Antioxidant requirements of endurance athletes: implications for health

This review discusses studies investigating the effects of antioxidant supplementation on exercise-induced oxidative stress with a focus on the health implications. The aim is to determine antioxidant requirements for endurance athletes. Overall, differences in methodology make it difficult to compare the relatively small number of published studies on this topic. The types of studies needed to more adequately assess the health effects of antioxidant supplements in athletes (long-term interventions with hard end points) have not been done. Therefore, there is currently insufficient evidence to recommend antioxidant supplements for endurance athletes.     

Effects of Enteral Immunonutrition on the Maintenance of Gut Barrier Function and Immune Function in Pigs With Severe Acute Pancreatitis

Background: This study evaluated the effects of enteral immunonutrition (EIN) supplemented with glutamine, arginine, and probiotics on gut barrier function and immune function in pigs with severe acute pancreatitis (SAP). Methods: The model was induced by retrograde injection of 5% sodium taurocholate and trypsin via the pancreatic duct. After induction of SAP, 18 pigs were randomly divided into 3 groups, in which either parenteral nutrition (PN), control enteral nutrition (CEN), or EIN was applied for 8 days. Serum and pancreatic fluid amylase concentration was determined. Intestinal permeability (lactulose to mannitol ratio) was measured by high‐performance liquid chromatography, and plasma endotoxin was quantified by the chromogenic limulus amebocyte lysate technique. Samples of venous blood and organs were cultured using standard techniques. Pancreatitis severity and villi of ileum were scored according to histopathologic grading. Plasma T‐lymphocyte subsets were measured by flow cytometry, and immunoglobulins (Igs) were determined via enzyme‐linked immunosorbent assay. Results: There were no significant differences in serum and pancreatic fluid amylases concentrations or in pancreatitis severity between any 2 of the 3 groups. Compared with PN and CEN, EIN significantly decreased intestinal permeability, plasma endotoxin concentration, and the incidence and magnitudes of bacterial translocation, but increased ileal mucosal thickness, villous height, crypt depth, and percentage of normal intestinal villi. Significant differences were found in CD3⁺, CD4⁺ lymphocyte subsets, the ratio of CD4⁺: CD8⁺ lymphocyte subsets, and serum IgA and IgG, but not IgM, between any 2 of the 3 groups. Conclusions: EIN maintained gut barrier function and immune function in pigs with SAP.     

Efficacy of Early Enteral Immunonutrition on Immune Function and Clinical Outcome for Postoperative Patients With Gastrointestinal Cancer

Background: Nutrition support is crucial for patients with gastrointestinal (GI) cancer after the operation. However, the controversy over the application of parenteral nutrition (PN) and early enteral immunonutrition (EEIN) has no determinate conclusion. Materials and Methods: We compared the effects of PN and EEIN on the postoperative nutrition condition, immune status, inflammation level, long‐term survival, and quality of life of the patients with GI cancer. Seventy‐eight patients were randomly divided into the PN group (n = 44) or EEIN group (n = 34). After an 8‐day nutrition treatment, clinical and immunological parameters were evaluated. Results: The EEIN group had a significantly shorter hospital stay and higher body mass index level on postoperative day 30 than those in the PN group (P < .05). However, total hospital cost and incidences of short‐term postoperative complications had no significant difference (P > .05). The percentages of CD4⁺, natural killer, and natural killer T lymphocyte cells and the ratio of CD4⁺/CD8⁺ in peripheral blood were significantly increased. Compared with the PN group, the EEIN group had a higher expression of activated cell surface markers such as CD27 and CD28. In addition, the secretion of interleukin (IL)–2 and interferon‐γ was significantly higher, and the secretion of tumor necrosis factor–α and IL‐10 was lower. Complication‐free survival in the EEIN group were longer than those in the PN group (P = .04). Conclusion: EEIN is superior to PN in improving nutrition status, enhancing immune function, and elevating quality of life.     

Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly

These guidelines were produced at the request of the General Directorate of Health within the scope of the French Nutrition and Health Program (PNNS). They concern the management of malnutrition in elderly persons living at home, in institutional care, or in hospital. They belong to a recent series of studies published by ANAES(1) or HAS. Preceding studies concerned the "Diagnostic assessment of protein-energy malnutrition in hospitalized adults" (ANAES, September 2003) and the work conducted by the Committee for the Assessment of Devices and Health Technologies (CEPP) on "Reimbursement procedures for dietary foods for special medical purposes for nutritional supplementation and home enteral nutrition" (HAS, September 2006). The objective of these guidelines is to develop a tool for identifying and managing elderly subjects who are malnourished or at risk of malnutrition.     

Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis

ObjectivesThe aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function.DesignSystematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197).Setting and ParticipantsRandomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions.MethodsOvid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values).ResultsWe included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21?1.42, I² = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70?2.34, I² = 6%), and gait speed (n = 4, standard weighted mean difference ?1.06, 95% CI -1.87 to ?0.25, I² = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index.Conclusions and ImplicationsOur systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.     

Immunonutrition in gastric cancer surgical patients

The aim of this study was to evaluate the potential advantages of perioperative versus postoperative administration of an enteral immune-enhancing diet on host defense and protein metabolism. Thirty subjects, candidates for gastrectomy for cancer, were randomly allocated into two groups. The first group (n = 15) received an enteral formula enriched with arginine, ω-3 fatty acids, and RNA 7 d before and 7 d after surgery; the second group (n = 15) received the same diet but only 7 d after surgery. Postoperative immune and inflammatory responses were investigated by phagocytosis ability of polymorphonuclear cells, interleukin-2 receptors (IL-2R), lymphocyte subsets, interleukin-6 (IL-6), and delayed hypersensitivity response (DHR). Prealbumin (PA), retinol binding protein, albumin, and transferrin were determined as protein synthesis indicators. Perioperative immunonutrition prevented the early postoperative impairment of phagocytosis, DHR, total number of lymphocytes, and CD4/CD8 ratio (P < 0.05 versus postoperative group). The IL-2R levels were significantly higher in the perioperative group (P < 0.05 versus postoperative on postoperative day [POD] 4 and 8). Perioperative group also showed lower levels of IL-6 (P < 0.05 versus postoperative on POD 1, 4, and 8) and higher levels of PA (P = 0.04 versus postoperative on POD 8). The perioperative administration of immunonutrition ameliorated the host defense mechanisms, controlled the inflammatory response, and improved the synthesis of short half-life constitutive proteins.     

Effects of Hydrolyzed Whey versus Other Whey Protein Supplements on the Physiological Response to 8 Weeks of Resistance Exercise in College-Aged Males

Objective: The objective of this study was to compare the chronic effects of different whey protein forms on body composition and performance when supplemented with resistance training.

Methods: Resistance-trained men (N = 56, 21.4 ± 0.4 years, 79.5 ± 1.0 kg) participated in an 8-week resistance training regimen (2 upper-body sessions and 2 lower-body sessions per week) and received one of 4 double-blinded treatments: 30 g/serving carbohydrate placebo (PLA) or 30 g/serving protein from either (a) 80% whey protein concentrate (WPC), (b) high-lactoferrin-containing WPC (WPC-L), or (c) extensively hydrolyzed WPC (WPH). All subjects consumed 2 servings of treatment per day; specifically, once immediately before and after training and between meals on nontraining days. Blood collection, one repetition maximum (1RM) testing for bench press and hack squat, and body composition assessment using dual-energy x-ray absorptiometry (DXA) occurred prior to training and 48 hours following the last training session.

Results: Total body skeletal muscle mass increased in all groups (p < 0.0125). There were similar between-group increases in upper-body (4%–7%, analysis of covariance [ANCOVA] interaction p = 0.73) and lower-body (24%–35%, ANCOVA interaction p = 0.85) 1RM strength following the intervention. Remarkably, WPH reduced fat mass (?6%), which was significantly different from PLA (+4.4%, p < 0.0125). No time or between-group differences were present for serum markers of health, metabolism, or muscle damage, with the exception of blood urea nitrogen being significantly lower for WPH than WPC (p < 0.05) following the intervention.

