Effect of early enteral nutrition on patients with digestive tract surgery: A meta-analysis of randomized controlled trials.

Postoperative early enteral nutrition (EEN) is useful for the effective recovery of patients that have undergone surgery. However, the feasibility and efficacy of EEN in patients with digestive tract surgery remain inconclusive. In the present meta-analysis, the PubMed, EMBASE, Web of Science, The Cochrane Library, China National Knowledge Infrastructure and VIP databases were searched to identify controlled trials of patients with and without EEN following digestive tract surgery between October, 1966 and December, 2014. Methodological quality assessment was carried out for each of the included studies. For estimation of the analysis indexes, relative risk (RR) was used as the effect size of the the categorical variable, while the weighted mean difference (MD) was used as the effect size of the continuous variable. The meta-analysis was conducted using RevMan 5.2 software. Eleven randomized controlled trials involving 1,095 patients were included in the meta-analysis. The results revealed that, EEN in patients with digestive tract surgery was more effective in decreasing the incidence of infectious [RR=0.50, 95% confidence interval (CI): 0.38, 0.67; P<0.01] and non-infectious complications (RR=0.72, 95% CI: 0.43, 1.22; P<0.05) and shortening the length of first bowel action (MD=-4.10, 95% CI: -5.38, -2.82; P<0.05). It also had a significant influence on increasing the serum albumin (MD=2.87, 95% CI: 1.03, 4.71; P<0.05) and serum prealbumin (MD=0.04, 95% CI: 0.02, 0.05; P<0.05) levels. In conclusion, the results of the study have shown that EEN in patients with digestive tract surgery improved the nutritional status, reduced the risk of postoperative complications, shortened the length of hospital stay and promoted the functional recovery of the digestive system.

Glutamine decreases intestinal mucosal injury in a rat model of intestinal ischemia-reperfusion by downregulating HMGB1 and inflammatory cytokine expression.

Intestinal ischemia-reperfusion (IR) is a common clinical pathophysiological process that is common in severe trauma, major surgery, and in post-resuscitation. Glutamine (Gln) reduces intestinal IR injury, however, its mechanism of action remains to be determined. High mobility group box 1 (HMGB1) protein, nuclear factor-κB (NF-κB), tumor necrosis factor-α (TNF-α), and interleukin-1 (IL-1) are mediators involved in the pathophysiology of intestinal IR injury. The aim of the present study was to investigate the effects of Gln on the intestinal mucosa of HMGB1 expression following IR to determine whether Gln relieved intestinal IR injury in the intestinal mucosal barrier. Forty-eight Sprague-Dawley rats were included in the present study. A model of intestinal ischemia-reperfusion injury was established by clamping the superior mesenteric artery of the rats to cause ischemia, followed by restoring blood flow. The animals were randomly divided into the control (n=24) and the Gln (n=24) groups for the experiments. The two groups of rats were given enteral nutrition with equal heat, nitrogen (heat 125.4 kJ/kg/day, nitrogen 0.2 g/kg/day). The Gln group of rats was fed with enteral nutrition plus 3% Gln, while the control rats were fed with enteral nutrition plus 3% soybean protein. After 7 days, the HMGB1 and plasma levels of NF-κB, TNF-α, IL-1, Gln, D-lactic acid and diamine oxidase (DAO) were observed. The changes in the morphology of intestinal mucosa were observed using electron microscopy. The plasma levels of TNF-α, IL-1, D-lactic acid and DAO, and the level of HMGB1, NF-κB, TNF-α and IL-1 in intestinal mucosa were significantly higher after IR (p<0.05), while the plasma level of Gln was lower in the two groups. In the control group, the plasma level of IL-1, TNF-α, DAO and D-lactic acid, and that of HMGB1, NF-κB, TNF-α, and IL-1 in intestinal mucosa were significantly higher, while the plasma level of Gln was lower than that prior to modeling on the 3rd and 7th days of the experiment. In the Gln group, the plasma level of IL-1, TNF-α, DAO and D-lactic acid, and that of HMGB1, NF-κB, IL-1, and TNF-α in intestinal mucosa were significantly higher (p<0.05) compared to the control on the 3rd and 7th days of the experiment. By contrast, after the 7th day, the plasma level of IL-1, TNF-α, DAO and D-lactic acid, and the level of HMGB1, NF-κB, IL-1, TNF-α in intestinal mucosa were significantly lower in the Gln group, while the plasma level of Gln was significantly higher than those in control group and after IR on the 7th day of the experiment. Additionally, the structure of villi and recess was damaged, villi was sparse and short, and considerable inflammatory cell influx embellished the lamina propria, lymphangiectasia, and edema after IR. On the 7th day, compared to after IR, the intestinal villi and recess structure of the controls was significantly restored in the Gln group. In conclusion, Gln repaired the intestinal mucosal injury in IR by reducing the expression of HMGB1 and inflammatory cytokines, and reducing the permeability of the intestinal mucosa.

