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Randomized Controlled Trial
. 2013 Jun 20;17(3):R123.
doi: 10.1186/cc12795.

Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study

Okan Bakiner, Emre Bozkirli, Semih Giray, Zulfikar Arlier, Ilknur Kozanoglu, Nurzen Sezgin, Cagla Sariturk, Eda Ertorer
Randomized Controlled Trial

Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study

Okan Bakiner et al. Crit Care. .

Abstract

Introduction: Glucagon-like peptide-1 (GLP-1) originates from the gastrointestinal system in response to the presence of nutrition in the intestinal lumen and potentiates postprandial insulin secretion. Also, it acts as an immune-modulator which has influences on cell-mediated immunity.

Materials and methods: The study was designed as a prospective, single-blinded study and carried out in the neurology intensive care unit (ICU) of a university hospital. Twenty-four naive patients with acute thromboembolic cerebrovascular events, with National Institute of Health (NIH) stroke scores between 12 and 16, were included. Any condition interfering with GLP-1 and immunity was regarded as exclusion criterion. Two patients died, and two dropped out of the study due to complicating conditions.

Results: Group 1 and Group 2 exhibited similar GLP-1 levels in the pre-feeding and post-feeding periods for both the first time and the third day of enteral feeding. Also, no significant change in pre-/post-feeding GLP-1 levels was observed within groups. T-helper and T-regulatory cells increased, T-cytotoxic cells decreased significantly in Group 1 (P=0.02; P=0.036; P=0.0019), but remained the same in Group 2 after enteral feeding. Positive but statistically insignificant clinical effects in terms of predisposition to infections (10% vs 40%) and median time of ICU stay (10 vs 15 days) were observed in Group 1.

Conclusions: Depending on our findings, we propose that early enteral feeding may cause amelioration in cell-mediated immunity via factors other than GLP-1 in ICU patients with acute thromboembolic stroke. However, the possible deleterious effects of parenteral nutrition cannot be ruled out.

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Figures

Figure 1
Figure 1
A scheme demonstrating the study protocol.
Figure 2
Figure 2
Characterization of T lymphocyte, T-helper, T-cytotoxic and foxP3 expressions. Lymphocytes had been selected from side/forward scatter and CD3, CD3CD4, CD3CD8 cells detected by using sequential gating. CD25+ foxP3+ TREG cells were shown within the CD4+ T cell population.
Figure 3
Figure 3
a. First day pre-feeding GLP-1 and after feeding peak GLP-1 levels (at 15 minutes) in cases (P = 0.85 for Group 1, P = 0.98 for Group 2). b. Third day pre-feeding GLP-1 and after feeding peak GLP-1 levels (at 60 minutes) in cases (P = 0.63 for Group 1, P = 0.28 for Group 2).
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