Conclusions: WPH may augment fat loss but did not provide any other advantages when used in combination with resistance training. More mechanistic research is needed to examine how WPH affects adipose tissue physiology.     

围手术期肠内免疫营养对肝硬化大鼠肝切除术后机能的影响

目的探讨肝硬化大鼠行大部分肝切除术时围手术期合理充分的营养支持方案。方法将48只肝硬化大鼠随机分为标准肠内营养组（A组，n=24）和肠内免疫营养组（B组，n=24），根据标本采集时间的不同，各组再分为术前，术后1、4和8天4个亚组，每组6只。两组大鼠分别用等热量的标准肠内营养剂和肠内免疫营养剂喂养8天后行68％肝切除术．术后再喂养至取标本。分别于术前、术后第1、4和8天取相应亚组大鼠血和肝组织标本．检测T淋巴细胞亚群、血清IgG、血清IL-6和增殖细胞核抗原阳性肝细胞计数。结果B组术后第1天CD3、CD4、CD4／CD8和IgG的值，术后第4天CD4、CD4／CD8和IgG的值，术后第8天CD4／CD8和IgG的值均显著高于A组（P〈0．051；B组术后第1、4天IL-6值显著低于A组（P〈0．05）。两组大鼠术后残肝有一定再生能力，B组增殖细胞核抗原阳性肝细胞计数在术后第4和8天显著高于A组（P〈0．05）。结论围手术期肠内免疫营养支持能减轻肝硬化大鼠肝切除术后免疫抑制。增强术后免疫功能，下调术后过度的急性炎症反应，还能增强残肝再生能力，使肝再生在术后较长时间内保持高水平。     

肠内营养制剂IMPACT对创伤大鼠免疫功能的影响

目的：旨在观察含有免疫促进作用营养物质（精氨酸、鱼油及核苷酸）的肠道营养制剂ＩＭ－ＰＡＣＴ对创伤后免疫抑制机体的免疫调节作用。方法：用双侧股骨骨折的创伤大鼠２１只,随机分为ＥＮＳＵＲＥ组、ＮＵＴＲＩＳＯＮ组和ＩＭＰＡＣＴ组进行肠道营养支持。肠道营养用量为８３７ｋＪ（２００ｋｃａｌ）／（ｋｇ·ｄ）,以灌胃的方法提供营养,共５天。实验前后观察体重、血常规、血白蛋白、外周血Ｔ淋巴细胞亚群分类和脾光镜标本的定量分析。结果：创伤后三组大鼠体重及血清白蛋白均下降,接受肠内营养ＩＭＰＡＣＴ组大鼠的免疫功能指标较其他两组有明显增强。结论：含有免疫促进作用营养物质的肠内营养制剂,可改善创伤后机体受抑制状态的免疫功能。     

The Effects of Fortetropin Supplementation on Body Composition,Strength, and Power in Humans and Mechanism of Action in a Rodent Model

Objective: The purpose of this study was to investigate the effects of Fortetropin on skeletal muscle growth and strength in resistance-trained individuals and to investigate the anabolic and catabolic signaling effects using human and rodent models.

Methods: In the rodent model, male Wistar rats (250 g) were gavage fed with either 1.2 ml of tap water control (CTL) or 0.26 g Fortetropin for 8 days. Then rats participated in a unilateral plantarflexion exercise bout. Nonexercised and exercised limbs were harvested at 180 minutes following and analyzed for gene and protein expression relative to mammalian target of rapamycin (mTOR) and ubiquitin signaling. For the human model, 45 (of whom 37 completed the study), resistance-trained college-aged males were divided equally into 3 groups receiving a placebo macronutrient matched control, 6.6 or 19.8 g of Fortetropin supplementation during 12 weeks of resistance training. Lean mass, muscle thickness, and lower and upper body strength were measured before and after 12 weeks of training.