Effects of glutamine on markers of intestinal inflammatory response and mucosal permeability in abdominal surgery patients: A meta-analysis.

The present meta-analysis was carried out to determine whether supplementation with glutamine (Gln) would reduce the intestinal inflammatory response and mucosal permeability in patients undergoing abdominal surgery. The PubMed, EMBASE, Web of Science, and The Cochrane Library databases were searched for randomized controlled trials on the effects of supplementation with Gln, and published from August, 1966 to June 2014. Inclusion criteria for the meta-analysis were: i) Study design was a randomized controlled trial, ii) study included patients undergoing abdominal surgery, iii) study patients received a supplementation with Gln peptide (Ala-Gln or Gly-Gln) whereas control patients did not use any supplements, and iv) study outcomes included inflammatory markers [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin (IL)-6, and IL-2 receptor] and markers of intestinal permeability [lactulose/mannitol, diamine oxidase, D(-)lactic acid, and endotoxin]. Qualities of controlled trials were assessed using the Jadad score. Meta-analyses were performed with fixed- or random-effect models depending on the heterogeneity of studies. There were 21 trials meeting the inclusion criteria. The meta-analysis revealed that the levels of CRP, TNF-α, and IL-6 in patients supplemented with Gln were significantly lower than those in control patients, whereas the levels of IL-2 receptor were increased by Gln supplementation. Gln also significantly decreased the lactulose/mannitol ratio, the levels of diamine oxidase and endotoxin, and tended to decrease the levels of cyclic D-lactic acid. In conclusion, Gln appears to effectively reduce the inflammatory response and intestinal mucosal permeability in patients after abdominal surgery.

Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis.

Malnutrition is an independent risk factor for complications, mortality, wound healing, length of hospital stay, and costs. Associations between nutritional support and surgical patients remain controversial. Databases, including Pubmed, EMBASE, Web of Science, CNKI, VIP, and the Cochrane Library, were searched to find randomized controlled trials (RCTs) that assessed the effect of nutritional support on clinical outcomes in perioperative malnourished patients. The methodological quality of each included trial was assessed. A meta-analysis was conducted with Rev Man 5.2. Fifteen RCTs, involving 3831 patients, were included in this meta-analysis. Compared with control group, results showed that nutritional support was more effective in decreasing the incidence of infectious [relative risk (RR): 0.58; 95% CI: 0.50, 0.68; p<0.01] and non-infectious complications (RR: 0.74; 95% CI: 0.63, 0.88; p<0.01), and shortening the length of hospital stay [weighted mean difference (WMD): -2.64; 95% CI: -5.13, -0.16; p<0.05]. Moreover, the incidence of infectious complications in the immune nutrition group was significantly lower than that in the standard nutrition group (RR: 0.75; 95% CI: 0.58, 0.97; p<0.05). However, changes in hospital costs (WMD: 894; 95% CI: -1140, 2928; p>0.05) and postoperative mortality (RR: 0.77; 95% CI: 0.41, 1.44; p>0.05) between the nutritional support group and control group were not significantly different. In conclusion, perioperative nutritional support was superior in improving clinical outcomes in malnourished patients, which could significantly reduce the incidence of complications and effectively shorten the length of hospital stay.

Effect of glutamine enriched nutrition support on surgical patients with gastrointestinal tumor: a meta-analysis of randomized controlled trials.

