2023-07-06 15:02:00
“Numerous clinical studies confirm that immunonutrition, i.e. the administration of specific nutritional formulas enriched by certain factors, reduces the risk of post-operative complications and hospitalization times. The guidelines of the European society for clinical nutrition and metabolism also recommend, in malnourished patients undergoing oncological surgery, the peri- or at least post-operative administration of a specific formula enriched with immunonutrients – omega 3 fatty acids, arginine, nucleotides (RNA) and antioxidants – which have demonstrated an effective antioxidant type action in capable of modulating and enhancing the host’s immune response to external stressors”. Thus Luigi Marano, referent for the Young section of Sico (Italian Society of Oncological Surgery) and associate professor of General Surgery at the University of Siena, commenting on the results of a survey – created by the young sections of Aiom, the Italian Medical Oncology Association; Airo, the Italian Association of Radiotherapy and Clinical Oncology and Sico, the Italian Society of Oncological Surgery – which reports that only 38% of patients receive a nutritional evaluation at diagnosis.
“Immunonutrition – continues the expert – is important not only in the peri-operative phase, but throughout the patient’s course, from admission to the hospital to his discharge and also in convalescence. Immunonutrients – he summarizes – reduce the inflammatory state, infectious complications and promote the repair of tissues damaged by surgical stress, with a substantial improvement in postoperative clinical outcomes”. In detail, “arginine – explains Marano – is an amino acid that plays a role in the immune system and is involved in the production of nitric oxide, which is a molecule useful in helping to dilate blood vessels” a condition that “improves the supply of oxygen and nutrients and favors the arrival of immune cells at sites of infection, such as the surgical site. It is also involved – he continues – in the production of cytokines, molecules capable of modulating the immune response”. Furthermore, being an amino acid, “it is a constituent of proteins which are useful for the synthesis of tissues such as collagen” for the reconstruction of tissues damaged by the operation.
Another important immunonutrient is RNA, ribonucleic acid, which is “involved in protein synthesis and in numerous functions of the immune system – continues Marano – It has a pleiotropic activity (more effects, ed) which includes the synthesis of antibodies , fundamental for the defense against pathogens, it can also stimulate the immune response and support it in the context of stressful events due to surgery or antiblastic therapies” against cancer.
“Other marked immunonutrients – adds Marano – are the omega 3 fatty acids. Eicosapentaenoic acid (Epa) and docosahexaenoic acid (Dha) are known because they have exceptional anti-inflammatory properties”. The inflammation induced by surgery can therefore be reduced by the activity of “omega 3 and antioxidants” which, at the same time, “promote faster and more effective healing, with fewer complications”.
Immunonutrition in cancer patients “is not only focused on surgical treatment – underlines the expert – but must also be set in the peri-treatment phase, because the same chemotherapy and radiotherapy are stressorgens, i.e. events that put a strain on the immune system. Immunonutrients are also needed to improve treatment outcomes and, among these, there is the completion of the course of treatment. In fact, it should not be underestimated – he adds – that many malnourished patients are then unable to bear the complete cycle of treatment ”.
In this regard, “I believe that at a technical table in which the entire diagnostic-therapeutic path of an oncological patient is decided – says Marano – a specialist with clinical nutrition skills cannot be missing in order to be able to decide on management, including nutritional and immunonutritional of the patient, to guarantee a supply of precision medicine, before the stressful event – chemo surgery or radiotherapy – for better clinical outcomes, fewer days of hospitalization, reduction of the risk of infection, greater long-term survival and – concludes – lower costs for the health service”.
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