Çocuk Sağlığı ve Hastalıkları Dergisi
2011 , Vol 54 , Num 3
*Turgay Coşkun
Hacettepe Üniversitesi Tıp Fakültesi Pediatri Profesörü
Immune response is compromised, to varying extent, in patients who have
surgery, trauma, burns, and injury. Massive activation of the inflammatory
cascade, with alterations in both innate and adaptive immune functions,
contributes significantly to increased susceptibility to infections. The resulting
septic syndromes are associated with development of multiple organ failure and
significant morbidity and mortality in most of the cases. Since nutrition and
immunity are interrelated, the use of enteral feedings enriched with immuneenhancing
ingredients was proposed for restoration of immune functions
and reducing infection rates in critically ill patients. Several nutrients like
arginine, glutamine, omega-3-fatty acids, and nucleotides (immunonutrients)
have been added to standard nutritional support solutions, and the use of
these formulations is known as “immunonutrition.” Immunonutrients, apart
from being dietary components, influence immunologic response mechanisms.
These immunonutrients may simply be acting as pharmacologic agents,
much like a drug, when consumed in amounts above the accepted daily
requirements. A new field in nutrition science has thus emerged, and a shift
from immunonutrition to pharmaconutrition has occurred. Pharmaconutrition is
expected to make a disease-state-specific nutrition therapy possible. In light of
the contemporary scientific research, we will be able to answer the questions
of how to administer the right nutrients, in the right amounts, at the right
time to critically ill patients. However, whether giving immunonutrients to
critically ill patients is beneficial remains controversial. Recent meta-analyses
have yielded encouraging results in terms of reducing infection rates, fewer
days on a ventilator and reduced length of intensive care unit and hospital
stay. Although controversy exists regarding the use of immunonutrients,
either alone or in the form of a mixture, in critically ill patients, they can
be administered safely with minimal risk of adverse outcome on condition
that the patients are selected properly. In patients suffering from systemic
inflammatory response syndrome, great caution should be exercised when
immune-enhancing substrates are involved, as they may aggravate systemic
inflammation.
Anahtar Kelimeler :
immünonütrisyon, farmakonütrisyon, glutamin, arjinin, nükleotidler,
omega-3 yağ asitleri, antioksidanlar
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