[Bacterial translocation from the nutritional perspective].

Abstract

A variety of situations involving loss of the physical integrity of the gastrointestinal barrier, excess intraluminal bacterial growth or immunological compromise of the host, have been shown experimentally to predispose to bacterial translocation. While colonization of the mesenteric ganglia is a mechanism which stimulates local immune defenses, distant colonization of other organs causes these defences to fail. In general, in the latter situation, a variety of factors must combine, notably the nutritional state or nutritional therapy. Protein malnutrition states do not alone generate bacterial translocation, but they do facilitate the distant dissemination of germs in situations such as endotoxemia. Bacterial translocation is objectivized after the prolonged use of total parenteral nutrition or of chemically defined non-fiber diets. The addition of fiber restores the architecture and physiology of the intestinal microvilli and prevents bacterial translocation in animals with a variety of morphological lesions of the intestinal barrier. While the results of the clinical studies are as yet not very conclusive, there is a clear link between bacteremia of intestinal origin and multiple organ failures. Nutritional support of patients with an acute metabolic compromise must, at least as inferred from the experimental studies, take account of the following factors: in the first place, the use of a preparation with a qualitatively and quantitatively suitable fiber content, to prevent atrophy of the intestinal villi; in the second place, the use of "scavenger" agents or physiological sweepers of the free radicals of oxygen, such as vitamin A, E or C or selenium; and, finally, day by day there is an increasing interest in the therapeutic use of substrates with immunomodulatory capacity, such as glutamine or arginine. On the other hand, the use must be questioned of substances such as Omega 3 series polyunsaturated fatty acids which are on their own able to increase lipidic peroxidation induced by free oxygen radicals.