Editor—In my editorial I said that the benefits of immunonutrition identified in meta-analyses are more pronounced in surgical than critically ill patients and that doubts remain about the efficacy of this approach in critically ill patients. I concluded that use of immunonutrition should be approached cautiously in most critically ill patients.
In addition, I highlighted that one trial showed significantly increased mortality in critically ill patients receiving immunonutrition, an effect that was more pronounced in patients with sepsis.1 My statements and conclusions are supported by a recent review of immunonutrition.2 At the time of writing my editorial (November 2002) the interim analysis of the Italian study was not published and so I could not consider it.
On balance, it appears that Knight and I are in agreement that benefits of immunonutrition in the critically ill are not yet realised. I certainly agree that different patients may require different immunonutrients during different stages of critical illness. This is what I alluded to in my conclusion that future efforts should try and define the most effective nutrients and optimal mixes for use in different patient groups.
I do not agree with Knight's statement that probiotics “are also immunonutrients (as defined by Calder).” This is because my definition indicates that immunonutrition involves the use of specific nutrients. Probiotics are not nutrients—they are organisms. However, I recognise that probiotics can modulate immune function and inflammatory processes,3 and I accept that they may have a role in modulating host responses in surgical4 and, perhaps, critically ill patients.
Competing interests: PC has been reimbursed for attending or paid a fee for speaking at conferences by Baxter Clintec, B Braun, Danone, Fresenius, Nestlé, Nuteral, and SHS International and has received research funding from Nutricia.
References
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