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Clinical nutrition, enteral and parenteral nutrition

Preoperative immunonutrition in patients at nutritional risk: results of a double-blinded randomized clinical trial



To evaluate the impact of preoperative immunonutrition (IN) on postoperative morbidity in patients at risk of malnutrition undergoing major gastrointestinal (GI) surgery.


The combination of malnutrition and major GI surgery entails high morbidity. The Nutritional Risk Score (NRS) reliably identifies patients who need preoperative nutrition; the optimal nutritional formula for these patients still needs to be defined. In all, 152 patients with a NRS3 and undergoing elective major GI surgery were randomized between IN or isocaloric-isonitrogenous nutrition (ICN) given for 5 days preoperatively. Patients and caregivers were blinded for the allocated intervention. Thirty days complication rate was the primary endpoint. Infections, length of hospital stay and compliance were considered as secondary outcomes.


Overall, 145 patients were available for analysis; the 73 patients in the IN group matched well with the 72 ICN patients with regards to patient's and surgical characteristics. In all, 39 IN and 33 ICN patients experienced a total of 48 and 50 postoperative complications, respectively (P=0.723). Both groups did not differ significantly concerning infectious (13 vs 9) complications. Independent risk factors for overall complications were malignant disease (odds ratio (OR)=4.304; confidence interval (CI) 1.317–14.002) and operative time (OR=1.004; CI 1.000–1.008).


In patients at nutritional risk, complications, infections and hospital stay after major GI surgery were comparable regardless of preoperative supplementation with IN or ICN.

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Sven Müller and Michel Roulet participated in the study design. Giustina Mariotti was the departmental study nurse responsible for data collection and management. Finally, we acknowledge all surgical residents, staff surgeons and nutritionists who were implicated in patients’ recruitment and follow-up. This study was supported by a research grant from Novartis Consumer Health Schweiz AG (Protocol SC-IMP.O-07-06–CH).


During the study period, the nutrition branch of Novartis was incorporated into Nestlé Nutrition. The investigators had full control of the data and performed statistical analysis.

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Correspondence to N Demartines.

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Hübner, M., Cerantola, Y., Grass, F. et al. Preoperative immunonutrition in patients at nutritional risk: results of a double-blinded randomized clinical trial. Eur J Clin Nutr 66, 850–855 (2012).

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  • abdominal surgery
  • immunonutrition
  • complications
  • compliance

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