Vincenza Zurlo Journal summary 2

This article published in the European Review for Medical and Pharmacological Sciences explores the effect of an immune enhancing enteral formula on both the immune function and intestinal function of patients who are receiving long-term antibiotic treatment. This study was done using a microbiological and immunological enteral nutrition (MEIN) formula that the researchers created which was an enteral formula with probiotics, glutamine and deep sea fish oil added to it. It was hypothesized that this type of formula would help reduce gastrointestinal symptoms that are often exacerbated in patients who are on both enteral feeding and long term antibiotics. This study included a group of 56 patients who were suffering from severe apoplexy and who were experiencing infectious pulmonary complications. These patients were between the ages of 62 and 75 years and were on enteral nutrition feedings prior to their admission. The experimental group and control group were randomly assigned and the experimental group received the MEIN formula while the control group received a basic enteral formula with added fiber. All patients had either nasogastric tubes or nasojejunal tubes. During the study, the researchers collected data related to diarrhea, abdominal pain, abdominal distention, arm muscle circumference and immune parameters. The researchers controlled for variables such as: age, admitting diagnosis, type of antibiotic treatment, and feeding modality prior to admission. They did not control for gender, comorbidities, medications, and nutrition status on admission. This study showed that patients in the MEIN group experienced abdominal distention and pain ad significantly lower rates than there enteral formula counterparts. Specifically, the instance of abdominal pain was 7.2% in the MEIN group and 31.1% in the EN group. Abdominal distention was experienced by 14.2% of the MEIN group and 39.3% of the EN group. Further, the MEIN group

experienced better tolerance than the regular EN group. The levels of immune parameters were also greatly increased in the MEIN group on the 10th and 20th days of the study. These results were not seen after the 1st day of the study. Specifically, levels of CD 4, CD 3, CD 8 and natural killer cells increased in number for the MEIN group. The researchers believe that the probiotics may aid in gut integrity in these patients and therefore improved their tolerance levels. They speculate that the omega-3 content of the fish oil may have helped to decrease inflammation and aided in immune function in these patients. The researchers did not give a detailed explanation as to why these benefits occurred for the MEIN group. It seems that the physiology behind how many of the components of the MEIN formula work is largely unknown. Furthermore, this study was done a highly specific patient population who experienced cerebral events. As such, it would be difficult to apply the results of this study to the rest of the patient population. Tolerance is a major obstacle when administering enteral feeds and the fact that the MEIN formula was better tolerated may be of clinical significance if further studies show similar results. This does lead to the question of did the MEIN patients have better overall outcomes merely based on the fact that they received more of their feeds due to better tolerance? Their better results may not have been because of immune-enhancing benefits of the formula alone but may also have been a result of better nutrition in general.

Reference 1. Shao X, Xu X. Effect of microbiological and immunological enteral nutrition on intestinal function and immune status in the patients with long-term use of antibiotics. European Review for Medical and Pharmacological Sciences. 2013; 17: 2481-2485.