Results: The human study results indicated a Group × Time effect (p ≤ 0.05) for lean mass in which the 6.6 g (+1.7 kg) and 19.8 g (+1.68 kg) but not placebo (+0.6 kg) groups increased lean mass. Similarly, there was a Group × Time effect for muscle thickness (p ≤ 0.05), which increased in the experimental groups only. All groups increased equally in bench press and leg press strength. In the rodent model, a main effect for exercise (p ≤ 0.05) in which the control plus exercise but not Fortetropin plus exercise increased both ubiquitin monomer protein expression and polyubiquitination. mTOR signaling was elevated to a greater extent in the Fortetropin exercising conditions as indicated by greater phosphorylation status of 4EBP1, rp6, and p70S6K for both exercising conditions.

Conclusions: Fortetropin supplementation increases lean body mass (LBM) and decreases markers of protein breakdown while simultaneously increasing mTOR signaling.     

Immunonutrition in High‐Risk Surgical Patients

Background: Immunomodulating diets (IMDs) have been demonstrated to improve immune function and modulate inflammation. However, the clinical benefit of these diets in patients undergoing elective surgery is controversial. The goal of this meta‐analysis was to determine the impact of IMDs on the clinical outcomes of high‐risk patients undergoing elective surgery. Methods: The review included prospective, controlled, clinical trials that compared the clinical outcome of elective surgical patients who were randomized to receive an IMD or a control enteral diet. Studies were stratified according to the type of IMD and the timing of the initiation of the IMD. Data were abstracted on study design, study size, patient population, and IMD used. The outcomes of interest were the acquisition of new infections, wound complications, length of hospital stay (LOS), and mortality. Meta‐analytic techniques were used to analyze the data. Results: Twenty‐one relevant studies were identified, which included a total of 1918 patients. Immunonutrition significantly reduced the risk of acquired infections, wound complications, and LOS. The mortality rate was 1% in both groups. The treatment effect was similar regardless of the timing of the commencement of the IMD. The benefits of immunonutrition required both arginine and fish oil. Conclusions: An immunomodulating enteral diet containing increased amounts of both arginine and fish oil should be considered in all high‐risk patients undergoing major surgery. Although the optimal timing cannot be determined from this study, it is suggested that immunonutrition be initiated preoperatively when feasible.     

Influence of low versus moderate glycemic index of diet on substrate oxidation and energy expenditure during incremental exercise in endurance athletes: a randomized counterbalanced cross-over trial

The study was aimed at assessing the influence of 3-week low glycemic index (LGI) versus moderate glycemic index (MGI) diet on substrate oxidation during incremental exercise. 17 runners completed two 3-week trials of either LGI or MGI diet in a randomised counterbalanced manner. Before and after each trial the incremental cycling test was performed. Metabolic alternations were observed only within tested diets and no significant differences in fat and carbohydrate (CHO) oxidation were found between MGI and LGI diets. Following MGI diet CHO oxidation rate increased. The AUC of fat oxidation decreased after both diets. Percent contribution of fat to energy yield declined, whereas contribution of CHO was augmented following MGI diet. This study indicates that the 3-week MGI diet increased the rate of carbohydrate oxidation during incremental cycling test and improved performance in acute intense exercise test, while both high-carbohydrate diets downregulated fat oxidation rate.     

危重症病人营养支持对免疫功能影响的临床研究

目的:探讨肠外 肠内营养(PN EN)与全肠外营养(TPN)支持,对危重症病人免疫功能的影响.方法:将40例危重症病人按就诊顺序分为两组,每组20例.试验组接受PN EN,对照组接受TPN,两组等氮、等热量供给.于治疗前、后检测血浆总蛋白、清蛋白、血红蛋白和转铁蛋白浓度,外周血IgA、IgG、IgM、淋巴细胞总数(TLC)及T细胞亚群CD3、CD4百分率和CD4/CD8比值.结果:试验组TLC和IgG与对照组相比,差异有显著性意义(P＜0.05);CD4和CD4/CD8比值也有升高(P＜0.05);其余指标无明显差异(P＞0.05).结论:PN EN较TPN更能改善危重症病人的免疫功能.     