BACKGROUND: Associations between glutamine (Gln) enriched nutrition support and surgical patients with gastrointestinal (GI) tumor remain controversy. The purpose of this meta-analysis was to assess the effect of Gln enriched nutrition support on surgical patients with GI tumor in term of relevant biochemical indices, immune indices, and clinical outcomes. METHODS: Six databases were systematically searched to find eligible randomized controlled trials (RCTs) from 1966 to May 2014. When estimated the analysis indexes, the relative risk (RR) was used as the effect size of the categorical variable, while the weighted mean difference (MD) was used as the effect size of a continuous variable. Meta-analysis was conducted with Rev Man 5.2. RESULTS: Thirteen RCTs, involving 1034 patients, were included in the meta-analysis. The analysis showed that Gln enriched nutrition support was more effective in increasing serum albumin (MD: 0.10; 95% confidence interval [CI]: 0.02-0.18; P < 0.05), serum prealbumin (MD: 1.98; 95% CI: 1.40-2.55; P < 0.05) and serum transferring (MD: 0.35; 95% CI: 0.12-0.57; P < 0.05), concentration of IgG (MD: 1.26; 95% CI: 0.90-1.63; P < 0.05), IgM (MD: 0.18; 95% CI: 0.11-0.25; P < 0.05), IgA (MD: 0.22; 95% CI: 0.10-0.33; P < 0.05), CD3 + (MD: 3.71; 95% CI: 2.57-4.85; P < 0.05) and CD4/CD8 ratio (MD: 0.27; 95% CI: 0.12-0.42; P < 0.05). Meanwhile, it was more significant in decreasing the incidence of infectious complications (RR: 0.67; 95% CI: 0.50-0.90; P < 0.05) and shortening the length of hospital stay (MD: -1.72; 95% CI: -3.31--0.13; P < 0.05). CONCLUSIONS: Glutamine enriched nutrition support was superior in improving immune function, reducing the incidence of infectious complications and shortening the length of hospital stay, playing an important role in the rehabilitation of surgical GI cancer patients.

Association of TLR4 gene polymorphisms with susceptibility to type 2 diabetes mellitus in the Chinese Han population.

Toll-like receptor 4 (TLR4) gene plays important roles in the susceptibility to type 2 diabetes mellitus (T2DM). This study aims to detect the potential association of TLR4 gene polymorphisms with the susceptibility to T2DM in the Chinese Han population. 685 T2DM patients and 690 healthy controls were enrolled in this case-control study. The genotypes of TLR4 gene polymorphisms were analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing methods. We detected the g.13726T>C and g.15090G>A genetic polymorphisms. Our data supported that the g.13726T>C and g.15090G>A genetic polymorphisms were significantly associated with the increased susceptibility to T2DM in the homozygote comparison, recessive model, and allele contrast (all P-values<0.01). The allele-C and genotype-CC of g.13726T>C and allele-A and genotype-AA of g.15090G>A genetic polymorphisms might be the risk factors for increasing the susceptibility to T2DM. These preliminary findings indicate that the g.13726T>C and g.15090G>A genetic polymorphisms of TLR4 gene are potentially related to the susceptibility to T2DM in the studied population, and might be used as molecular markers for evaluating the risk of T2DM.

Effect of L-arginine on immune function: a meta-analysis.

L-arginine plays an important role in immune regulation by affecting the immune response and inflammation. This meta-analysis was performed to assess whether L-arginine supplementation could improve the outcomes of immune function, and to evaluate the safety of L-arginine supplementation. Four databases (PubMed, EMBASE, Web of Science, the Cochrane Library) for all randomized controlled trials investigating the effects of supplementation with L-arginine published from 1966 to September 2013 were searched. The quality of controlled trials was assessed with the Jadad method. Meta-analyses were performed with fixed- or random-effects models according to heterogeneity of studies. Data from 11 trials involving 321 patients were enrolled. Meta-analysis showed that the L-arginine supplement group had a significantly greater CD4⁺ T-cell proliferation response (MD 5.03; 95% CI 1.11, 8.95; p<0.05), and that the incidence of infectious complications was lower (OR 0.40; 95% CI 0.17, 0.95; p<0.05) than control.

Protective effects of bifidobacterial adhesin on intestinal mucosa of stressed male rats via modulation of inflammation.

This study aimed to assess BA impact on inflammation markers and repair of intestinal mucosa. Forty-eight rats were randomly divided into stress (n = 24) and BA (n = 24) groups. Stress was induced by fettering in all animals, fed enterally with 125.4 kJ/kg/d and 0.2 g/kg/d nitrogen. Then, rats were treated for 8 days with 5 mg/kg/d BA (BA group) or 5 mg/kg/d saline (Stress group). Levels of NF-κB, IL-10, TNF-α, and IFN-γ were measured at different time points, in plasma and intestinal mucosa samples. Changes in intestinal mucosa morphology were observed by electron microscopy. Plasma and/or mucosal levels of NF-κB, TNF-α, and IFN-γ were significantly higher in both groups after stress induction (P < 0.05). These high levels persisted in control animals throughout the experiment, and were significantly reduced in the BA group, 3 and 8 days after stress induction (P < 0.05). Interestingly, IL-10 levels were increased after BA treatment (P < 0.05). At day 8, ileal mucosal villi and crypt structure were significantly restored in the BA group. Bifidobacterial adhesin plays a role in repairing intestinal mucosa injury after stress by regulating the release of inflammatory mediators in the intestinal mucosa.

