Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Effect of immune-enhancing enteral nutrition formula enriched with plant-derived n-3 fatty acids on natural killer cell activity in rehabilitation patients

  • Cho, Jung Min (National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University) ;
  • Choi, Hyo Seon (Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University) ;
  • Cho, Youn Soo (Department of Nutrition and Dietetics, Yonsei University Severance Hospital) ;
  • Park, So Young (Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine) ;
  • Kim, Deog Young (Department & Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine) ;
  • Lee, Jong Ho (National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, College of Human Ecology, Yonsei University)
  • Received : 2019.01.24
  • Accepted : 2019.06.17
  • Published : 2019.10.01
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Abstract

BACKGROUND/OBJECTIVES: Enteral nutrition formulas with immune-enhancing nutrients, such as n-3 fatty acids, may manage patients' nutritional status and pathophysiological processes. The aim of our study was to investigate natural killer (NK) cell activity alterations and related cytokine changes resulting from feeding with soybean oil-containing enteral nutrition formula (control group) and plant-derived n-3 fatty acid-enriched enteral nutrition formula. SUBJECTS/METHODS: Subjects participated for 14 consecutive days and consumed enteral formula containing canola and flaxseed oil (n3EN, test group) in nonsurgical patients hospitalized for rehabilitation. Blood samples were collected on the first day and 14 days after the consumption of each formula daily, and anthropometric parameters were collected. Hematology and biochemical values were analyzed, and NK cell activities and serum cytokine concentration were measured. A total of sixty subjects were included in the analysis, excluding dropouts. RESULTS: No significant differences were found in biochemical parameters. The n3EN group's NK cell activities at effector:tumor cell ratios of 10:1, 5:1, 2.5:1 and 0.625:1 were significantly higher than those of the control group after two weeks (P < 0.05). However, there were no statistically significant differences in serum cytokine interleukin (IL)-12, $interferon-{\gamma}$, $IL-1{\beta}$, IL-6 and tumor necrosis $factor-{\alpha}$ values between the two groups. CONCLUSIONS: In conclusion, this study elucidates the beneficial effects of plant-derived n-3 fatty acid supplementation in enteral formula on NK cell activity.

