Studies have shown that arginine deficiency occurs as a result of surgical injury.6 Immunonutrition supplements have varying concentrations Selleck Cabozantinib of these key ingredients and the ideal dosages are not well defined. In fact, the relative dosages of the immune-modulating

ingredients even vary at times from country to country in products made by the same manufacturer. No consensus exists about standard dosages for these ingredients and immunonutrients are frequently included (albeit in lower quantities) in standard oral nutritional supplements (ONS). The role of standard ONS for preoperative nutritional optimization is not well delineated. Standard ONS formulations are typically high in protein and supplemented with vitamins

and minerals. They are inexpensive, widely distributed, and commonly used by patients who desire nutritional supplementation when GSK-3 inhibition recovering from an illness. Data describing the effects of standard ONS in the preoperative period are scarce. Whether the clinical benefits of preoperative IN are substantial when compared with isocaloric and isonitrogenous standard nutritional formulations is an unanswered question. It might be that the benefit of preoperative IN supplementation can be achieved by supplementation with high levels of protein and standard vitamins and minerals, not the additional arginine, fish oil, and other immunonutrients. In the current meta-analysis, we examine the effects of IN vs standard nutritional supplements and vs regular MTMR9 diet with no supplements. Studies of the preoperative provision of ONS identified as IN or immune-modulating as compared with standard oral nutrition formulas or no supplements were reviewed. Only randomized controlled trials (RCTs) with primary comparisons between the nutrition interventions were included. For inclusion, studies should have reported on clinically relevant outcomes pertaining to the postoperative period, namely wound infections, infectious and noninfectious complications, and length of hospital stay. Retrospective studies and those using perioperative IN or parenteral

nutrition were excluded. We conducted a systematic review of the published literature to identify all relevant RCTs that used IN preoperatively. Using text word or MeSH headings containing “randomized,” “blind,” “clinical trial,” “immunonutrition,” “immune modulating,” and “human,” we performed searches for relevant articles on Analytical Abstracts, BIOSIS Previews, Embase, Foodline: SCIENCE, FSTA, MEDLINE, electronic databases Cochrane Controlled Trials Register from 1990 to January 2014. The data were prepared in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses statement7 (Fig. 1). Data extraction and critical appraisal of identified studies were carried out by the authors for compliance with inclusion criteria.