[Meta-analysis of branched chain amino acid-enriched nutrition to improve hepatic function in patients undergoing hepatic operation].

OBJECTIVE: To perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation. METHODS: The electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2. RESULTS: A total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01]. CONCLUSION: BCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.

[Prognosis of patients with early enteral nutrition after gastrointestinal operation: a meta-analysis].

OBJECTIVE: To systematically assess the effect of early enteral nutrition support after gastrointestinal operation on prognosis. METHODS: The Cochrane Library, PubMed, CBM, CNKI, Wanfang, and VIP databases were retrieved via computer system for randomized controlled trails(RCTs) with early enteral nutrition support to patients undergoing gastrointestinal operation. Quality of studies was evaluated by the Cochrane Jadad rating scale. Nutrition indexes, bowel function indices, postoperative complications, health-economics indices were collected. Meta-analysis was conducted with RevMan 5.2. RESULTS: Eleven relevant RCTs studies with 1087 cases were enrolled, including 541 patients in the study group(early enteral nutrition) and 546 in the control group. Meta-analysis showed that patients in the study group had significantly higher levels of plasma albumin and prealbumin than those in the control group(WMD=2.87, 95%CI:1.03-4.71; WMD=0.04, 95%CI:0.02-0.05). The time of postoperative bowel ventilation in the study group was significantly shorter than that in the control group(WMD=4.10, 95%CI:-5.38--2.82). The postoperative complication rate in the study group was significantly lower as compared to the control group(RR=0.64, 95%CI:0.44-0.93). CONCLUSION: Early enteral nutrition support after gastrointestinal operation is safe and effective, which can improve the nutritional status, promote bowel function return, and reduce postoperative complication rate.

Brain-derived neurotrophic factor inhibits glucose intolerance after cerebral ischemia.

Brain-derived neurotrophic factor is associated with the insulin signaling pathway and glucose tabolism. We hypothesized that expression of brain-derived neurotrophic factor and its receptor may be involved in glucose intolerance following ischemic stress. To verify this hypothesis, this study aimed to observe the changes in brain-derived neurotrophic factor and tyrosine kinase B receptor expression in glucose metabolism-associated regions following cerebral ischemic stress in mice. At day 1 after middle cerebral artery occlusion, the expression levels of brain-derived neurotrophic factor were significantly decreased in the ischemic cortex, hypothalamus, liver, skeletal muscle, and pancreas. The expression levels of tyrosine kinase B receptor were decreased in the hypothalamus and liver, and increased in the skeletal muscle and pancreas, but remained unchanged in the cortex. Intrahypothalamic administration of brain-derived neurotrophic factor (40 ng) suppressed the decrease in insulin receptor and tyrosine-phosphorylated insulin receptor expression in the liver and skeletal muscle, and inhibited the overexpression of gluconeogenesis-associated phosphoenolpyruvate carboxykinase and glucose-6-phosphatase in the liver of cerebral ischemic mice. However, serum insulin levels remained unchanged. Our experimental findings indicate that brain-derived neurotrophic factor can promote glucose metabolism, reduce gluconeogenesis, and decrease blood glucose levels after cerebral ischemic stress. The low expression of brain-derived neurotrophic factor following cerebral ischemia may be involved in the development of glucose intolerance.

[Development and interpretation of China medical nutrition therapy guideline for diabetes (2010)].

Nutritional therapy is the basis for all types of diabetes treatment, but has not been properly applied due to the lack of scientific criteria. In 2010, the China Medical Nutrition Therapy Guideline for Diabetes was successfully developed based on the up-to-dated scientific research evidences (especially those from China) using Oxford Centre for Evidence-Based Medicine grading system. These guidelines cover the nutrition-based prevention and treatment of diabetes and its complication as well as the parenteral and enteral nutritional supports, with an attempt to improve the quality of life and lower the burdens of diabetes and its complications.

Effects of moxibustion at shenque (CV 8) on serum IL-12 level and NK cell activities in mice with transplanted tumor.

The study was to investigate the effect of moxibustion on the serum IL-2, IL-12 levels and NK cell and ascitic tumor cell activities in H-22 mice with tumor and its mechanisms. The method used in the study was that the IL-2 and IL-12 levels were determined by the double antibody method with ELISA, and the NK cell activities by the MTT measure. The results showed that moxibustion elevated the serum IL-2 and IL-12 levels and the NK cell activities of the mice with tumor, and the elevations were of significance as compared with the controls (P < 0.05). It is concluded that moxibustion can inhibit the growth of tumor, which is related to the increase of the serum IL-2 and IL-12 levels and the strengthening of NK cell activities.