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Zhang Y, Zhang J, Zhu L, Hao J, He F, Xu T, Wang R, Zhuang W, Wang M. A Narrative Review of Nutritional Therapy for Gastrointestinal Cancer Patients Underwent Surgery. J INVEST SURG 2023; 36:2150337. [DOI: 10.1080/08941939.2022.2150337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Yujie Zhang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglin Zhang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastrointestinal Surgery, Yibin Second People’s Hospital, Yibin, China
| | - Lili Zhu
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Hao
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Fengjun He
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Xu
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Rui Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Zhuang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Mojin Wang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
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Flores-López A, Guevara-Cruz M, Avila-Nava A, González-Garay AG, González-Salazar LE, Reyes-Ramírez AL, Pedraza-Chaverri J, Medina-Campos ON, Medina-Vera I, Reyes-García JG, Tovar AR, Serralde-Zúñiga AE. n-3 Polyunsaturated Fatty Acid Supplementation Affects Oxidative Stress Marker Levels in Patients with Type II Intestinal Failure: A Randomized Double Blind Trial. Antioxidants (Basel) 2023; 12:1493. [PMID: 37627489 PMCID: PMC10451159 DOI: 10.3390/antiox12081493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Type II intestinal failure (IF-II) is a condition in which the gastrointestinal tract is compromised. Liver complications may occur because of the pathology and/or prolonged use of parenteral nutrition (PN); oxidative stress has been implicated as one of the causes. Lipid emulsions containing n-3 polyunsaturated fatty acids (PUFAs) have been proposed for the treatment. We aimed to evaluate the effect of 7-day n-3 PUFA supplementation on oxidative stress in IF-II patients receiving PN. This was a randomized, controlled, double-blinded, pilot trial of adult patients with IF-II, receiving either conventional PN (control) or PN enriched with n-3 PUFAs (intervention). Twenty patients were included (14 men, 49 ± 16.9 years), with the ANCOVA analysis the glucose (p = 0.003), and direct bilirubin (p = 0.001) levels reduced; whereas the high-density lipoprotein cholesterol (HDL-C) increased (p = 0.017). In the random-effect linear regression analysis, a reduction (p < 0.0001) in the malondialdehyde (MDA) level was found in the intervention group when the covariables age, HDL-C level, and alanine aminotransferase activity were considered. After 1 week of PN supplementation with n-3 PUFAs, the marker levels of some oxidative stress, blood lipids, and hepatic biomarkers improved in patients with IF-II.
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Affiliation(s)
- Adriana Flores-López
- Servicio Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Martha Guevara-Cruz
- Departamento Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Azalia Avila-Nava
- Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida 97130, Mexico
| | | | - Luis E. González-Salazar
- Servicio Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Ana L. Reyes-Ramírez
- Servicio Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - José Pedraza-Chaverri
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Omar N. Medina-Campos
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Isabel Medina-Vera
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Mexico City 04530, Mexico
| | - Juan G. Reyes-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Armando R. Tovar
- Departamento Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Aurora E. Serralde-Zúñiga
- Servicio Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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[Parenteral supplementation with EPA/DHA omega-3 fatty acids improves recovery prognosis in critically ill patients]. NUTR HOSP 2023; 40:3-12. [PMID: 36602145 DOI: 10.20960/nh.04227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Introduction: the decision to supplement total parenteral nutrition (TPN) with emulsions of omega-3 (Ω3) eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids (FA) of marine origin is based on the clinical benefits obtained in different medical situations and surgical procedures, among which reductions in hospital stay, days of mechanical ventilation, incidence of infections and mortality stand out. However, the evidence in critically ill patients remains contradictory. Objective: the objective of this clinical trial was to analyze the effect of supplementation with EPA/DHA Ω3 FAs on clinical prognostic markers - medical, nutritional and biochemical - in critically ill patients, relating to outcome. Method: a clinical, controlled, randomized, single-center trial in 64 critically ill adult patients, of which 47 patients were randomized to receive TPN supplemented with EPA/DHA Ω3 FAs in doses of 0.1 g/kg/day (n = 23) and 0.2 g/kg/day (n = 24), compared with a historical control group with TPN without supplementation (n = 17). Clinical prognosis markers were determined at baseline and at the end of nutritional support (medical, nutritional and biochemical). Results: the two groups with supplementation showed a statistically significant reduction in mortality (p < 0.005); the clinical prognostic markers SOFA, APACHE II, SAPS 3, NUTRIC, RTL and CRS were consistent in showing a significant improvement (p < 0.005), of prognosis with doses of 0.1 and 0.2 g/kg/day of EPA/DHA Ω3 FAs, respectively. Conclusion: supplementation of parenteral nutrition with EPA/DHA Ω3 fatty acids at doses of 0.1 g and 0.2 g/kg/day improves recovery prognosis and the probability of survival in critically ill patients.
