Immunonutrition in critically ill patients: a systematic review and analysis of the literature
Abstract
Background The role of immuno-modulating diets (IMDs) in critically ill patients is controversial. Objective The goal of this meta-analysis was to determine the impact of IMD's on hospital mortality, nosocomial infections and length of stay (LOS) in critically ill patients. Outcome was stratified according to type of IMD and patient setting. Data sources MEDLINE, Embase, Cochrane Register of Controlled Trials. Study selection RCT's that compared the outcome of critically ill patients randomized to an IMD or a control diet. Data synthesis Twenty-four studies (with a total of 3013 patients) were included in the meta-analysis; 12 studies included ICU patients, 5 burn patients and 7 trauma patients. Four of the studies used formulas supplemented with arginine, two with arginine and glutamine, nine with arginine and fish oil (FO), two with arginine, glutamine and FO, six with glutamine alone and three studies used a formula supplemented with FO alone. Overall IMD's had no effect on mortality or LOS, but reduced the number of infections (OR 0.63; 95% CI 0.47-0.86, P = 0.004, I(2) = 49%). Mortality, infections and LOS were significantly lower only in the ICU patients receiving the FO IMD (OR 0.42, 95% CI 0.26-0.68; OR 0.45, 95% CI 0.25-0.79 and WMD -6.28 days, 95% CI -9.92 to -2.64, respectively). Conclusions An IMD supplemented with FO improved the outcome of medical ICU patients (with SIRS/sepsis/ARDS). IMDs supplemented with arginine with/without additional glutamine or FO do not appear to offer an advantage over standard enteral formulas in ICU, trauma and burn patients.
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High arginine plus fish oil formulas compared to sole fish oil and/or arginine formulas have differing effects on mortality in critically ill patients.
“High arginine plus fish oil formulas compared to sole fish oil and/or arginine formulas have differing effects on mortality in critically ill patients”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [57]
Arginine may counteract the benefits of fish oil.
“suggesting that arginine may counteract the benefits of fish oil [57].”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [57]
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- Authors
- Marik, P. E., & Zaloga, G. P.
- Affiliations
- Thomas Jefferson University (US)
- Baxter (United States) (US)
- Corresponding author
- Marik, Paul E.
- ORCID
- Marik, Paul E.
- Venue
- Intensive Care Medicine
- Published
- 2008-07-15
- Volume
- 34
- Issue
- 11
- Pages
- 1980-1990
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2001318507
- Cited by
- 295
- References
- 7
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 2 · 2023: 10 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 8 · 2018: 7 · 2017: 9 · 2016: 11 · 2015: 25 · 2014: 32 · 2013: 32 · 2012: 24
- FWCI
- 3.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- immunonutrition, critically ill patients, enteral nutrition, fish oil supplementation, L-arginine, glutamine, nosocomial infections, in-hospital mortality, length of hospital stay, sepsis, acute respiratory distress syndrome, trauma patients, burn patients, intensive care unit patients
- MeSH terms
- Arginine, Critical Care, Cross Infection, Enteral Nutrition, Food, Formulated, Glutamine, Humans, Intensive Care Units, Length of Stay, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Critical Illness, Hospital Mortality
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