Keywords

References

  1. Corrigan ML, Escuro AA, Celestin J, Kirby DF. Nutrition in the stroke patient. Nutr Clin Pract 2011;26:242-52. https://doi.org/10.1177/0884533611405795
  2. Wirth R, Smoliner C, Jager M, Warnecke T, Leischker AH, Dziewas R; DGEM Steering Committee. Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med 2013;5:14. https://doi.org/10.1186/2040-7378-5-14
  3. Liu H, Ling W, Shen ZY, Jin X, Cao H. Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy. J Dig Dis 2012;13:401-6. https://doi.org/10.1111/j.1751-2980.2012.00596.x
  4. Seike J, Tangoku A, Yuasa Y, Okitsu H, Kawakami Y, Sumitomo M. The effect of nutritional support on the immune function in the acute postoperative period after esophageal cancer surgery: total parenteral nutrition versus enteral nutrition. J Med Invest 2011;58:75-80. https://doi.org/10.2152/jmi.58.75
  5. Calder PC. Rationale and use of n-3 fatty acids in artificial nutrition. Proc Nutr Soc 2010;69:565-73. https://doi.org/10.1017/S0029665110000157
  6. Ruxton CH, Reed SC, Simpson MJ, Millington KJ. The health benefits of omega-3 polyunsaturated fatty acids: a review of the evidence. J Hum Nutr Diet 2004;17:449-59. https://doi.org/10.1111/j.1365-277X.2004.00552.x
  7. Hardin-Fanning F, Boissonneault GA, Lennie TA. Polyunsaturated fatty acids. Immunomodulators in older adults. J Gerontol Nurs 2011;37:20-8. https://doi.org/10.3928/00989134-20110914-50
  8. Kim YS, Sayers TJ, Colburn NH, Milner JA, Young HA. Impact of dietary components on NK and Treg cell function for cancer prevention. Mol Carcinog 2015;54:669-78. https://doi.org/10.1002/mc.22301
  9. Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Crit Care Med 1999;27:2799-805. https://doi.org/10.1097/00003246-199912000-00032
  10. Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Ann Surg 1999;229:467-77. https://doi.org/10.1097/00000658-199904000-00004
  11. Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001;286:944-53. https://doi.org/10.1001/jama.286.8.944
  12. Zheng Y, Li F, Qi B, Luo B, Sun H, Liu S, Wu X. Application of perioperative immunonutrition for gastrointestinal surgery: a meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr 2007;16 Suppl 1:253-7.
  13. Ma C, Tsai H, Su W, Sun L, Shih Y, Wang J. Combination of arginine, glutamine, and omega-3 fatty acid supplements for perioperative enteral nutrition in surgical patients with gastric adenocarcinoma or gastrointestinal stromal tumor (GIST): A prospective, randomized, double-blind study. J Postgrad Med 2018;64:155-63. https://doi.org/10.4103/jpgm.JPGM_693_17
  14. Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, van den Berghe G, Pichard C. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr 2006;25:180-6. https://doi.org/10.1016/j.clnu.2006.02.007
  15. Snyderman CH, Kachman K, Molseed L, Wagner R, D'Amico F, Bumpous J, Rueger R. Reduced postoperative infections with an immune-enhancing nutritional supplement. Laryngoscope 1999;109:915-21. https://doi.org/10.1097/00005537-199906000-00014
  16. Kudsk KA, Minard G, Croce MA, Brown RO, Lowrey TS, Pritchard FE, Dickerson RN, Fabian TC. A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications. Ann Surg 1996;224:531-43. https://doi.org/10.1097/00000658-199610000-00011
  17. Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017;36:623-50. https://doi.org/10.1016/j.clnu.2017.02.013
  18. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev 2011;24:141-73. https://doi.org/10.1128/CMR.00027-10
  19. Khanapure SP, Garvey DS, Janero DR, Letts LG. Eicosanoids in inflammation: biosynthesis, pharmacology, and therapeutic frontiers. Curr Top Med Chem 2007;7:311-40. https://doi.org/10.2174/156802607779941314
  20. Massaro M, Habib A, Lubrano L, Del Turco S, Lazzerini G, Bourcier T, Weksler BB, De Caterina R. The omega-3 fatty acid docosahexaenoate attenuates endothelial cyclooxygenase-2 induction through both NADP(H) oxidase and $PKC{\varepsilon}$ inhibition. Proc Natl Acad Sci U S A 2006;103:15184-9. https://doi.org/10.1073/pnas.0510086103
  21. Thomas DR, Ashmen W, Morley JE, Evans WJ; Council for Nutritional Strategies in Long-Term Care. Nutritional management in long-term care: development of a clinical guideline. J Gerontol A Biol Sci Med Sci 2000;55:M725-34. https://doi.org/10.1093/gerona/55.12.M725
  22. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J; A.S.P.E.N. Board of Directors. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 2009;33:122-67. https://doi.org/10.1177/0148607108330314
  23. United States Department of Agriculture (USDA). Composition of Foods Raw, Processed, Prepared - USDA National Nutrient Database for Standard Reference, Release 28. Beltsville (MD): USDA; 2005.
  24. World Health Organization. Global Database on Body Mass Index: an Interactive Surveillance Tool for Monitoring Nutrition Transition. Geneva: WHO; 2012.
  25. Sprecher H. The roles of anabolic and catabolic reactions in the synthesis and recycling of polyunsaturated fatty acids. Prostaglandins Leukot Essent Fatty Acids 2002;67:79-83. https://doi.org/10.1054/plef.2002.0402
  26. Yaqoob P, Calder PC. Fatty acids and immune function: new insights into mechanisms. Br J Nutr 2007;98 Suppl 1:S41-5. https://doi.org/10.1017/S0007114507832995
  27. Calder PC. The relationship between the fatty acid composition of immune cells and their function. Prostaglandins Leukot Essent Fatty Acids 2008;79:101-8. https://doi.org/10.1016/j.plefa.2008.09.016
  28. Weiss G, Meyer F, Matthies B, Pross M, Koenig W, Lippert H. Immunomodulation by perioperative administration of n-3 fatty acids. Br J Nutr 2002;87 Suppl 1:S89-94. https://doi.org/10.1079/BJN2001461
