Abstract
Accumulating experimental evidence has suggested that dietary arginine supplementation enhances immune function in human and animal models. Previous studies have combined the use of arginine, n-3 fatty acids and nucleotides and therefore the specific role of arginine is not known. Objective: To compare the effects of arginine enteral supplementation vs. an isocaloric and isonitrogenous standard diet on the immune and metabolic response and clinical outcome in burn patients. Methods: Controlled, randomized double-blind study. We evaluated 23 children aged 1–5 yrs, 48 hrs after burn injury, type AB or B, with total body surface area (TBSA) burn between 10 and 40%. They were assigned to a study group (SG supplemental arginine: 2% calories, n = 12) and a control group (CG: isocaloric and isonitrogenous standard diet, n = 11), both receiving total enteral nutrition for 14 days. Serial blood samples at day 2, 8, and 15 after burn injury were collected in each patient for determination of lymphoproliferative response (Concanavalina A), plasma interleukin (IL-1,IL-6), tumor necrosis factor-alpha (TNF-alpha), metabolic stress response with C-reactive protein (CRP), prealbumin, albumin, glycemia, and total urinary nitrogen. Clinical course of injury was assessed by hospitalization days. Results: Arginine-supplemented diet was associated to a significant improvement in lymphoproliferative response (Repeat measures analysis of variance ANOVA: p<0.05). In both group, similar significantly increased IL-6 plasmatic levels were detected 48 hrs after burn (SG: 52.8 ± 48.9 pg/mL vs CG 65.8 ± 83.4 pg/mL) and decreased in days after burn without significant difference according to the type of nutrition therapy (Day 15 SG: 5.2 ± 2.7 pg/mL vs Day 15 CG: 7.2 ± 6.6 pg/mL,t test p:NS ). There were no significant differences in the concentrations of C-reactive protein, prealbumin, albumin, glycemia and total urinary nitrogen in both groups. No significant differences in hospitalization days were found between both groups (SG: 21 ± 7.1 days vs CG 24 ± 6.3 days). Both formulas were well tolerated, and no deaths were observed. Conclusions: The specific nutrient substrate, arginine-supplemented diet, improves mitogen-stimulated lymphocyte blastogenesis in burn pediatric patients.
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Marín, B., Rodríguez-Osiac, L., Castillo-Durán, C. et al. Controlled Study of Arginine-Supplemented Diet in Burn Pediatric Patients: Immunological and Metabolic Effect. Pediatr Res 53, 872 (2003). https://doi.org/10.1203/00006450-200305000-00048
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DOI: https://doi.org/10.1203/00006450-200305000-00048