Title: | Continuous administration of enteral lipid- and protein-rich nutrition limits inflammation in a human endotoxemia model |
Author(s): | Lubbers, T.; Kox, M. ; Haan, J.J. de; Greve, J.W.; Pompe, J.C. ; Ramakers, B.P.C. ; Pickkers, P. ; Buurman, W.A. |
Publication year: | 2013 |
Source: | Critical Care Medicine, vol. 41, iss. 5, (2013), pp. 1258-1265 |
ISSN: | 0090-3493 |
DOI: | https://doi.org/10.1097/CCM.0b013e31827c0a17 |
Publication type: | Article / Letter to editor |
Please use this identifier to cite or link to this item : https://hdl.handle.net/2066/118213 ![]() |
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Subject: | DCN MP - Plasticity and memory N4i 1: Pathogenesis and modulation of inflammation IGMD 7: Iron metabolism N4i 1: Pathogenesis and modulation of inflammation DCN MP - Plasticity and memory N4i 1: Pathogenesis and modulation of inflammation |
Organization: | Intensive Care Anesthesiology |
Journal title: |
Critical Care Medicine
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Volume: | vol. 41 |
Issue: | iss. 5 |
Page start: | p. 1258 |
Page end: | p. 1265 |
Abstract: |
OBJECTIVE: : An overzealous inflammatory response is an important cause of morbidity and mortality in surgical, trauma, and critically ill patients. Enteral administration of lipid-rich nutrition was previously shown to attenuate inflammation and reduce organ damage via a cholecystokinin-1 receptor-mediated vagovagal reflex in animal studies. The current preclinical study investigates the immunomodulatory potential of a custom-made enteral nutrition during systemic inflammation in man. DESIGN: : Double-blind, randomized controlled trial. SETTING: : Intensive care research unit. SUBJECTS: : Male volunteers. INTERVENTIONS: : After an overnight fast, 18 healthy male subjects received an IV bolus of Escherichia coli lipopolysaccharide (2 ng/kg). Subjects in the fasted group (n = 6) were deprived of food throughout the study, while subjects in the intervention groups were fed either custom-made lipid- and protein-rich nutrition (n = 6) or isocaloric control nutrition (n = 6) via nasojejunal tube, starting 1 hour prior to lipopolysaccharide administration until 6 hours afterward. MEASUREMENTS AND MAIN RESULTS: : Bolus lipopolysaccharide administration resulted in a marked inflammatory response. Continuous postpyloric administration of nutrition significantly increased plasma cholecystokinin levels throughout the lipopolysaccharide-induced inflammatory response. Lipid- and protein-rich nutrition attenuated circulating levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 and the interleukin-1 receptor antagonist compared with control nutrition (all p < 0.05) and fasted subjects (all p < 0.05). In additional, lipid- and protein-rich nutrition augmented the anti-inflammatory response, reflected by increased plasma levels of interleukin-10 compared with fasted subjects (p < 0.0001). CONCLUSIONS: : The current preclinical study expands the immunomodulating effects of enteral nutrition as previously observed in rodents to man. Continuous administration of enteral nutrition resulted in a rapid anti-inflammatory effect. Furthermore, enrichment of the nutritional composition with lipid and protein was shown to enhance the anti-inflammatory potential. Therefore, continuous enteral administration of lipid- and protein-rich nutrition is a promising intervention to modulate the immune response in the early course of systemic inflammation in man.
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