Clinical trias of immunonutrition in surgical cancer patients

In the last years adding specific nutrients, such as arginine, omega-3 fatty acids and nucleotides, has modified standard enteral diets. These substrates have been shown to up-regulate host immune response, control inflammatory response, and improve nitrogen balance and protein synthesis after injury. Most randomized trials focused on clinical outcome have been carried out in gastrointestinal (GI) cancer patients undergoing elective surgery. When immunonutrition was limited to the postoperative period the results were conflicting, probably because the amount of substrates given in the first days after surgery was not sufficient to reach adequate tissue and plasma concentration quickly enough to be active. Better results on outcome were obtained when the immunoenhancing diet was administered before surgery. This enabled to reduce significantly the postoperative infection rate in either malnourished or well-nourished patients. Cost-benefit analyses showed that immunonutrition is cost-effective when compared to the standard treatment