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Soliman OM, Abbas YH, Aboelhassan AMA, Ismail EA. Could early infusion of fish-oil-based lipid emulsion affect the need for intensive care in moderately diseased COVID-19 patients? A randomized clinical trial. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2022. [PMCID: PMC9287710 DOI: 10.1186/s42077-022-00251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Sixty moderate diseased COVID-19 patients were divided into two equal groups and were enrolled in a randomized double-blind clinical trial. Group C was delivered standard enteral nutrition plus 100 ml/day of 0.9% normal saline. Group L was delivered fish-oil-based lipid emulsion (FOBLE) supplementation to standard enteral nutrition at a dose of 100 ml/day. Both groups infused at a rate of 12.5 ml/h over 8 h for 5 days. We aimed to compare the effect of FOBLE versus placebo in COVID-19 disease to clarify the impact on the number of patients shifted to the ICU, oxygenation, inflammatory markers, and short-term outcomes (7 days). Results The failed conventional care and shift to ICU was significantly lower in group L in comparison to group C (six patients (20.0%) versus 14 patients (46.7%) shifted to ICU, P-value = 0.028). The inflammatory markers were determined and evaluated. Throughout the trial, there were no significant changes with the exception of the 7th day neutrophil/lymphocyte ratio (NLR), when the ratio was lower in group L than in group C (6.10 (3.90–7.20) versus 9.65 (8.30–10.90), respectively, P-value 0.001). Conclusions In moderate diseased COVID-19 patients, early administration of parenteral FOBLE as an adjuvant to enteral feeding reduces shifts and so minimizes the burden on the ICU. Trial registration ClinicalTrials.gov PRS (NCT04957940). Registered on 5 July 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s42077-022-00251-0.
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Nutritional Support with Omega-3 Fatty Acids in Burn Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Nutrients 2022; 14:nu14142874. [PMID: 35889830 PMCID: PMC9320673 DOI: 10.3390/nu14142874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background: In burn patients, the profound effect of nutritional support on improved wound healing and a reduced rate of hospitalization and mortality has been documented. Fish oil as a primary source of omega-3 fatty acids in nutritional support may attenuate the inflammatory response and enhance immune function; however, unclear effects on the improvement of clinical outcomes in burn patients remain. Methods: The systematic literature review was conducted by searching the electronic databases: Cochrane Library, PubMed, ScienceDirect, and Scopus to assess the randomized controlled trials of nutritional support with omega-3 fatty acids compared to control diets in patients that presented with burns from any causes. Results: Seven trials were included in this meta-analysis. We found no significant differences in length of stay (LOS) (p = 0.59), mortality (p = 0.86), ventilation days (p = 0.16), gastrointestinal complications—e.g., constipation and diarrhea (p = 0.73)—or infectious complications—e.g., pneumonia and sepsis (p = 0.22)—between the omega-3-fatty-acid-receiving group and the control/other diets group. Conclusions: We did not find a benefit of omega-3 support in reducing the various complications, mortality and LOS in burn patients. Further studies are necessary to find the effect of nutritional support with omega-3 fatty acids over low-fat diets in this population.
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Vanzant E, Loftus T, Kamel A, Carmichael E, Rosenthal MD. Nutritional impact of omega 3 fatty acids and metabolites in acute and chronic critical illness. Curr Opin Clin Nutr Metab Care 2022; 25:75-80. [PMID: 35115447 DOI: 10.1097/mco.0000000000000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Lipids have been utilized historically as a calorie dense means to ensure delivery of essential fatty acids (FA). Since the development of mixed lipid emulsion and investigation of immunomodulatory formulas, there has been an awakening that not all lipids are created equal. This narrative review focuses on contemporary evidence in the utilization of lipids (namely omega 3 fatty acids) in both acute and chronic critical illness. RECENT FINDINGS Though randomized control trials and meta-analyses provide little guidance regarding clinical practice for patients suffering from chronic critical illness, available literature suggests the potential to use lipid formulas to decrease the inflammatory cycle that drives catabolism. Additionally, this review will address the expanding evidence that specialized pro-resolving mediators (SPMs) may be the future of immunomodulating inflammation in acute and chronic critical illness and the persistent inflammation, immunosuppression, and catabolic syndrome (PICS). SUMMARY Although societal guidelines, expert consensus, and literature support the use of omega 3 fatty acids in the acute critically ill population, more research is needed regarding omega 3 fatty acids for chronic critical illness and PICS.
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Affiliation(s)
- Erin Vanzant
- Division of Trauma and Acute Care Surgery, Department of Surgery, College of Medicine, University of Florida
| | - Tyler Loftus
- Division of Trauma and Acute Care Surgery, Department of Surgery, College of Medicine, University of Florida
| | - Amir Kamel
- Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Ethan Carmichael
- Division of Trauma and Acute Care Surgery, Department of Surgery, College of Medicine, University of Florida
| | - Martin D Rosenthal
- Division of Trauma and Acute Care Surgery, Department of Surgery, College of Medicine, University of Florida
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Hou Y, Wang SF, Zhou K, Dai SX. Comparison and recommendation of dietary patterns based on nutrients for Eastern and Western patients with inflammatory bowel disease. Front Nutr 2022; 9:1066252. [PMID: 36817063 PMCID: PMC9928567 DOI: 10.3389/fnut.2022.1066252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Inflammatory bowel disease (IBD), a non-specific chronic idiopathic inflammatory condition of the digestive system, requires lifelong treatment in which drugs are the mainstay, along with surgery when necessary. In adjuvant therapies, the diet is considered to be an essential, controllable, and economical component. However, the majority of recent nutrition research has focused on the general effects of nutrients on IBD, with little attention given to the advantages and negative aspects of individual foods and dietary combinations. To cover these shortcomings, we surveyed the benefits and drawbacks of typical foods and their chemical compositions on intestinal pathophysiology by comparing nutrients existing in the foods in Eastern and Western countries. Moreover, for Eastern and Western patients with IBD, we innovatively propose a 3-step dietary recommendation based on modified customary eating habits, including lowering the triggering foods, modifying dietary advice to control disease progression, and improving surgery prognosis.
