Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients

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Abstract
Objective: It is known that the immune system is frequently affected in patients with head and neck cancer. Although immune dysfunction could be multifactorial, this immune system may be modulated by specific nutritional substrates, such as arginine. The aim of our study was to evaluate the effect of enteral nutrition supplemented with arginine on c-reactive protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor (TNF) in surgical head and neck cancer patients. Design: Randomized trial. Setting: Tertiary care. Subjects: A population of 36 patients with oral and laryngeal cancer were enrolled. Interventions: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplements with arginine and dietary fibre (group I, n=18); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II, n=18). Perioperatively and on postoperative day 5 the following parameters were evaluated: serum values of prealbumin, transferrin, albumin, total number of lymphocytes, interleukin 6, tumour necrosis factor and c-reactive protein. Results: The mean age was 59.610.9 y (two females/34 males). No significant intergroup differences in the trend of the three plasma proteins and weight were detected. CRP decreased in both groups (group I: 152.976.9 vs 68.982.5 mg/dl; Pvs 43.659.1 mg/dl; Pvs 35.683.4 pg/ml; NS; and group II: 22.840 vs 9.917.7 pg/ml; NS). TNF did not show any differences (group I: 4.61.6 vs 5.11.5 pg/ml; NS; and group II: 8.86.1 vs 5.81.7 pg/ml; NS). Lymphocytes increased in both groups (group I: 1405.6517 vs 1634529106/ml; Pvs 1561541106/ml; P<0.05). Conclusion: Enhanced formula did not change IL6 and TNF levels. Further studies are needed to determine whether route of nutrition or type of formula is the key in these patients.