Immunonutrition: a South African perspective

Abstract

Clinical nutrition has evolved from providing nutrients to meet the patient’s needs to nutrition therapy that additionally aims to provide specific nutrients, or combinations thereof, which can reduce infection and improve outcomes in critically ill patients. The value of immunonutrition in the management of critically ill, preoperative and postoperative patients is now acknowledged by many healthcare practitioners. Amid the demonstration of clinical and economic benefit in defined conditions, South African practitioners should aim to translate current knowledge to best practice in order to optimise nutrition therapy and ultimately clinical outcome in critically ill patients. For the future, a paradigm shift to pharmaconutrition has been suggested. This practice dissociates the administration of key single nutrients, in the form of requirement-based parenteral or enteral nutrition, from the delivery of pharmaconutrients in the full effective pharmacological dose, as evaluated in large, well-designed trials, in order to achieve therapeutic effects. This has been evaluated in large, well designed trials. The purpose of this review is not to provide an exhaustive overview of the available literature on immunonutrition, but rather to highlight key and recent significant studies, with a focus on energy and protein, glutamine, arginine, omega-3 fatty acids and micronutrients, and relate them to the South African context. Finally, the bigger picture should always be borne in mind, within the settings of the complexity of the acute phase response and the heterogeneity of the critical care population. As the evidence base evolves, the definition of optimal nutrition therapy should include all relevant components in the right mix, at the right time, to the right patients, to ensure optimal clinical benefit and outcome.