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Affiliation(s)
- Yue Hou
- Department of Gastroenterology, (Guangdong Provincial Geriatrics Institute), National Key Clinical Specialty, Guangdong Provincial People’s Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Sai-Feng Wang
- Department of Gastroenterology, (Guangdong Provincial Geriatrics Institute), National Key Clinical Specialty, Guangdong Provincial People’s Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Ke Zhou
- Department of Obstetrics and Gynecology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Shi-Xue Dai
- Department of Gastroenterology, (Guangdong Provincial Geriatrics Institute), National Key Clinical Specialty, Guangdong Provincial People’s Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Gastroenterology, Geriatric Center, National Regional Medical Center, Ganzhou Hospital Affiliated to Guangdong Provincial People’s Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Ganzhou, Jiangxi, China
- *Correspondence: Shi-Xue Dai,
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Zhang T, Li G, Duan M, Lv T, Feng D, Lu N, Zhou Y, Gu L, Zhu W, Gong J. Perioperative parenteral fish oil supplementation improves postoperative coagulation function and outcomes in patients undergoing colectomy for ulcerative colitis. JPEN J Parenter Enteral Nutr 2021; 46:878-886. [PMID: 34609004 DOI: 10.1002/jpen.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ulcerative colitis (UC) is an independent risk factor for thromboembolism, especially during the perioperative period. This study aimed to determine the effects of perioperative parenteral nutrition (PN) supplemented with fish oil (FO) on coagulation function and postoperative outcomes in patients with UC. METHODS This retrospective cohort included 92 consecutive patients who underwent colectomy for UC. Postoperative coagulation indices and outcomes, including thromboelastography (TEG) findings and comprehensive complication index (CCI), were compared. The relative change in serum D-dimer (ΔD-dimer) levels and maximal amplitude (ΔMA) on TEG were also determined. RESULTS Patients receiving PN supplemented with FO (n = 48) had lower D-dimer (P = .036) levels on postoperative day (POD) 5 and a higher MA (P < 0.001) on POD 1 than those who did not receive it (n = 44). A lower ΔD-dimer level (P = .048) and ΔMA (P < 0.001) were also observed in patients receiving FO. The incidence of major postoperative complications (6.3 vs 22.7%; P = .017) and CCI (20.9 vs 23.4%; P = .044) were significantly lower in patients receiving FO. In multivariate analysis, FO (odds ratio, 0.231; 95% confidence interval, 0.055-0.971; P = .046) was a positive protector of major postoperative complications. CONCLUSION Perioperative PN supplemented with FO improved coagulation function and reduced major postoperative complications in patients with UC requiring colectomy. These results may provide cues in formulating management strategies for preventing thromboembolisms and postoperative complications in patients with UC.
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Affiliation(s)
- Tenghui Zhang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guangke Li
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Ming Duan
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Tengfei Lv
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Dengyu Feng
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Nan Lu
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Yan Zhou
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Lili Gu
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Lipid-Free Parenteral Nutrition Is Associated with an Increased Risk of Hepatic Dysfunction in Surgical Critically Ill Patients: A Retrospective Observational Study. Healthcare (Basel) 2021; 9:healthcare9091096. [PMID: 34574872 PMCID: PMC8467940 DOI: 10.3390/healthcare9091096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 01/03/2023] Open
Abstract
To evaluate the effects of lipid-free parenteral nutrition (PN) and various intravenous fat emulsions (IVFEs) on hepatic function in surgical critically ill trauma/acute care surgery patients. We retrospectively reviewed trauma/acute care surgery patients without admission hepatic disorder that received PN. The PN groups include lipid-free, soybean oil/medium-chain triglyceride, olive oil-based, and fish-oil contained PN. We excluded patients with (1) age <18 years, (2) without surgery, (3) preexisting liver injury/diseases, (4) hyperbilirubinemia at admission, (5) received more than one type of PN, and (6) repeated ICU episodes in the same hospitalization. Hepatic dysfunction was considered as serum total–bilirubin >6.0 mg/dL. The demographics, severity score, comorbidities, blood stream infection, and mortality were collected for analyses. The major outcome is hepatic function. We also performed analyses stratified by separated lipid doses (g/kg/day). A total of 249 patients were enrolled. There were no demographic differences among groups. The lipid-free PN group had a higher incidence of hepatic dysfunction and mortality. Compared to the lipid-free group, the other three IVFEs had significantly lower risks of hepatic dysfunction, while the olive oil-based group had a significantly lower risk of 30 and 90-day mortality. After being stratified by separating lipid doses, the soybean oils showed a decreasing trend of hepatic dysfunction and mortality with increased dosage. Fish oil >0.05 g/kg/day was associated with lower hepatic dysfunction incidences. Our findings suggest that, when compared to IVFEs, surgical critically ill patients with trauma/acute care surgery that received lipid-free PN are associated with an increased risk of hepatic dysfunction. In addition, the olive oil-based group had a significantly lower risk of mortality, while fish oil >0.05 g/kg/day was associated with lower incidences of hepatic dysfunction; however, further studies are warranted.
