International Journal of Colorectal Disease

, Volume 27, Issue 4, pp 513–520 | Cite as

Influence of postoperative enteral nutrition on cellular immunity. A random double-blinded placebo controlled clinical trial

Original Article



The aim of this study was to discover if the cellular immunological response is different in patients receiving early postoperative enteral nutrition compared to patients who only receive “water”.


In a random double-blind prospective trial, 30 patients received Nutridrink® and 30 patients received placebo (water) through a nasoduodenal tube from the day of operation to the fourth postoperative day. Leukocyte differential count was examined preoperatively, and on the first, third, and seventh postoperative days. Subpopulations of lymphocytes were flow cytometrically analysed. IL-1ra and soluble IL-2R were investigated by use of an enzyme-linked immunosorbent assay.


In the enteral nutrition group, a significantly larger number of circulating monocytes and NK-cells and a significantly larger expression of HLA-DR were found. In the nutrition group, a tendency to larger numbers of T-lymphocyte subpopulations was found. No difference in IL-1ra and soluble IL-2R was found between the groups.


Early postoperative enteral nutrition has an important influence on the immediate unspecific cellular immunity and an activating effect on the specific cellular immunity compared to “no food”.


Abdominal surgery Postoperative nutrition Cellular immunity HLA-DR Natural killer cells Monocytes 


  1. 1.
    van Bokhorst-de Van Der Schueren MA, Quak JJ, von Blomberg-van der Flier BM BM, Kuik DJ, Langendoen SI, Snow GB, Green CJ, van Leeuwen PA (2001) Effect of perinutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. Am J Clin Nutr 73:323–332PubMedGoogle Scholar
  2. 2.
    Riso S, Aluffi P, Brugnani M, Farinetti F, Pia F, D’Andrea F (2000) Postoperative enteral immunonutrition in head and neck cancer patients. Clin Nutr 19(6):407–412PubMedCrossRefGoogle Scholar
  3. 3.
    Kemen M, Senkal M, Homann HH, Mumme A, Dauphin AK, Baier J, Wndeler J, Neumann H, Zumtobel V (1995) Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients. Crit Care Med 23(4):652–659PubMedCrossRefGoogle Scholar
  4. 4.
    Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, Eickhoff U, Kemen M (1999) Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg 134(12):1309–1316PubMedCrossRefGoogle Scholar
  5. 5.
    Braga M, Gianotti L, Nespoli L, Radaelli G, Di Carlo V (2002) Nutritional approach in malnourished surgical patients: a prospective randomized study. Arch Surg 137(2):174–180PubMedCrossRefGoogle Scholar
  6. 6.
    Gianotti L, Braga M, Fortis C, Soldini L, Vignali A, Clombu S, Radaeli G, Di Carlo V (1999) A prospective, randomized clinical trial on perioperative feeding with an arginine-, omega-3 fatty acid-, and RNA-enriched enteral diet: effect on host response and nutritional status. JPEN J Parenter Enteral Nutr 23(6):314–320PubMedCrossRefGoogle Scholar
  7. 7.
    Lennard TW, Shenton BK, Borzotta A, Donnelly PK, White M, Gerrie LM, Proud G, Taylor RM (1985) The influence of surgical operations on components of the human immune system. Br J Surg 72(10):771–776PubMedCrossRefGoogle Scholar
  8. 8.
    Haupt W, Riese J, Mehler C, Weber K, Zowe M, Hohenberger W (1998) Monocyte function before and after surgical trauma. Dig Surg 15(2):102–104PubMedCrossRefGoogle Scholar
  9. 9.
    McIrvine AJ, Mannick JA (1983) Lymphocyte function in the critically ill surgical patient. Surg Clin N Am 63(2):245–261PubMedGoogle Scholar
  10. 10.
    Beier-Holgersen R, Boesby S (1996) Influence of postoperative enteral nutrition on post-surgical infections. Gut 39(6):833–835PubMedCrossRefGoogle Scholar
  11. 11.
    Toft P, Dagnaes-Hansen F, Tonnesen E, Petersen MS (2002) Influence of surgery and endotoxin-induced sepsis combined on natural killer cell activity, oxidative burst of granulocytes and antigen presentation capability of monocytes. Acta Anaesthesiol Scand 46(4):405–410PubMedCrossRefGoogle Scholar
  12. 12.
    Beier-Holgersen R, Brandstrup B (1999) Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the multitest® CMI. Scand J Gastroenterol 34:98–102PubMedCrossRefGoogle Scholar
  13. 13.
    Murakami S, Sakata H, Tsuji Y, Okubo K, Takahashi T, Kikuchi M, Hirayama R (2003) Changes in the levels of serum-soluble interleukin-2 receptor after surgical stress. Surg Today 33(8):565–570PubMedCrossRefGoogle Scholar
  14. 14.
    Maruna P, Gurlich R, Frasko R, Chachkhiani I, Marunova M, Owen K, Peskova M (2002) Cytokines and soluble cytokine receptors in the perioperative period. Sb Lek 103(2):273–282, Abstract onlyPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of SurgeryHillerød University HospitalHillerødDenmark
  2. 2.Department of SurgeryHvidovre University HospitalCopenhagenDenmark
  3. 3.HelsingørDenmark

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