  29. Barrett AH, Porter WL, Marando G, Chinachoti P. Effect of various antioxidants, antioxidant levels, and encapsulation on the stability of fish and flaxseed oils: assessment by fluorometric analysis. J Food Process Preserv 2011;35:349-58. https://doi.org/10.1111/j.1745-4549.2009.00474.x
  30. Kolanowski W, Laufenberg G. Enrichment of food products with polyunsaturated fatty acids by fish oil addition. Eur Food Res Technol 2006;222:472-7. https://doi.org/10.1007/s00217-005-0089-8
  31. Kolanowski W, Swiderski F, Berger S. Possibilities of fish oil application for food products enrichment with omega-3 PUFA. Int J Food Sci Nutr 1999;50:39-49. https://doi.org/10.1080/096374899101409
  32. Moretta A, Bottino C, Mingari MC, Biassoni R, Moretta L. What is a natural killer cell? Nat Immunol 2002;3:6-8. https://doi.org/10.1038/ni0102-6
  33. Forel JM, Chiche L, Thomas G, Mancini J, Farnarier C, Cognet C, Guervilly C, Daumas A, Vely F, Xeridat F, Vivier E, Papazian L. Phenotype and functions of natural killer cells in critically-ill septic patients. PLoS One 2012;7:e50446. https://doi.org/10.1371/journal.pone.0050446
  34. Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz J Med Biol Res 2003;36:433-46. https://doi.org/10.1590/S0100-879X2003000400004
  35. Wada M, DeLong CJ, Hong YH, Rieke CJ, Song I, Sidhu RS, Yuan C, Warnock M, Schmaier AH, Yokoyama C, Smyth EM, Wilson SJ, FitzGerald GA, Garavito RM, Sui X, Regan JW, Smith WL. Enzymes and receptors of prostaglandin pathways with arachidonic acidderived versus eicosapentaenoic acid-derived substrates and products. J Biol Chem 2007;282:22254-66. https://doi.org/10.1074/jbc.M703169200
  36. Souza-Fonseca-Guimaraes F, Adib-Conquy M, Cavaillon JM. Natural killer (NK) cells in antibacterial innate immunity: angels or devils? Mol Med 2012;18:270-85. https://doi.org/10.2119/molmed.2011.00201
  37. Narni-Mancinelli E, Jaeger BN, Bernat C, Fenis A, Kung S, De Gassart A, Mahmood S, Gut M, Heath SC, Estelle J, Bertosio E, Vely F, Gastinel LN, Beutler B, Malissen B, Malissen M, Gut IG, Vivier E, Ugolini S. Tuning of natural killer cell reactivity by NKp46 and Helios calibrates T cell responses. Science 2012;335:344-8. https://doi.org/10.1126/science.1215621
  38. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G, Wernerman J; DGEM (German Society for Nutritional Medicine), Ebner C, Hartl W, Heymann C, Spies C; ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr 2006;25:210-23. https://doi.org/10.1016/j.clnu.2006.01.021
  39. Drewry AM, Ablordeppey EA, Murray ET, Beiter ER, Walton AH, Hall MW, Hotchkiss RS. Comparison of monocyte human leukocyte antigen-DR expression and stimulated tumor necrosis factor alpha production as outcome predictors in severe sepsis: a prospective observational study. Crit Care 2016;20:334. https://doi.org/10.1186/s13054-016-1505-0
  40. Kjaergaard AG, Nielsen JS, Tonnesen E, Krog J. Expression of NK cell and monocyte receptors in critically ill patients--potential biomarkers of sepsis. Scand J Immunol 2015;81:249-58. https://doi.org/10.1111/sji.12272
  41. Hall MW, Knatz NL, Vetterly C, Tomarello S, Wewers MD, Volk HD, Carcillo JA. Immunoparalysis and nosocomial infection in children with multiple organ dysfunction syndrome. Intensive Care Med 2011;37:525-32. https://doi.org/10.1007/s00134-010-2088-x
  42. Hall MW, Geyer SM, Guo CY, Panoskaltsis-Mortari A, Jouvet P, Ferdinands J, Shay DK, Nateri J, Greathouse K, Sullivan R, Tran T, Keisling S, Randolph AG; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network PICFlu Study Investigators. Innate immune function and mortality in critically ill children with influenza: a multicenter study. Crit Care Med 2013;41:224-36. https://doi.org/10.1097/CCM.0b013e318267633c
  43. Lee JG, Kim YS, Lee YJ, Ahn HY, Kim M, Kim M, Cho MJ, Cho Y, Lee JH. Effect of immune-enhancing enteral nutrition enriched with or without beta-glucan on immunomodulation in critically ill patients. Nutrients 2016;8:336. https://doi.org/10.3390/nu8060336
  44. Lee DH, Kim M, Kim M, Lee YJ, Yoo HJ, Lee SH, Lee JH. Agedependent alterations in serum cytokines, peripheral blood mononuclear cell cytokine production, natural killer cell activity, and prostaglandin $F2{\alpha}$. Immunol Res 2017;65:1009-16. https://doi.org/10.1007/s12026-017-8940-0
  45. Flick DA, Gifford GE. Pharmacokinetics of murine tumor necrosis factor. J Immunopharmacol 1986;8:89-97. https://doi.org/10.3109/08923978609031087
  46. Hayes KC, Hull TC, Delaney GA, Potter PJ, Sequeira KA, Campbell K, Popovich PG. Elevated serum titers of proinflammatory cytokines and CNS autoantibodies in patients with chronic spinal cord injury. J Neurotrauma 2002;19:753-61. https://doi.org/10.1089/08977150260139129
  47. Agarwal N, Chitrika A, Bhattacharjee J, Jain SK. Correlation of tumour necrosis factor-$\alpha$ and interleukin-6 with anthropometric indices of obesity and parameters of insulin resistance in healthy north Indian population. J Indian Acad Clin Med 2011;12:196-204.
  48. Jason J, Archibald LK, Nwanyanwu OC, Byrd MG, Kazembe PN, Dobbie H, Jarvis WR. Comparison of serum and cell-specific cytokines in humans. Clin Diagn Lab Immunol 2001;8:1097-103. https://doi.org/10.1128/CDLI.8.6.1097-1103.2001
  49. Nordenstrom J, Carpentier YA, Askanazi J, Robin AP, Elwyn DH, Hensle TW, Kinney JM. Metabolic utilization of intravenous fat emulsion during total parenteral nutrition. Ann Surg 1982;196:221-31. https://doi.org/10.1097/00000658-198208000-00016