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Chronic Critical Illness and PICS Nutritional Strategies. J Clin Med 2021; 10:jcm10112294. [PMID: 34070395 PMCID: PMC8197535 DOI: 10.3390/jcm10112294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/26/2022] Open
Abstract
The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI.
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Liu C, Yang J, Dong W, Yuan J. Effects of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e25138. [PMID: 33725995 PMCID: PMC7982173 DOI: 10.1097/md.0000000000025138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gastrointestinal complications and malnutrition are common problems that affect postoperative rehabilitation and survival of patients with esophageal cancer. Evidence has shown that probiotics have a positive effect on improving gastrointestinal complications and nutritional status of patients with esophageal cancer after surgery, but there is a lack of prospective studies on this topic. We designed this prospective randomized controlled trial to evaluate the effects of probiotics on gastrointestinal complications and nutritional status in patients with postoperative esophageal cancer. METHODS This is a prospective, randomized, double-blind, placebo-controlled trial. It was approved by the Clinical Research Ethics Committee of our hospital. 192 patients will be randomly divided into probiotics group and the placebo group in a 1:1 ratio. After operation, probiotics and placebo will be given orally for 8 weeks. The indexes of nutritional status and incidence of digestive tract complications will be recorded and the data will be analyzed by SPSS 18.0 software. DISCUSSION This study will evaluate the effect of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer. The results of this study will provide clinical basis for the use of probiotics in postoperative treatment of esophageal cancer. TRIAL REGISTRATION OSF Registration number: D DOI 10.17605/OSF.IO/QHW86.
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Affiliation(s)
- Chao Liu
- The NO.2 Hospital of Baoding Department of Gastroenterology
| | - Jing Yang
- The NO.2 Hospital of Baoding Department of Gastroenterology
| | - Weiwei Dong
- The NO.2 Hospital of Baoding Department of Gastroenterology
| | - Jinyan Yuan
- Shanxi Provincial People's Hospital Thoracic Surgery
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Martindale RG, Berlana D, Boullata JI, Cai W, Calder PC, Deshpande GH, Evans D, Garcia-de-Lorenzo A, Goulet OJ, Li A, Mayer K, Mundi MS, Muscaritoli M, Pradelli L, Rosenthal M, Seo JM, Waitzberg DL, Klek S. Summary of Proceedings and Expert Consensus Statements From the International Summit "Lipids in Parenteral Nutrition". JPEN J Parenter Enteral Nutr 2021; 44 Suppl 1:S7-S20. [PMID: 32049392 DOI: 10.1002/jpen.1746] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/24/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). METHODS The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. RESULTS The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence-based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω-3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. CONCLUSIONS This article provides a set of expert consensus statements to complement formal PN guideline recommendations.
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Affiliation(s)
- Robert G Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David Berlana
- Pharmacy Service, Vall d'Hebron Barcelona Hospital Campus and Department of Nutrition, University of Barcelona, Barcelona, Spain
| | - Joseph I Boullata
- Department of Nutrition Sciences, Drexel University, Philadelphia, Pennsylvania, USA.,Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Cai
- Department of Pediatric Surgery, Division of Pediatric Gastroenterology and Nutrition, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Girish H Deshpande
- Neonatal NICU, Nepean Hospital, Kingswood, NSW, Australia.,Sydney Medical School, Nepean, University of Sydney, Australia
| | - David Evans
- Department of Surgery, Ohio State University Medical Center, Columbus, Ohio, USA
| | | | - Olivier J Goulet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, National Reference Center for Rare Digestive Diseases, Hospital Necker-Enfants Malades, University of Paris-Descartes, Paris, France
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Konstantin Mayer
- Vidia Kliniken Karlsruhe, Medizinische Klinik IV, Karlsruhe, Germany
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Martin Rosenthal
- Department of Surgery, Division of Trauma and Acute Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jeong-Meen Seo
- Division of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dan L Waitzberg
- Department of Gastroenterology, Lim 35, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Stanislaw Klek
- Department of General and Oncology Surgery, Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
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Lou PH, Lucchinetti E, Wawrzyniak P, Morsy Y, Wawrzyniak M, Scharl M, Krämer SD, Rogler G, Hersberger M, Zaugg M. Choice of Lipid Emulsion Determines Inflammation of the Gut-Liver Axis, Incretin Profile, and Insulin Signaling in a Murine Model of Total Parenteral Nutrition. Mol Nutr Food Res 2021; 65:e2000412. [PMID: 32729969 DOI: 10.1002/mnfr.202000412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/16/2020] [Indexed: 12/19/2022]
Abstract
SCOPE The aim of this study is to test whether the choice of the lipid emulsion in total parenteral nutrition (TPN), that is, n-3 fatty acid-based Omegaven versus n-6 fatty acid-based Intralipid, determines inflammation in the liver, the incretin profile, and insulin resistance. METHODS AND RESULTS Jugular vein catheters (JVC) are placed in C57BL/6 mice and used for TPN for 7 days. Mice are randomized into a saline group (saline infusion with oral chow), an Intralipid group (IL-TPN, no chow), an Omegaven group (OV-TPN, no chow), or a chow only group (without JVC). Both TPN elicite higher abundance of lipopolysaccharide binding protein in the liver, but only IL-TPN increases interleukin-6 and interferon-γ, while OV-TPN reduces interleukin-4, monocyte chemoattractant protein-1, and interleukin-1α. Insulin plasma concentrations are higher in both TPN, while glucagon and glucagon-like peptide-1 (GLP-1) were higher in IL-TPN. Gluconeogenesis is increased in IL-TPN and the nuclear profile of key metabolic transcription factors shows a liver-protective phenotype in OV-TPN. OV-TPN increases insulin sensitivity in the liver and skeletal muscle. CONCLUSION OV-TPN as opposed to IL-TPN mitigates inflammation in the liver and reduces the negative metabolic effects of hyperinsulinemia and hyperglucagonemia by "re-sensitizing" the liver and skeletal muscle to insulin.
