Efeito da suplementação de glutamina e ácido graxo ômega-3 ao suporte nutricional enteral pré-operatório dos pacientes submetidos à esofagectomia

Abstract

The method of choice for the treatment of advanced megaesophagus is esophagectomy, which results in acute inflammatory response mediated by pro-inflammatory cytokines. The implementation of nutritional therapy with immunonutrients can modulate the immune response and consequently the acute phase response. The present study compared The present study compared the variables of body composition, hematological data and serum concentration of albumin and cytokines in the preoperative and postoperative periods of patients with advanced megaesophagus submitted to esophagectomy after supplemented enteral nutritional therapy of glutamine and omega-3 fatty acid. A prospective study was conducted, which evaluated 20 patients in five moments, called M1, M2, M3, M4 and M5. M1 was characterized by the initial evaluation, M2 one day before surgery and M3, M4 and M5, on the fifth, seventh and ninth postoperative day, respectively. The nutritional evaluation was performed in M1, M2 and M4, and the collection of blood samples in M1, M2, M3 and M5. Weight and body mass index did not show significant changes at any time. Fat-free mass, skeletal muscle mass, intracellular and extracellular water, total body water and the extracellular water ratio by total body water increased significantly in M4, while the water ratio and fat mass reduced significantly in M2. The fat mass also reduced in the M4, as well as the phase angle. There was a significant increase in leukocytes in M5, decrease in lymphocytes in M3 and increase in neutrophils in the same period. Albumin reduced significantly in M2, M3 and M5. IL-1β, IL-8, IL-10 and TNF-α showed values below the detection limit of the ELISA. For IL-6, no significant difference was observed between the moments. The water retention characteristic of the acute phase response interfered in the analysis of the variables of body composition and serum albumin concentration. ELISA, a method used to evaluate the serum concentration of cytokines may not have been the best for quantification of serum levels, since only IL-6 presented values above the limit of detection. Therefore, under the conditions employed in this study, the supplemental nutritional therapy of glutamine and omega-3 fatty acid does not seem to contribute to improve the data analyzed.