Proceedings of the Nutrition Society

Digestive Disorders Federation Conference

BAPEN and Nutrition Society Symposium: Immuno nutrition & novel substrates

Novel nutritional substrates in surgery

Digestive Disorders Federation 2012 meeting, the first combined meeting of the British Society of Gastroenterology, Association of Upper Gastrointestinal Surgeons, BAPEN and British Association for the Study of the Liver, the Arena Convention Centre, Liverpool, UK. 17–20 June 2012.

Nikki Buijsa1a2, Elisabeth A. Wörnera1, Saskia J. H. Brinkmanna1, Joanna Luttikholda1, Barbara S. van der Meija3, Alexander P. J. Houdijka2 and Paul A. M van Leeuwena1 c1

a1 Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands

a2 Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands

a3 Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands


Pharmaco-nutrients have beneficial effects on protective and immunological mechanisms in patients undergoing surgery, which are important for recovery after injury and in combating infectious agents. The aim of this review article was to outline the potential of the administration of nutritional substrates to surgical patients and the underlying mechanisms that make them particularly important in peri-operative care. Surgery causes a stress response, which has catabolic effects on the body's substrate stores. The amino acid glutamine is a stimulating agent for immune cells. It activates protective mechanisms through its role as a precursor for antioxidants and it improves the barrier function of the gut. Arginine also enhances the function of the immune system, since it is the substrate for T-lymphocytes. Furthermore, n-3 PUFA stabilise surgery-induced hyper-inflammation. Taurine is another substrate that may counteract the negative effects of surgical injury on acid–base balance and osmotic balance. These pharmaco-nutrients rapidly become deficient under the influence of surgical stress. Supplementation of these nutrients in surgical patients may restore their protective and immune-enhancing actions and improve clinical outcome. Moreover, pre-operative fasting is still common practice in the Western world, although fasting has a negative effect on the patient's condition and the recovery after surgery. This may be counteracted by a simple intervention such as administering a carbohydrate-rich supplement just before surgery. In conclusion, there are various nutritional substrates that may be of great value in improving the condition of the surgical patient, which may be beneficial for post-operative recovery.

(Online publication February 15 2013)

Key Words:

  • Glutamine;
  • Arginine;
  • n-3 PUFA;
  • Taurine;
  • Carbohydrates;
  • Surgery


  • CHO:carbohydrate;
  • iNOS:inducible nitric oxide synthase;
  • LOS:length of hospital stay;
  • MDSC:myeloid derived suppressor cells;
  • Th:T-helper


c1 Corresponding author: Professor P. A. M. van Leeuwen, fax +31 20 444 4512, email