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

• Published in: Critical care (London, England) England), 2013-06, Vol.17 (3), p.R123-R123, Article R123
• Main Authors: Bakiner, Okan, Bozkirli, Emre, Giray, Semih, Arlier, Zulfikar, Kozanoglu, Ilknur, Sezgin, Nurzen, Sariturk, Cagla, Ertorer, Eda
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers - blood; Critical care medicine; Enteral feeding; Enteral Nutrition - methods; Enteral Nutrition - trends; Female; Glucagon; Glucagon-Like Peptide 1 - blood; Health aspects; Humans; Immunity, Cellular - physiology; Intensive Care Units - trends; Male; Methods; Middle Aged; Prospective Studies; Single-Blind Method; Stroke (Disease); Time Factors; Tube feeding
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc12795

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. 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. 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. 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.