In general, surgery can be divided into three main phases: the preoperative period; the period during the surgery; and the postoperative, or recovery, period. At each of these stages, patients can take an active role in their own well-being by following documented steps to support their body’s antioxidant stores, reduce inflammation, and modulate the immune responses that accompany surgery. By paying careful attention to nutritional status, patients can speed their recovery and experience more successful results (Asher ME 2004; Schmiesing CA et al 2005).
Most surgeons now recognize that good attention to nutrition, including its effects on antioxidant and inflammatory status, can have major positive impact on the outcome of a surgical procedure (Calder PC 2004). No longer a minor part of the postoperative orders, a comprehensive nutritional program begun in the weeks prior to surgery and continued at the earliest possible postoperative moment is known to increase survival, reduce complications, minimize length of hospital stays, keep costs down, and significantly enhance patients’ quality of life (Ellis LM et al 1991).
While many different mixtures of nutrients have been used in immunonutrition, several main components appear to provide maximum benefit. The goal of reducing the exaggerated inflammatory response to surgery is met through the provision of omega-3 fatty acids, largely derived from fish oils (Grimble RF 2005). These fatty acids can shift the production of cytokines away from those that stimulate inflammation (Heller A et al 2000). They also make cell and mitochondrial membranes more resistant to oxidant stress (Ates E et al 2004), which reduces tissue damage and prevents amplification of the inflammatory response. Most effective immunonutrient supplements contain substantial quantities of omega-3 fatty acids.
More than 170 studies have been published on various immunonutrient combinations that have shown positive results (Grimble RF 2005). Patients given a preoperative formula containing omega-3 fatty acids and arginine had significantly improved systemic immune responses, gut oxygen levels, and gut perfusion compared with control patients (Braga M et al 2002). In a different study, patients supplemented with arginine, glutamine, and omega-3 fatty acids had higher postoperative total protein and immunoglobulin levels, higher levels of infection-fighting white blood cells, and lower levels of pro-inflammatory cytokines and tumor necrosis factor than did unsupplemented controls, demonstrating that these supplements enhanced host defenses while modulating the exaggerated inflammatory response (Chen da W et al 2005).
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