Nutrient modification of inflammatory mediator production.

Recent evidence suggests that dietary manipulations may influence the production of endogenous inflammatory mediators. Hence, nutritional modulation during critical illness may affect survival through mechanisms far more complex than the maintenance of mere caloric and nitrogen balance. Provision of nutrients through parenteral routes to normal volunteers promotes an exaggerated cytokine response after an endotoxin challenge. Similarly, alterations in the specific protein, lipid, and micronutrient intake in septic animal models can dramatically influence the elaboration of inflammatory mediators generated by septic stimuli. However, unlike clinical work examining the differential outcome of parenterally and enterally fed patients, the theoretical advantages of specific amino acid or lipid modulation await confirmation by controlled human investigation and clinical trials.