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Affiliation(s)
- Phing-How Lou
- Department of Pharmacology, University of Alberta, Edmonton, T6G 2R3, Canada
| | - Eliana Lucchinetti
- Department of Anesthesiology and Pain Medicine and Cardiovascular Research Centre, University of Alberta, Edmonton, T6G 2R3, Canada
| | - Paulina Wawrzyniak
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Zurich, 8032, Switzerland
| | - Yasser Morsy
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, 8091, Switzerland
| | - Marcin Wawrzyniak
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, 8091, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, 8091, Switzerland
| | - Stefanie D Krämer
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, 8093, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, 8091, Switzerland
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zurich, Zurich, 8032, Switzerland
- Center for Integrative Human Physiology, University of Zurich, Zurich, 8057, Switzerland
| | - Michael Zaugg
- Department of Pharmacology, University of Alberta, Edmonton, T6G 2R3, Canada
- Department of Anesthesiology and Pain Medicine and Cardiovascular Research Centre, University of Alberta, Edmonton, T6G 2R3, Canada
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Guirgis FW, Black LP, DeVos E, Henson M, Ferreira J, Miller T, Rosenthal M, Leeuwenburgh C, Kalynych C, Moldawer L, Jones L, Crandall M, Reddy ST, Gao H, Wu S, Moore F. Lipid intensive drug therapy for sepsis pilot: A Bayesian phase I clinical trial. J Am Coll Emerg Physicians Open 2020; 1:1332-1340. [PMID: 33392541 PMCID: PMC7771745 DOI: 10.1002/emp2.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/26/2020] [Accepted: 08/07/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Cholesterol may be protective in sepsis. Patients with early sepsis may have critically low cholesterol levels that are associated with poor outcomes. The study objective was to test the safety of a fish oil-containing lipid injectable emulsion for stabilizing early cholesterol levels in sepsis. METHODS Phase I Bayesian optimal interval design trial of adult patients with septic shock (Sequential Organ Failure Assessment score ≥4 or vasopressor dependence). Using sequential dose escalation, participants received 2 doses of 1.0 to 1.6 g/kg of lipid emulsion (Smoflipid 20% lipid emulsion) within 48 hours of enrollment. Cholesterol levels, function, and organ failure were assessed serially during the first 7 days of hospital admission. MEASUREMENTS AND MAIN RESULTS A total of 10 patients with septic shock were enrolled. One patient withdrew for social reasons. Another patient had an unrelated medical complication and received 1 drug dose. Of 9 patients, mean age was 58 years (SD 16), median Sequential Organ Failure Assessment was 8, and 28-day mortality was 30%. No serious adverse events related to lipid infusion occurred. The six occurrences of non-serious adverse events possibly related to lipid infusion included hyperglycemia (1), elevated triglycerides (3), anemia (1), and vascular access redness/pain (1) for all doses. The mean change in total cholesterol levels from enrollment was -7 (SD 16.6) at 48 hours and 14 (SD 25.2) at 7 days. CONCLUSIONS Fish oil-containing lipid emulsion administration during early septic shock was safe. Further studies are needed to assess effects on cholesterol levels, function, and organ failure. CLINICAL TRIAL REGISTRATION NCT03405870.
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Affiliation(s)
- Faheem W. Guirgis
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Lauren Page Black
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Elizabeth DeVos
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Morgan Henson
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Jason Ferreira
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Taylor Miller
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Martin Rosenthal
- Department of SurgeryUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric ResearchUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Colleen Kalynych
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Lyle Moldawer
- Department of SurgeryUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Lisa Jones
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Marie Crandall
- Department of SurgeryUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | | | - Hanzhi Gao
- Department of BiostatisticsCollege of Public Health & Health Professions College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Sam Wu
- Department of BiostatisticsCollege of Public Health & Health Professions College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Frederick Moore
- Department of SurgeryUniversity of Florida College of MedicineGainesvilleFloridaUSA
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15
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High Dose Intravenous Fish Oil Reduces Inflammation-A Retrospective Tale from Two Centers. Nutrients 2020; 12:nu12092865. [PMID: 32961695 PMCID: PMC7551918 DOI: 10.3390/nu12092865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
AIM Patients on parenteral nutrition (PN) are prone to inflammation. This may aggravate an existing proinflammatory state and become a critical factor in the development of liver dysfunction (LD). Intravenous fish oil may attenuate this inflammatory state, but data on its use in adults are scarce. The aim of this study was to investigate the effects of adding a pure fish oil intravenous lipid emulsion (ILE) into short- and long-term PN in patients either at risk of, or with existing, inflammation. METHODS A retrospective analysis of 61 patients (32 female, 29 male, mean age 51.5 ± 12.6 years) who received all-in-one PN, including amino acids, glucose, and lipids supplemented with pure fish oil ILE, was performed. Pure fish oil ILE (Omegaven®, Fresenius Kabi, Bad Homburg, Germany) was used along with the standard ILE to reach a fish oil dose of 0.4-0.5 g fish oil/kg/d. Diagnoses were chronic intestinal failure (CIF, n = 20), Crohn's disease (CD, n = 22), and ulcerative colitis (UC, n = 19). The observation period was 12 months for CIF and 21 days for UC and CD. RESULTS A reduction in inflammation was noticeable in all patients and became statistically significant in CD (hsCRP p < 0.0001, ESR p = 0.0034, procalcitonin p = 0.0014, Il-6 p = 0.001) and UC groups (hsCRP and ESR p < 0.0001, Il-6 p = 0.0001, TNF-α p = 0.0113). In the CIF group, the total bilirubin concentration (p = 0.2157) and aspartate transaminase SGOT (p = 0.1785) did not vary over time. CONCLUSIONS PN with pure fish oil ILE reduces some inflammatory parameters in IBD and maintains liver function parameters in CIF patients. Fish oil might become a valuable ingredient in both short- and long-term PN in patients at risk of liver dysfunction.
