Impact of the feeding route on gut mucosal immunity
- PMID: 24500441
- DOI: 10.1097/MCO.0000000000000033
Impact of the feeding route on gut mucosal immunity
Abstract
Purpose of review: Enteral nutrition is recommended as a standard nutritional therapy in clinical settings. The rationale behind enteral nutrition may be decreased infectious morbidities compared with parenteral nutrition. However, the mechanism may not be well understood.
Recent findings: Animal studies have revealed that enteral nutrition, compared with parenteral nutrition, preserves the gut-associated lymphoid tissue mass and function with well controlled gut cytokine milieu and intracellular signaling pathway, leading to the maintenance of intestinal and extraintestinal acquired mucosal immunity. Moreover, enteral nutrition can enhance the gut innate immunity by increasing the antimicrobial peptides, such as secretory phospholipase A2. More importantly, a recent clinical study demonstrated preoperative parenteral nutrition without enteral nutrition to decrease the number of T cells, IgA-producing cells, and mature dendritic cells in human terminal ileum, which are consistent with the data obtained from animal studies. Investigation of the mechanism has given us some surrogates of enteral nutrition during parenteral nutrition, such as glutamine, butyric acid, cytokines, and other mediators. However, to date, no surrogates can restore parenteral-nutrition-induced impairment of host defense completely.
Summary: Because enteral nutrition is a practical way to preserve gut immunity, clinicians should make any efforts to shorten the period of enteral nutrition absence and increase the dose according to the degree of tolerance.
Similar articles
-
Parenteral glutamine supplementation in combination with enteral nutrition improves intestinal immunity in septic rats.Nutrition. 2015 May;31(5):766-74. doi: 10.1016/j.nut.2014.11.021. Epub 2014 Dec 30. Nutrition. 2015. PMID: 25837225
-
Nutritional and pharmacological enhancement of gut-associated lymphoid tissue.Can J Gastroenterol. 2000 Nov;14 Suppl D:145D-151D. doi: 10.1155/2000/308787. Can J Gastroenterol. 2000. PMID: 11110628 Review.
-
Reversal of parenteral nutrition-induced gut mucosal immunity impairment with small amounts of a complex enteral diet.J Trauma. 2008 Aug;65(2):360-5; discussion 366. doi: 10.1097/TA.0b013e31817c9711. J Trauma. 2008. PMID: 18695472
-
Is there evidence that the gut contributes to mucosal immunity in humans?JPEN J Parenter Enteral Nutr. 2007 May-Jun;31(3):246-58. doi: 10.1177/0148607107031003246. JPEN J Parenter Enteral Nutr. 2007. PMID: 17463152 Review.
-
Lack of preoperative enteral nutrition reduces gut-associated lymphoid cell numbers in colon cancer patients: a possible mechanism underlying increased postoperative infectious complications during parenteral nutrition.Ann Surg. 2013 Dec;258(6):1059-64. doi: 10.1097/SLA.0b013e31827a0e05. Ann Surg. 2013. PMID: 23187750
Cited by
-
Influence of preoperative peripheral parenteral nutrition with micronutrients after colorectal cancer patients.Biomed Res Int. 2015;2015:535431. doi: 10.1155/2015/535431. Epub 2015 Apr 27. Biomed Res Int. 2015. PMID: 26000296 Free PMC article.
-
TLR2-Dependent Signaling for IL-15 Production Is Essential for the Homeostasis of Intestinal Intraepithelial Lymphocytes.Mediators Inflamm. 2016;2016:4281865. doi: 10.1155/2016/4281865. Epub 2016 Aug 1. Mediators Inflamm. 2016. PMID: 27563173 Free PMC article.
-
Gastroenterologist's Guide to Gastrostomies.Dig Dis Sci. 2022 Aug;67(8):3488-3496. doi: 10.1007/s10620-022-07538-0. Epub 2022 May 17. Dig Dis Sci. 2022. PMID: 35579798 Review.
-
Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial.Intensive Care Med. 2019 Jul;45(7):948-956. doi: 10.1007/s00134-019-05649-3. Epub 2019 May 29. Intensive Care Med. 2019. PMID: 31143999 Clinical Trial.
-
Management of gastrointestinal failure in the adult critical care setting.Curr Opin Crit Care. 2022 Apr 1;28(2):190-197. doi: 10.1097/MCC.0000000000000924. Curr Opin Crit Care. 2022. PMID: 35131994 Free PMC article. Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Research Materials
Miscellaneous
