Immunonutrition: One Point of View

There is a growing interest in manipulating the immune response using nutrients for the purpose of improving disease outcome. According to the Con-sensus Panel Recommendations from the US Sum-mit on Immune-Enhancing Enteral Therapy held in 2001, patients who should benefit from immunonu-trition include (1) patients undergoing major elec-tive gastrointestinal (GI) surgery, especially mal-nourished patients; (2) patients with blunt and penetrating torso trauma; (3) malnourished patients undergoing surgery for head and neck cancer; (4) patients with severe head injury; (5) burn patients; and (6) ventilator-dependent nonseptic patients at risk for infection.1 Several commercially available formulas are mar-keted using the concept of immune modulation but offer varying amounts and types of immunonutri-ents (Table 1). Although numerous nutrients have been reported to stimulate or modulate immune function, the majority of the clinical data and peer-reviewed trials have used arginine, glutamine, -3 fatty acids, and nucleotides.2 In this manuscript, an overview of immune-modulating nutrients and their purported effects is presented, followed by two inter-pretations of the scientific evidence about the status of immunonutrition for use in clinical practice