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16
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Pradelli L, Klek S, Mayer K, Omar Alsaleh AJ, Rosenthal MD, Heller AR, Muscaritoli M. Cost-Effectiveness of Parenteral Nutrition Containing ω-3 Fatty Acids in Hospitalized Adult Patients From 5 European Countries and the US. JPEN J Parenter Enteral Nutr 2020; 45:999-1008. [PMID: 32713007 PMCID: PMC8451886 DOI: 10.1002/jpen.1972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 01/17/2023]
Abstract
Background ω‐3 Fatty acid (FA)–containing parenteral nutrition (PN) is associated with improvements in patient outcomes and with reductions in hospital length of stay (HLOS) vs standard PN regimens (containing non–ω‐3 FA lipid emulsions). We present a cost‐effectiveness analysis of ω‐3 FA–containing PN vs standard PN in 5 European countries (France, Germany, Italy, Spain, UK) and the US. Methods This pharmacoeconomic model was based on estimates of ω‐3 efficacy reported in a recent meta‐analysis and data from country‐specific sources. It utilized a probabilistic discrete event simulation model to compare ω‐3 FA–containing PN with standard PN in a population of critically ill and general ward patients. The influence of model parameters was evaluated using probabilistic and deterministic sensitivity analyses. Results Overall costs were reduced with ω‐3 FA–containing PN in all 6 countries compared with standard PN, ranging from €1741 (±€1284) in Italy to €5576 (±€4193) in the US. Expenses for infections and HLOS were lower in all countries for ω‐3 FA–containing PN vs standard PN, with the largest cost differences for both in the US (infection: €825 ± €4001; HLOS: €4879 ± €1208) and the smallest savings in the UK for infections and in Spain for HLOS (€63 ± €426 and €1636 ± €372, respectively). Conclusion This cost‐effectiveness analysis in 6 countries demonstrates that the superior clinical efficacy of ω‐3 FA–containing PN translates into significant decreases in mean treatment cost, rendering it an attractive cost‐saving alternative to standard PN across different healthcare systems.
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Affiliation(s)
| | - Stanislaw Klek
- Department of General and Oncology Surgery with Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Konstantin Mayer
- ViDia Hospitals, Department of Pulmonary and Sleep Medicine, Karlsruhe, Germany
| | | | - Martin D Rosenthal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Axel R Heller
- Department of Anesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
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17
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Immunomodulation by an Omega-6 Fatty Acid Reduced Mixed Lipid Emulsion in Murine Acute Respiratory Distress Syndrome. J Clin Med 2020; 9:jcm9072048. [PMID: 32610690 PMCID: PMC7408915 DOI: 10.3390/jcm9072048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is associated with both high morbidity and mortality in intensive care units worldwide. Patients with ARDS often require parenteral nutrition with lipid emulsions as essential components. In the present study, we assessed the immunomodulatory and apoptotic effects of a modern, n-6-reduced lipid emulsion mixture in murine ARDS. Methods: Mice received an infusion of either normal saline solution, pure long-chain triglyceride (LCT) emulsion, or SMOF (soybean oil, medium-chain triglycerides, olive oil, and fish oil) before a lipopolysaccharide (LPS) challenge. Mice were sacrificed at different time points (0, 24, or 72 h) after ARDS induction, and an analysis of inflammatory cytokines, protein concentrations, and the cellular composition of the alveolar and interstitial compartments was performed with special focus on alveolar apoptosis and necrosis. Results: Mice infused with SMOF showed decreased leukocyte invasion, protein leakage, myeloperoxidase activity, and cytokine production in alveolar spaces after LPS challenge compared to animals that received LCT. There were fewer cells in the lung interstitium of the SMOF group compared to the LCT group. Both lipid emulsions exerted pro-apoptotic and pro-necrotic properties on alveolar immune cells, with significantly increased necrosis in mice infused with LCT compared to SMOF. Conclusion: SMOF has both anti-inflammatory and pro-resolving influences in murine ARDS. Partial replacement of n-6 fatty acids with n-3/n-9 fatty acids may therefore benefit critically ill patients at risk for ARDS who require parenteral nutrition.
