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Sains Malaysiana
49(3)(2020): 625-634 http://dx.doi.org/10.17576/jsm-2020-4903-17
A Systematic Review on the
Effectiveness of Enteral Immunonutrition (EIN) on Pre- and Post-Operative
Outcomes in Gastric Cancer Patients (Suatu Ulasan Sistematik tentang Keberkesanan Imunonutrisi Enteral (EIN) kepada Hasil Operatif Pra dan Pos pada Pesakit Kanser Gastrik) RUTH MERRY
PARANJOTHI YANOK1, IKLIL IMAN MOHD SA’ID1,
SHIN HWA CHAU1, KAI YEE SENG1, NIK SHANITA
SAFII1,4 & WEI BOON YAP2,3
1Dietetics Programme, Faculty of Health Sciences, Universiti
Kebangsaan Malaysia, Jalan Raja Abdul Aziz, 50300 Kuala Lumpur,
Federal Territory, Malaysia 2Biomedical Science Program, Faculty of Health Sciences,
Universiti Kebangsaan Malaysia, Jalan Raja Abdul Aziz, 50300 Kuala
Lumpur, Federal Territory, Malaysia 3Center of Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia,
Jalan Raja Abdul Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia 4Center of Community Health, Faculty of Health Sciences,
Universiti Kebangsaan Malaysia, Jalan Raja Abdul Aziz, 50300 Kuala
Lumpur, Federal Territory, Malaysia Diserahkan: 13 Jun 2019/Diterima: 11 November
2019
Abstract Gastric
cancer is one of the most common upper gastrointestinal malignancies.
To date, enteral immunonutrition (EIN) has gained increasing attention
as it is found to effectively enhance the host’s immunity and improve
the metabolic status of gastric cancer patients undergoing gastrectomy.
The health-boosting effects of EIN are believed to originate from
a number of nutritional elements such as omega-3 fatty acids, glutamine,
arginine and nucleic acid precursors that help reduce the incidences
of post-operative complications and shorten the length of hospital
stay among the aforementioned patients. However, little was known
about the consistency of health-boosting benefits conferred by EIN.
Hence, according to PRISMA (Preferred Reporting Items for Systematic
reviews and Meta-Analyses) protocol, this systematic review was
carried out using nine meticulously and specifically selected full-length
articles focusing on the pre- and post-operative effects of EIN
including physical, biochemical, clinical and immunological outcomes
on gastric cancer patients. Among the selected articles, seven of
them focused on post-operative EIN while the remaining two concentrated
on pre-operative EIN. In most of the selected studies, more than
one immunonutritional components (arginine, glutamine, omega-3 fatty
acid, RNA) were integrated. Patients receiving EIN showed significantly
improved immunity, for example, increase in CD4+ T and NK cell counts
that are responsible for fighting pathogens. In addition to that,
individuals receiving EIN also showed increased levels of inflammatory
biomarkers in their sera such as pre-albumin and transferrin. This
results in shorter period of post-operative hospital stay that in
turn permits progressive healing process and increases the survival
rate due to minimal frequency of post-operative infections. Conclusively,
our systematic review acknowledges that regardless of the initiation
timing (pre-operative or post-operative) of immunonutrition, EIN
can improve the overall health status of gastric cancer patients
including infection complications and the length of hospital stay
through regulation of immune responses. Keywords: Arginine; enteral immunonutrition; gastric
cancer; glutamine; omega-3 fatty acids; RNA Abstrak Kanser gastrik adalah
salah satu kanser yang umum di bahagian atas gastroperut. Kini,
imunonutrisi enteral (EIN) semakin mendapat perhatian kerana pendekatan
ini didapati dapat meningkatkan keimunan tubuh badan dan memperkukuh
fungsi metabolik badan bagi pesakit yang menjalani gastrektomi.
Kesan peningkatan kesihatan EIN dipercayai berasal daripada unsur
pemakanan seperti asid lemak omega-3, glutamin, arginin dan prekursor
asid nukleik yang dapat mengurangkan kejadian komplikasi pasca-operasi
dan memendekkan tempoh penginapan di hospital dalam kalangan pesakit
tersebut. Namun, konsistensi manfaat EIN dalam meningkatkan kesihatan
masih kurang perinci. Oleh itu, dengan berpandukan protokol PRISMA
(Preferred Reporting Items for Systematic reviews and Meta-Analyses),
kajian tinjauan sistematik ini telah dijalankan dengan teliti dengan
menggunakan sembilan artikel penuh spesifik yang memfokuskan kesan
pra- dan pasca-operasi EIN yang merangkumi segi fizikal, biokimia,
klinikal dan keimunan dalam kalangan pesakit kanser gastrik. Antara
artikel yang terpilih, tujuh daripadanya tertumpu pada kesan pasca-operasi
EIN manakala dua artikel lagi menumpu pada kesan pra-operasi EIN.
Kebanyakan kajian terpilih menggabungkan lebih daripada sejenis
komponen imunonutrisi (arginina, glutamina, asid lemak omega-3, RNA). Pesakit yang menerima EIN menunjukkan peningkatan
dalam penanda biologi seperti bilangan sel T CD4+ dan NK yang bertanggungjawab
untuk melawan patogen. Tambahan pula, individu yang menerima EIN
juga menunjukkan peningkatan dalam aras serum penanda inflamasi
seperti pra-albumin and transferrin. Hal ini memendekkan tempoh
penginapan pasca-operasi di hospital, seterusnya mempercepat proses
penyembuhan dan meningkatkan kadar kemadirian akibat penurunan kebarangkalian
jangkitan pasca-operasi. Secara konklusi, ulasan sistematik ini
mendapati tanpa kira masa permulaan imunonutrisi (pra-operasi atau
pasca-operasi), EIN dapat menambah baik status kesihatan pasakit
kanser gastrik secara keseluruhan termasuk komplikasi jangkitan
dan tempoh penginapan hospital melalui regulasi tindak balas keimunan.
Kata
kunci: Arginina; asid lemak omega-3; glutamina; imunonutrisi enteral; kanser gastrik; RNA RUJUKAN
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