No Clinical or Biochemical Evidence for Essential Fatty Acid Deficiency in Home Patients Who Depend on Long‐Term Mixed Olive Oil– and Soybean Oil–Based Parenteral Nutrition

Background: Home parenteral nutrition (HPN) patients depend on lipid emulsions as part of their parenteral nutrition regimen to provide essential fatty acids (EFAs). Mixed‐oil sources are used in modern lipid emulsions to decrease the amount of proinflammatory EFAs, mainly linoleic acid, which is present in large amounts in soybean oil. It is unknown whether patients who fully depend on such mixed lipids have adequate EFA supply. We therefore evaluated whether HPN patients who depend on mixed olive oil– and soybean oil–based HPN show clinical or biochemical evidence of EFA deficiency. Materials and Methods: Fatty acid status was assessed in plasma phosphatidylcholine (PC) and peripheral blood mononuclear cells from 30 patients receiving mixed olive oil– and soybean oil–based HPN (>3 months, ≥5 times per week) and 30 healthy controls. Innate immune cell functions were evaluated by assessing expression of surface membrane molecules, and reactive oxygen species, and cytokine production. Results: None of the patients or controls showed clinical evidence (skin rash) or biochemical evidence (increased Holman index [>0.2]) for EFA deficiency. The Holman index in plasma PC (median [25th–75th percentile]) was significantly higher in patients (0.019 [0.015–0.028]) compared with controls (0.015 [0.011–0.017]). No differences were found in innate immune cell functions between groups, except for a 3.6‐fold higher tumor necrosis factor–α production in patients. Conclusion: We found no clinical or biochemical evidence that HPN patients who fully and long‐term depend on mixed olive oil– and soybean oil–based lipids have an increased risk for EFA deficiency.     

肠内营养对获得性免疫缺陷综合征患者T淋巴细胞免疫功能的影响

目的 研究肠内营养对获得性免疫缺陷综合征(AIDS)患者T淋巴细胞免疫功能的影响.方法 采用随机数字法将79例AIDS患者随机分为两组:(1)对照组(n=33):仅给予常规治疗;(2)肠内营养(EN)组(n=46):在常规治疗的基础上,每日给予EN.于试验前和试验第30天,分别测定两组患者的CD3、CD4、CD8细胞计数.结果 试验前,两组患者的血糖及血丙氨酸转氨酶、天冬氨酸转氨酶、总蛋白(TP)、白蛋白(ALB)和尿素氮、肌酐、前白蛋白(PA)水平间差异均无统计学意义(P均＞0.05);试验第30天,EN组患者的血TP(P=0.015)、ALB(P=0.007)和PA(P=0.022)水平明显高于对照组.对照组试验前与试验第30天的CD3、CD4、CD8细胞计数间差异均无统计学意义(P均＞0.05),EN组患者试验第30天的CD4细胞计数明显高于试验前(P=0.012).结论 EN支持可改善AIDS患者的营养状况和T淋巴细胞免疫功能.

Abstract：

Objective To investigate the effect of enteral nutrition (EN) on the T lymphocytes-mediated immune function in patients with acquired immune deficiency syndrome (AIDS). Methods Totally 79 AIDS patients were randomly divided into enteral nutrition ( EN ) group ( supported with EN daily in addition to conventional treatment; n = 46) and control group (underwent conventional treatment only; n = 33 ). T lymphocytes including CD3, CD4, and CD8 cells as well as blood biochemical parameters including alanine aminotransferase ( ALT), aspartate aminotransferase (AST), glucose ( Glu ), total protein (TP), albumin ( ALB ), blood urea nitrogen (BUN) , Cr, and prealbumin (PA) were determined immediately before management (T0) and on the 30th day(T1). Results ALT, AST, Glu, TP, ALB, BUN, Cr, and PA showed no significant differences between these two groups before management ( all P ＞ 0. 05 ). The levels of TP ( P = 0. 015), ALB ( P = 0. 007 ), and PA ( P =0. 022 ) were significantly higher in EN group than those in control group at T1. The cell counts of CD3, CD4, and CD8 were not significantly different at T0, while the cell count of CD4 was significantly higher in EN group than that in control group at T1 ( P ＜ 0. 05 ). Conclusion EN can improve the nutritional status and T lymphocytesmediated immune function in AIDS patients.     