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Mohamed Elfadil O, Bonnes SL, Salonen BR, Vellapati S, Patel J, Narasimhan R, Hurt RT, Mundi MS. New Uses for a New Oil: Clinical Applications of Fish Oil Lipid Emulsion. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00259-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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19
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Lucchinetti E, Lou PH, Wawrzyniak P, Wawrzyniak M, Scharl M, Holtzhauer GA, Krämer SD, Hersberger M, Rogler G, Zaugg M. Novel Strategies to Prevent Total Parenteral Nutrition-Induced Gut and Liver Inflammation, and Adverse Metabolic Outcomes. Mol Nutr Food Res 2020; 65:e1901270. [PMID: 32359213 DOI: 10.1002/mnfr.201901270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/09/2020] [Indexed: 12/15/2022]
Abstract
Total parenteral nutrition (TPN) is a life-saving therapy administered to millions of patients. However, it is associated with significant adverse effects, namely liver injury, risk of infections, and metabolic derangements. In this review, the underlying causes of TPN-associated adverse effects, specifically gut atrophy, dysbiosis of the intestinal microbiome, leakage of the epithelial barrier with bacterial invasion, and inflammation are first described. The role of the bile acid receptors farnesoid X receptor and Takeda G protein-coupled receptor, of pleiotropic hormones, and growth factors is highlighted, and the mechanisms of insulin resistance, namely the lack of insulinotropic and insulinomimetic signaling of gut-originating incretins as well as the potentially toxicity of phytosterols and pro-inflammatory fatty acids mainly released from soybean oil-based lipid emulsions, are discussed. Finally, novel approaches in the design of next generation lipid delivery systems are proposed. Propositions include modifying the physicochemical properties of lipid emulsions, the use of lipid emulsions generated from sustainable oils with favorable ratios of anti-inflammatory n-3 to pro-inflammatory n-6 fatty acids, beneficial adjuncts to TPN, and concomitant pharmacotherapies to mitigate TPN-associated adverse effects.
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Affiliation(s)
- Eliana Lucchinetti
- Department of Anesthesiology and Pain Medicine and Cardiovascular Research Centre, University of Alberta, Edmonton, T6G 2R3, Canada
| | - Phing-How Lou
- Department of Pharmacology, University of Alberta, Edmonton, T6G 2R3, Canada
| | - Paulina Wawrzyniak
- Division of Clinical Chemistry and Biochemistry, Children's Hospital Zurich, Zurich, 8032, Switzerland
| | - Marcin Wawrzyniak
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 8091, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 8091, Switzerland
| | - Gregory A Holtzhauer
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, 8093, Switzerland
| | - Stefanie D Krämer
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, 8093, Switzerland
| | - Martin Hersberger
- Division of Clinical Chemistry and Biochemistry, Children's Hospital Zurich, Zurich, 8032, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 8091, Switzerland
| | - Michael Zaugg
- Department of Anesthesiology and Pain Medicine and Cardiovascular Research Centre, University of Alberta, Edmonton, T6G 2R3, Canada.,Department of Pharmacology, University of Alberta, Edmonton, T6G 2R3, Canada
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20
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Sadu Singh BK, Narayanan SS, Khor BH, Sahathevan S, Abdul Gafor AH, Fiaccadori E, Sundram K, Karupaiah T. Composition and Functionality of Lipid Emulsions in Parenteral Nutrition: Examining Evidence in Clinical Applications. Front Pharmacol 2020; 11:506. [PMID: 32410990 PMCID: PMC7201073 DOI: 10.3389/fphar.2020.00506] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
Lipid emulsions (LEs), an integral component in parenteral nutrition (PN) feeding, have shifted from the primary aim of delivering non-protein calories and essential fatty acids to defined therapeutic outcomes such as reducing inflammation, and improving metabolic and clinical outcomes. Use of LEs in PN for surgical and critically ill patients is particularly well established, and there is enough literature assigning therapeutic and adverse effects to specific LEs. This narrative review contrarily puts into perspective the fatty acid compositional (FAC) nature of LE formulations, and discusses clinical applications and outcomes according to the biological function and structural functionality of fatty acids and co-factors such as phytosterols, α-tocopherol, emulsifiers and vitamin K. In addition to soybean oil-based LEs, this review covers clinical studies using the alternate LEs that incorporates physical mixtures combining medium- and long-chain triglycerides or structured triglycerides or the unusual olive oil or fish oil. The Jaded score was applied to assess the quality of these studies, and we report outcomes categorized as per immuno-inflammatory, nutritional, clinical, and cellular level FAC changes. It appears that the FAC nature of LEs is the primary determinant of desired clinical outcomes, and we conclude that one type of LE alone cannot be uniformly applied to patient care.
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Affiliation(s)
- Birinder Kaur Sadu Singh
- Nutrition Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Ban Hock Khor
- Dietetics Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Sharmela Sahathevan
- Dietetics Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Abdul Halim Abdul Gafor
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Enrico Fiaccadori
- Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Tilakavati Karupaiah
- Faculty of Health & Medical Science, School of BioSciences, Taylor's University Lakeside Campus, Selangor, Malaysia
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21
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Klek S, Chambrier C, Cooper SC, Gabe S, Kunecki M, Pironi L, Rahman F, Sobocki J, Szczepanek K, Wanten G, Lincke N, Glotzbach B, Forbes A. Home parenteral nutrition with an omega-3-fatty-acid-enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study): study protocol for a randomized, controlled, multicenter, international clinical trial. Trials 2019; 20:808. [PMID: 31888740 PMCID: PMC6938010 DOI: 10.1186/s13063-019-3994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. METHODS/DESIGN The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. DISCUSSION Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03282955. Registered on 14 September 2017.
