Parenteral and enteral immunonutrition

Parenteral and Enteral Immunonutrition In this paper 'immunonutrition' is defined as every parenteral or enteral nutrition formula containing at least one immunomodulating nutrient in a concentration higher than necessary to conserve body mass. Commercially available products contain as immunomodulating macronutrients glutamine, omega-3 fatty acids (omega-3 FA), arginine, and/or nucleotides. Moreover, enteral immunonutrition formulas generally contain a higher content of antioxidative micronutrients such as vitamin C and A, beta-carotin, selen, zinc and copper. In accordance with the published studies and the recommendation of the Austrian and German Societies of Clinical Nutrition (AKE, DGEM), a recommendation for parenteral or enteral glutamine administration can be given for patients in severe catabolic state and in the immediate postoperative/posttraumatic situation. The enteral administration of a formula containing arginine, omega-3 FA, and nucleotides can be recommended in the pre- and postoperative state and for ICU patients with a low APACHE score. The parenteral administration of omega-3 FA reduces the inflammatory activity of neutrophils and monocytes. Appropriate data demonstrating an improved prognosis of the patients when supplying omega-3 FA are still lacking, however.