Pharmaconutrition: a new emerging paradigm

PURPOSE OF REVIEW: This paper highlights recent studies of interest and provides rationale for why deficiencies with the current scientific paradigm of immunonutrition has produced studies with conflicting results, and why it should be replaced with a new paradigm termed 'pharmaconutrition'. RECENT FINDINGS: Considering the overall treatment effect of immune-modulating nutrients, parenteral glutamine is recommended in patients receiving parenteral nutrition, while enteral glutamine should be considered in burn and trauma patients. Antioxidants, particularly selenium, should be considered for critically ill patients, and enteral formulas enriched with fish oils are recommended in patients with acute respiratory distress syndrome. Arginine-supplemented diets are not recommended. There are currently insufficient data to enable useful recommendations on the optimal route, timing, duration and dosage of each nutrient. The pending results of a large, rigorously designed, randomized trial, however, in which nutrients are viewed and tested as pharmacological agents, promise to clarify some of the current ambiguities and inform future practice. SUMMARY: This review provides insights into why the current paradigm of immunonutrition has failed to consistently demonstrate a beneficial effect of key immunomodulating nutrients, and offers a timely solution through the new paradigm of pharmaconutrition.