Resposta inflamatória e imune do paciente com câncer gástrico submetido à terapia nutricional enteral e imunomoduladora

Abstract

Supplementation with immunomodulatory diet is recommended preoperatively for major cancer surgery in order to reduce infectious complications and length of stay. The aim of this study was to evaluate the effect of high-protein diet and immunomodulatory diet in nutritional status, inflammatory and immune response in gastric cancer patients in the preoperative and postoperative period.This is a prospective cohort study, with intervention in patients of the National Cancer Institute (INCA). After admission all patients received polymeric high-protein diet to correct protein-calorie intake during the median of 96 days at preoperative period. Five to seven days before surgery, high-protein diet was stopped and started immunomodulatory diet. On admission, after high-protein diet after immunomodulatory diet and postoperatively were collected nutritional parameters such as patient-generated subjective global assessment (PG-SGA), body weight, height, body mass index (BMI), midarm circumference (MC), midarm muscle circumference (MMC), triceps skinfold thickness (TSF), weight loss percentage (% PP), albumin, prealbumin; inflammatory parameters were listed as C-reactive protein (CRP) interleukins 1 and 6 (IL-1, IL-6), tumor necrosis factor-&#61537; (TNF-&#61537;), PCR/albumin ratio and Glasgow Prognostic Score (GPS); of immune parameters were collected: CD4, CD8, and Natural killer cells. In addition, the postoperative outcome within 30 days was observed, as the complications rates and death. Thirty-seven patients were included 59.5% male, 56.8% elderly (&#8805; 60 years), 43.2% eutrophic according PG-SGA and 81.1% with advanced cancer stage, 48.6% underwent total gastrectomy. Overall, 29.4% had complications and 11.8% died. Complications occurred particularly in those patients with higher IL-6 levels, with lower CD4/CD8 ratio and lower protein-calorie intake preoperatively, according t test. Patients who had IL-6 levels above 2,1pg / mL showed an 11.0 times greater risk of developing complications and/or death in the postoperative period, according to logistic regression adjusted for preoperative time (p=0.013; 95% CI = 1.7- 72.8). The presence of death was higher in individuals with CPR/albumin ratio <0.2 (p=0.021) and GPS 1 and 2 (p=0.011), according to chi-square test. We conclude that patients who consumed more than 80% of immunomodulatory diet had higher postoperative CD4, although it was not found reduced complications rate or length of stay. The high protein and immunomodulatory diet was able to maintain the nutritional and immune status of patients with gastric cancer in pre- and postoperative period, but in relation to inflammatory parameters there was no decrease after immunomodulatory diet.