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This is the seventh issue of TOP NUTRITION NEWSLETTER in 1998.In this issue, immunonutrition is updated and the latest issue on this new topic is presented.

The immune system is designed to protect the individual from foreign substances or organisms. It is expressed as cellular and humoral immunity. The former is dependent upon T lymphocytes and the latter on B lymphocytes, which become plasma cells and secrete antibodies. The immune system can be influenced by protein-energy malnutrition (PEM) and by catabolic illnesses such as sepsis and trauma, which in turn cause PEM. Specific trace element and vitamin deficiencies can also alter the immune state. However, overnutrition and obesity can also influence immune mechanisms. Obesity can promote the development of diabetes, which can alter the immune state. Finally, immunity becomes less effective with ageing and this process is enhanced by associated malnutrition.Immunonutrition is searched at the MEDLINE and the abstracts are presented to update your knowledge on this issue.

"Advances in Metabolic and Nutritional Support in Trauma and Sepsis" in June 1998 issue of Nutrition is the advanced metabolic support in trauma and sepsis. There is increasing evidence that delivery of nutrients via the gastrointestinal tract reduces the septic morbidity in severely injured patients. The article of early enteral nutrition insurgical patients reviews the most current data and also reviews the importance of the gut-associated Iymphoid tissue as an important factor in maintaining the host defenses. Although brief periods of starvation and catabolism are tolerable in otherwise healthy individuals, protracted nutritional deprivation can manifest as immunocomproniise, irreversible organ injury, and late mortality. Moreover, patients with severe injuries or preexisting illnesses who exhibit exaggerated inflammatory responses may be further predisposed to such deleterious consequences following the insult. The optimal supply of appropriate nutrients and substrates in such circumstances has often been championed as a necessary means of restoring proper cellular metabolism, wound healing, immune competence, and proper organ function. However, much debate surrounds the present efficacy of nutritional therapy in modulating the immune response associated with injury and stress.

Patients in the ICU are one of the groups, together with GI patients, short bowel patients, oncological patients, who are most likely to benefit from nutrition intervention. Clinical studies with glutamine, one of immunonutrients, showed beneficial effects on whole-body protein metabolism, and immune function. Glutamine-containing amino acid solutions are presently available in European countries at a comparatively low cost. The patients who are likely to benefit from this advantage must be identified. The leading article by Dr. Wernerman, "Glutamine-containing TPN: a question of life and death for ICU patients" is worth reading in this time.

The influence of an enteral diet supplemented with immunonutrients on the incidence of systemic inflammatory response syndrome (SIRS) and multiple organ failure (MOF) in patients after severe trauma. Although this randomized control study resulted in no significant difference in T-lymphocyte, CD4/CD8 ratio, IL-2 receptor expression, infection rate, mortality and hospital stay, the beneficial effects of immunonutrition was observed in critically ill patients. What are the beneficial effects of enteral immunonutrition in this February 1998 isuue of Nutrition entitled "Influence of arginine, omega-3 fatty acids and nucleotide-supplemented enteral support on SIRS and MOF in patients after severe trauma".

Wish you will enjoy updated information. I will try to update this important issue whenever I can. The information era is not "NO INFORMATION, BUT TOO MUCH INFORMATION". I have selected only the most reliable sources for you. If you have different opinions, please do not hesitate to e-mail [shwewin@thai-otsuka.co.th].