老年患者胰十二指肠切除术后不同营养支持方法对肝功能和临床结局的影响

目的比较胰十二指肠切除术后老年患者肠外营养（PN）联合肠内营养（EN）与单纯PN对术后内毒素血症、肝功能与临床结局的影响。方法回顾性总结我院不同时段接受胰十二指肠切除术老年患者共48例,其中术后接受PN联合EN营养支持的患者25例为研究组（PN＋EN组）,单纯给予PN营养支持的患者23例为对照组（PN组）。记录其一般资料、比较术后内毒素水平和肝功能变化,以及临床结局（死亡率、并发症、术后住院日和总住院费用等）。结果两组内毒素水平术后1d较术前均有升高趋势,但组间比较差异无统计学意义（P〉0．05）,后随时间逐渐下降,其中术后7和14d分别与术后1d的差值比较,PN＋EN组的下降幅度显著大于PN组（P〈0．01）;两组谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素值术后1d较术前均有升高趋势,但组间比较差异无统计学意义（P〉0．05）,术后逐渐下降,术后14d与术后1d的差值PN＋EN组下降幅度显著高于PN组（P〈0．05）;PN＋EN组感染并发症（2／25,8．0％）显著低于PN组（6／23,26．0％,P〈0．05）;总并发症发生率、术后住院日、总住院费用两组差异无统计学意义（P〉0．05）。结论老年患者胰十二指肠切除术后PN联合EN可降低内毒素血症、改善肝功能、减少术后感染并发症。     

The Effects of Nitrate-Rich Supplementation on Neuromuscular Efficiency during Heavy Resistance Exercise

Objective: Nitrate-rich (NR) supplements can enhance exercise performance by improving neuromuscular function and the aerobic cost of exercise. However, little is known about the effects of nitrate on dynamic, multijoint resistance exercise.

Methods: Fourteen resistance-trained men (age, 21.1 ± 0.9 years; height, 173.2 ± 2.9 cm: body mass, 77.6 ± 4.3 kg; squat one-repetition maximum [1RM], 127.5 ± 18.8 kg) participated in a randomized, double-blind, crossover experiment. Subjects consumed an NR or nitrate-poor (NP) supplement for 3 days, performed a bout of heavy resistance exercise, completed a washout, and then repeated the procedures with the remaining supplement. Before, during, and after exercise, individual and gross motor unit efficiency was assessed during isometric and dynamic muscle contractions. In addition, we compared physical performance, heart rate, lactate, and oxygen consumption (VO₂).

Results: Nitrate-rich supplementation resulted in lower initial muscle firing rates at rest and lower mean and maximum firing rates over the course of fatiguing exercise. Nitrate-poor supplementation was accompanied by increased mean and maximum firing rates by the end of exercise and lower initial firing rates. In addition, NR supplementation resulted in higher mean peak electromyography (EMG) amplitudes. Heart rate, lactate, and physical performance did not differ by treatment, but oxygen consumption increased more frequently when the NP supplement was consumed.

Conclusion: Supplementation with an NR beetroot extract–based supplement provided neuromuscular advantages during metabolically taxing resistance exercise.     

谷氨酰胺对危重患者免疫功能影响的随机对照研究

目的探讨危重患者补充谷氨酰胺(Gln)的肠外营养和标准肠外营养比较能否改善免疫功能。方法将60例外科危重患者随机分为实验组和对照组,每组30例,其中实验组由于Gln应用时间不够以及病情变化突然死亡等原因剔除5例。实验组给予强化Gln的全肠外营养支持,对照组为标准全肠外营养支持,两组等热等氮供给。检测治疗前、后血浆总蛋白、白蛋白、血红蛋白浓度,外周血IgA、IgG、IgM、总淋巴细胞数及T细胞亚群CD3、CD4百分率及CD4/CD8比值。结果实验组的总淋巴细胞数、IgG、CD4百分率和CD4/CD8比值均高于营养支持前及对照组(P<0.05)。结论强化Gln的肠外营养支持能改善外科危重患者机体的免疫功能,促进患者的康复,为危重患者有效的营养支持治疗提供临床研究依据。