Annals of Clinical Nutrition and Metabolism

Table. 1.

Table. 1. Table 1

Recommendations from current guidelines on the use of perioperative immunonutrition

Guidelines	Recommendations
ESPEN guideline: clinical nutrition in surgery [9]	- Peri- or at least postoperative administration of a specific formula enriched with immunonutrients (arginine, ω-3-fatty acids, ribonucleotides) should be given to malnourished patients undergoing major cancer surgery. There is currently no clear evidence for the use of these formulae enriched with immunonutrients vs. standard ONS exclusively in the preoperative period - Patients with severe nutritional risk shall receive nutritional therapy prior to major surgery even if operations including those for cancer must be delayed. A period of 7–14 days may be appropriate - When patients do not meet their energy needs from normal food, they should be recommended ONS unrelated to their nutritional status during the preoperative period - Preoperatively, ONS shall be given to all malnourished cancer and high-risk patients undergoing major abdominal surgery. A special group of high-risk patients are elderly people with sarcopenia - Immune modulating ONS including arginine, ω-3 fatty acids, and nucleotides can be preferred and administered for 5–7 days preoperatively - Preoperative enteral nutrition/ONS should preferably be administered prior to hospital admission to avoid unnecessary hospitalization and to lower the risk of nosocomial infections
Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: SCCM and ASPEN [20]	- We suggest that immune-modulating enteral formulations (arginine with other agents, including EPA, DHA, glutamine, and nucleic acid) not be used routinely in the MICU. Consideration for these formulations should be reserved for patients with traumatic brain injury and perioperative patients in the SICU - We suggest that immune-modulating formulations containing arginine and fish oil be considered in patients with severe trauma - Based on expert consensus, we suggest the use of either arginine-containing immune-modulating formulations or EPA/DHA supplements with standard enteral formula in patients with traumatic brain injury

Guidelines

Recommendations

ESPEN guideline: clinical nutrition in surgery [9]

- Peri- or at least postoperative administration of a specific formula enriched with immunonutrients (arginine, ω-3-fatty acids, ribonucleotides) should be given to malnourished patients undergoing major cancer surgery. There is currently no clear evidence for the use of these formulae enriched with immunonutrients vs. standard ONS exclusively in the preoperative period - Patients with severe nutritional risk shall receive nutritional therapy prior to major surgery even if operations including those for cancer must be delayed. A period of 7–14 days may be appropriate - When patients do not meet their energy needs from normal food, they should be recommended ONS unrelated to their nutritional status during the preoperative period - Preoperatively, ONS shall be given to all malnourished cancer and high-risk patients undergoing major abdominal surgery. A special group of high-risk patients are elderly people with sarcopenia - Immune modulating ONS including arginine, ω-3 fatty acids, and nucleotides can be preferred and administered for 5–7 days preoperatively - Preoperative enteral nutrition/ONS should preferably be administered prior to hospital admission to avoid unnecessary hospitalization and to lower the risk of nosocomial infections

Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: SCCM and ASPEN [20]

- We suggest that immune-modulating enteral formulations (arginine with other agents, including EPA, DHA, glutamine, and nucleic acid) not be used routinely in the MICU. Consideration for these formulations should be reserved for patients with traumatic brain injury and perioperative patients in the SICU - We suggest that immune-modulating formulations containing arginine and fish oil be considered in patients with severe trauma - Based on expert consensus, we suggest the use of either arginine-containing immune-modulating formulations or EPA/DHA supplements with standard enteral formula in patients with traumatic brain injury

ESPEN = European Society for Clinical Nutrition and Metabolism; ONS = oral nutritional supplements; SCCM = Society of Critical Care Medicine; ASPEN = American Society for Parenteral and Enteral Nutrition; EPA = eicosapentaenoic acid; DHA = docosahexaenoic acid; MICU = medical intensive care unit; SICU = surgical intensive care unit.

Ann Clin Nutr Metab 2023;15:46-50 https://doi.org/10.15747/ACNM.2023.15.2.46