Recognition that specific nutrients can be beneficial when consumed in amounts above the accepted daily requirements has provided a major impetus for the critical examination of dietary approaches with single or multiple nutrient supplements chosen to modulate the inflammatory response, enhance immune function, or improve the blood-gut barrier. Patients suffering the effects of hypercatabolism caused by surgery, cancer, or extensive burns are prime candidates for immunonutrition, as the intervention has come to be known, as are immunosuppressed patients with the human immunodeficiency virus or other overwhelming infections. This review focuses on key nutrients used in clinical trials for which a body of information on the mode of action and metabolic pathways is available. The topics covered include the amino acids, glutamine and arginine; omega-3 fatty acids, eicosapentaenoic acid and docosahexanoic acid; vitamin A; and zinc. Lastly, we address the area of pre- and probiotics and how "friendly" microorganisms are being incorporated into therapeutic regimens aimed at sustaining health. The use of immunonutrition requires judicious consideration of the potential undesirable effects of certain additives in clinical settings where enhanced immune responsiveness can translate into tissue damage and altered mucosal defenses.
