Enriching Enteral Nutrition Doesn’t Affect Infection Risk

Among mechanically ventilated ICU patients, receipt of high-protein nutrition via a feeding tube enriched with immune-modulating nutrients (such as glutamine, omega-3 fatty acids, and antioxidants) vs standard high-protein nutrition didn’t result in a significant difference in the incidence of new complications and may be harmful as suggested by an increased risk of death at six months, according to a study in an issue of the Journal of the American Medical Association.

Several meta-analyses have reported that use of immune-modulating nutrients in enteral nutrition is associated with reductions in illness from infections and improved recovery from critical illness compared with standard enteral nutrition. However, there is a lack of consensus in guidelines regarding enteral administration of immune-modulating nutrients,according to background information in the article.

Arthur R. H. van Zanten, MD, PhD, of the Gelderse Vallei Hospital in Ede, the Netherlands, and colleagues randomly assigned 301 adult ICU patients who were expected to be ventilated and to require enteral nutrition for more than 72 hours to either immune-modulating nutrients (152patients) or high-protein enteral nutrition (149 patients). The patients were from 14 ICUs in the Netherlands, Germany, France, and Belgium. Patients were followed for up to six months.

The researchers found that there were no significantdifferences in the incidence of new infections between groups. Overall, 53% of those in the immune-modulating nutrients group vs 52% in the high-protein enteral nutrition group had new infections. No significant differences wereobserved in outcomes such as mechanical ventilation duration, ICU and hospital lengths of stay, and a measure of organ failure. The six-month mortality rate was higher in the medical subgroup: 54% in the immune-modulating nutrients group vs 35% in the high-protein enteral nutrition group.

“These findings do not support the use of high-protein enteral nutrition enriched with immune-modulating nutrients in these patients,” the authors conclude.

Source: Journal of the American Medical Association

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