Comparison of a immunonutrition formula enriched arginine, glutamine and omega-3 fatty acid, with a currently high-enriched enteral nutrition for trauma patients.

The severe trauma or burn patients required aggressive resuscitation, operation and metabolic support to reduce morbidity and motality. Nutrition is one of the most important treatment for these patients, improving body protein and immune function, reducing rate of infection and shortening hospitalization. METHOD: To evaluate the metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids (fish oil) supplementation, we performed a prospective study in patients age 15-60 yrs after severe trauma (Injury Severity Scores (ISS) 15-30) or burn patients (body surface area (BSA) 30-60%) in Siriraj Hospital. They were randomized to receive either Neomune or Traumacal. The nasogastric feeding was started in post-injury day 2 (PID2) with half of concentration at the rate of 30 ml/h. From PID3 to PID10, the normal concentration was administered at the rate of 80-100 ml/h depending on optimal caloric requirement. All patients received 5 per cent dextrose in half or full strength saline solution as clinically indicated. No other oral nutrients apart from study formula were allowed during the study. Blood sample was with-drawn on PID2, PID6 and PID11 for measurements of CBC, coagulogram, albumin, transferrin, CRP, LFT, BUN, Cr, CD3, CD19, CD4, CD8, C3, IgG, IgM, and IgA. Nitrogen balance was calculated from UUN. Unpaired student t-test was applied to compare variables between the two groups. RESULTS: 36 patients were selected (16 trauma and 20 burn), male = 29, mean age = 29.86 yrs. The patients were divided equally into two groups to receive Neomune or Traumacal. The data were compared and showed significance on total protein on PID11 (Neomune = 6.52 +/- 1.29, Traumacal = 5.59 +/- 1.21, p = 0.03) and serum triglycerides on PID11 (Neomune = 128.39 +/- 53.45, Traumacal = 186.25 +/- 84.07, p = 0.02). The ICU stay was observed shorter in Neomune than in Traumacal group (3.41 and 7.83 days) with no statistical significance. The wean-off respirator day was also shorter in Neomune than in Traumacal group (2.71 and 7.39 days). One patient in each group died. CONCLUSIONS: The feeding of Neomune in critically injured patients was well tolerated as Traumacal and significant improvement was observed in serum protein. Shorten ICU stay and wean-off respirator day may benefit from using the immunonutrient formula.

The use of low calorie diet supplement in weight reduction: A preliminry report.

Low calorie diet (LCD) supplement has gained popularity in weight control programs. The efficacy, acceptance and adverse effects of LCD (Modellim 40R, Medicfast) were evaluated during a 12 week weight reduction program in 11 obese volunteers. They were 2 males and 9 females, age 37.4 + 9.4 year old (mean + SD) whose body mass indices (BMI) ranged from 28.8 – 40.7 kg/m2 (mean + SD = 31.44 + 4.84). During the weight reduction period, a diet containing 800 kcal/day was prescribed in every case with a supplement of 1 packet of LCD (40 kcal) before lunch and dinner, and whenever they felt hungry. Regular exercise were also encouraged. At the beginning and at the end of the program, blood specimens were analysed for liver, kidney and thyroid function, electrolytes and other macro minerals. Lipid profiles and complete blood count were also done. All volunteers were interviewed and examined initially and every 2 weeks thereafter by one of the investigators. One female volunteer was withdrawn from the study after the first week because of aversion to LCD. The others tolerated the LCD well. They were consumed 1-3 packets daily (mean + SD 1.44 + 0.7). At the end of twelfth week, the weight loss was 3.1 + 2.9 kg (range -1.4 – 8.1 kg). There was no well-accepted in most of the cases and can be used as a supplement during weight reduction without any serious side effects.