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Pharmaconutrition: Which substrates?
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DOI：10.1016/j.ejso.2022.12.003.png)
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Abstract
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With the term pharmaconutrition or immunonutrition is intended the use of specific nutritional substrates having the ability of modulating specific mechanisms involved in several immune and inflammatory pathways. To achieve these goals, these substrates have to be administered with over physiologic dose. Glutamine and omega -3 polyunsaturated fatty acids, used as single substrate, did not show clear clinical advantages on solid endpoints such as postoperative complications. Despite several multiple substrate enteral feeds are available on the market, very few of them have been tested in randomized clinical trial to prove efficacy. The most extensive investigated formulation is a combination of arginine, omega -3 fatty acids, ribonucleic acid with or without glutamine. Several meta -analyses of randomized clinical trials have been conducted to compare the effects of enteral immunonutrition with control diets on post -surgical morbidity. The results consistently showed that the use of enteral multiple substrate formulas significantly reduced infectious complications and duration of hospitalization. In a more contemporary view, pharmaconutrition should be tested more accurately in the contest of enhanced recovery programs, during neoadjuvant chemotherapy, and in the prehabilitation setting. (c) 2022 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Keywords:
RANDOMIZED CLINICAL-TRIAL
POSTOPERATIVE IMMUNE-RESPONSE
STANDARD ENTERAL NUTRITION
OMEGA-3 FATTY ACID
LEAN BODY-MASS
GASTROINTESTINAL SURGERY
ENHANCED RECOVERY
CANCER-PATIENTS
DOUBLE-BLIND
PERIOPERATIVE IMMUNONUTRITION
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