Impact of early enteral nutrition on cell mediated immunity versus late enteral nutrition and its relationship with Glucagon Like Peptide-1 in intensive care unit patients

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 824-833-GI Regulatory Peptides
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-829
Melek Eda Ertorer*1, Okan Sefa Bakiner1, Emre Bozkirli1, Semih Giray2, Zulfikar Arlier2, Ilknur Kozanoglu2, Nurzen Sezgin2 and Cagla Sariturk2
1Baskent University School of Medicine, Adana, Turkey, 2Baskent University School of Medicine
Introduction: Glucagon like peptide-1 (GLP-1) originates from gastrointestinal system in response to the presence of nutrition in intestinal lumen and potentiate postprandial insulin secretion. Also, it acts as an immune-modulator which has influences on cell-mediated immunity.

The aim of this study was to inquire impact of early enteral nutrition versus late enteral nutrition on plasma GLP-1 levels and relationship between GLP-1 changes and cell-mediated immunity.

Methods: The study was designed as a prospective, randomized, single-blinded study and carried out in neurology intensive care unit (ICU) of an university hospital. Twenty-four naive patients with acute thromboembolic cerebrovascular event, NIH stroke scores between 12-16 were included. Any condition interfering with GLP-1 and immunity was regarded as exclusion criterion. Two patients died, two were dropped out due to complicating conditions.

  Patients were randomly subjected according to first enteral feeding time: early enteral feeding; within first 24 hours (Group 1), late enteral feeding; beginning 48 hours after admission (Group 2) via nasogastric tube. Blood samples were obtained before, at 5th, 15th, 30th, 60th and 120th minutes of first enteral feeding for GLP-1 assays, procedure was repeated on third day. Before and 24 hours after first enteral feeding, samples were also taken for immunological analysis. Clinical observations were recorded.

Pre-post feeding plasma GLP-1 changes between the two groups and within groups was evaluated. Lymphocyte subgroup changes before and 24 hours after first enteral feeding and relationship to GLP-1 changes  was sought as well.

Results: Group 1 and Group 2 exhibited similar GLP-1 levels in prefeeding and postfeeding periods for both first time and  third day of enteral feeding. Also no significant change in pre-post feeding GLP-1 levels were observed within groups. T-helper and T regulatory cells increased, T-cytotoxic cells decreased significantly in Group 1(p=0.017; p=0.04; p=0.0028), but didn’t change in Group 2 after enteral feeding.  Positive clinical effects in terms of predisposition to infections and  median ICU stay time  were observed in Group 1.

Conclusions: Depending on our findings, we propose that early enteral feeding causes amelioration of cell mediated immunity via factors other than GLP-1 in ICU patients with acute thromboembolic stroke.

Nothing to Disclose: MEE, OSB, EB, SG, ZA, IK, NS, CS

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