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Enriched enteral nutrition did not reduce infections for mechanical ventilation patients
There was no benefit of enteral nutrition enriched with immune-modulating nutrients in improving infectious complications among patients requiring mechanical ventilation, according to data from the MetaPlus study, published in JAMA.
This is in contrast to several smaller studies that reported reductions in infectious morbidity when enteral nutrition was enriched with immune-modulating nutrients.
In addition, the enriched nutrition was associated with a higher mortality rate at 6 months, after adjustment for age and APACHE-II score, according to Arthur R. H. van Zanten, MD, PhD, of the department of intensive care at Gelderse Vallei Hospital in Ede, Netherlands.
Arthur R. H. van Zanten
“The results from the study were unexpected, and do not support the use of high-protein enteral nutrition enriched with immune-modulating nutrients in these patients,” van Zanten told Infectious Disease News. “This investigational feed was a newly designed composition based on previous studies. We are unable to conclude which ingredients may have caused the increased mortality risk, and we are working on post-hoc analyses to evaluate the effect of the individual immune-modulating ingredients on mortality in our patient population.”
The double blind study included 301 adult patients at 14 ICUs who were expected to receive mechanical ventilation and require enteral nutrition for more than 72 hours. The patients were randomly assigned to high-protein enteral nutrition with immune-modulating nutrients (n=152) or standard high-protein enteral nutrition (n=149).
There was no difference in the incidence of new infections between groups: 53% in the group that received nutrition with the immune-modulating nutrients vs. 52% in the standard nutrition group. There were no statistically significant differences between groups, with the exception of a higher 6-month mortality in the subgroup of medical patients who received enriched nutrition: 54% vs. 35% in those who received standard nutrition.
According to van Zanten, a previous study, the REDOXS trial, reported increased mortality in similar patients who were receiving glutamine supplements, which were a component in the experimental feed used in this study. The daily glutamine intake in the REDOXS trial, however, was much greater than the recommended glutamine intake of 0.3 to 0.5 g/kg that was used in the MetaPlus study.
“At present, it is speculative to consider that the negative effects demonstrated in our study are due to the supplementation of glutamine, as other immune-modulating ingredients may also have been responsible for the observed effects,” van Zanten said. “However, it is another new negative study with glutamine. We believe that our study should at least lead to a reevaluation of recommendations on enteral immune-modulating ingredients stated in guidelines, for reasons of lack of efficacy and serious safety concerns.” – by Emily Shafer
Disclosure: van Zanten reports receiving honoraria from Abbott, Baxter, Danone, Fresenius Kabi, Nestle, Novartis and Nutricia.