Pomar,María D, Y1 - 2014/05/04/ PY - 2014/01/28/received PY - 2014/04/07/revised PY - 2014/04/28/accepted PY - 2014/5/22/entrez PY - 2014/5/23/pubmed PY - 2015/8/15/medline KW - Arginine KW - Enteral nutrition KW - Head and neck cancer KW - Immunonutrition KW - Meta-analysis KW - Systematic review SP - 951 EP - 7 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 33 IS - 6 N2 - INTRODUCTION: Arginine improves healing and modulates inflammation and the immune response. A systematic review and meta-analysis were conducted to assess whether arginine-enriched enteral formulas reduce complications (fistulas, wound infections, other infections) and hospital length of stay (LoS) in patients undergoing surgery for head and neck cancer. METHODS: Medline, CENTRAL, and Trip Database were searched using the search strategy "Head and Neck Neoplasms" AND "Enteral Nutrition" AND "Arginine" OR "Immunonutrition". Inclusion criteria comprised: type of study (RCT), language (English, Spanish), outcomes (complications of surgery, LoS), and methodological quality (Jadad scale). The odds ratio (OR) and confidence intervals (95% CI) were calculated using the Mantel-Haenszel method, and the mean difference (MD) with the random effects method. Heterogeneity was assessed using Cochran's Q. RESULTS: Six studies were included, with 397 patients receiving peri/postoperative enteral nutrition with different doses of arginine (6.25-18.7 g/L). Enteral formulas containing arginine were associated with a reduction in fistulas [OR = 0.36 (95% CI 0.14-0.95), p = 0.039; Q = 3.93, p = 0.269], and LoS [MD = -6.8 (95% CI -12.6 to -0.9) days, p = 0.023; Q = 2.44, p = 0.486]. There were no reductions in wound infections [OR = 1.04 (95% CI 0.49-2.17), p = 0.925; Q = 1.60, p = 0.809] or other infections [OR = 0.79 (95% CI 0.48-1.31); p = 0.369; Q = 7.94, p = 0.094]. Arginine administration did not increase the occurrence of diarrhoea [OR = 1.80 (95% CI 0.50-6.52), p = 0.375; Q = 0.16, p = 0.691]. CONCLUSIONS: The administration of arginine-enriched enteral nutrition led to a significant reduction in fistulas and hospital stay in patients undergoing surgery for head and neck cancer. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/24844870/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(14)00128-9 DB - PRIME DP - Unbound Medicine ER -