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Affiliation(s)
- Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, 15 Tyniecka Street, 32-050, Skawina, Poland.
| | - Cécile Chambrier
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Sheldon C Cooper
- GI Medicine - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Simon Gabe
- St Mark's Hospital, Northwick Park, Watford Road, Harrow, HA1 3UJ, UK
| | - Marek Kunecki
- Wojewódzki Specjalistyczny Szpital im. M. Pirogowa w Łodzi, Oddział Chirurgii Ogólnej i Naczyniowej, ul. Wólczańska 191/195, 90-531, Łódź, Poland
| | - Loris Pironi
- Department of Medical and Surgical Science, University of Bologna, St. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy
| | - Farooq Rahman
- University College Hospital, 250 Euston Road, London, NW1 2PG, UK
| | - Jacek Sobocki
- Samodzielny Publiczny Szpital Kliniczny im. Prof. dr W. Orlowskiego, Oddzial Kliniczny Zywienia i Chirurgii, ul. Czerniakowska 231, 00-416, Warszawa, Poland
| | - Kinga Szczepanek
- Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, 15 Tyniecka Street, 32-050, Skawina, Poland
| | - Geert Wanten
- Radboud Universitair Medisch Centrum, Afdeling Maag-, Darm- en Leverziekten, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicole Lincke
- Medical Scientific Affairs, B. Braun Melsungen AG, Carl-Braun-Str. 1, 34212, Melsungen, Germany
| | - Bernhard Glotzbach
- Medical Scientific Affairs, B. Braun Melsungen AG, Carl-Braun-Str. 1, 34212, Melsungen, Germany
| | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
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22
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Guirgis FW, Black LP, Rosenthal MD, Henson M, Ferreira J, Leeuwenburgh C, Kalynych C, Moldawer LL, Miller T, Jones L, Crandall M, Reddy ST, Wu SS, Moore FA. LIPid Intensive Drug therapy for Sepsis Pilot (LIPIDS-P): Phase I/II clinical trial protocol of lipid emulsion therapy for stabilising cholesterol levels in sepsis and septic shock. BMJ Open 2019; 9:e029348. [PMID: 31537565 PMCID: PMC6756323 DOI: 10.1136/bmjopen-2019-029348] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Sepsis is a life-threatening, dysregulated response to infection. Both high-density lipoprotein and low-density lipoprotein cholesterol should protect against sepsis by several mechanisms; however, for partially unknown reasons, cholesterol levels become critically low in patients with early sepsis who experience poor outcomes. An anti-inflammatory lipid injectable emulsion containing fish oil is approved by the Food and Drug Administration as parenteral nutrition for critically ill patients and may prevent this decrease in serum cholesterol levels by providing substrate for cholesterol synthesis and may favourably modulate inflammation. This LIPid Intensive Drug therapy for Sepsis Pilot clinical trial is the first study to attempt to stabilise early cholesterol levels using lipid emulsion as a treatment modality for sepsis. METHODS AND ANALYSIS This is a two-centre, phase I/II clinical trial. Phase I is a non-randomised dose-escalation study using a Bayesian optimal interval design in which up to 16 patients will be enrolled to evaluate the safest and most efficacious dose for stabilising cholesterol levels. Based on phase I results, the two best doses will be used to randomise 48 patients to either lipid injectable emulsion or active control (no treatment). Twenty-four patients will be randomised to one of two doses of the study drug, while 24 control group patients will receive no drug and will be followed during their hospitalisation. The control group will receive all standard treatments mandated by the institutional sepsis alert protocol. The phase II study will employ a permuted blocked randomisation technique, and the primary endpoint will be change in serum total cholesterol level (48 hours - enrolment). Secondary endpoints include change in cholesterol level from enrolment to 7 days, change in Sequential Organ Failure Assessment score over the first 48 hours and 7 days, in-hospital and 28-day mortality, lipid oxidation status, inflammatory biomarkers, and high-density lipoprotein function. ETHICS AND DISSEMINATION Investigators are trained and follow good clinical practices, and each phase of the study was reviewed and approved by the institutional review boards of each institution. Results of each phase will be disseminated through presentations at national meetings and publication in peer-reviewed journals. If promising, data from the pilot study will be used for a larger, multicentre, phase II clinical trial. TRIAL REGISTRATION NUMBER NCT03405870.
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Affiliation(s)
- Faheem W Guirgis
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Lauren Page Black
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | | | - Morgan Henson
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Jason Ferreira
- Pharmacy, University of Florida Health at Jacksonville, Jacksonville, Florida, USA
| | | | - Colleen Kalynych
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Lyle L Moldawer
- Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Taylor Miller
- Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Lisa Jones
- Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Marie Crandall
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Srinivasa T Reddy
- Medicine; Molecular and Medical Pharmacology, UCLA College of Medicine, Los Angeles, California, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Frederick A Moore
- Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
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Lin Z, Jin J, Shan X. Fish oils protects against cecal ligation and puncture‑induced septic acute kidney injury via the regulation of inflammation, oxidative stress and apoptosis. Int J Mol Med 2019; 44:1771-1780. [PMID: 31545434 PMCID: PMC6777667 DOI: 10.3892/ijmm.2019.4337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022] Open
Abstract
Septic acute kidney injury (AKI) is usually caused by sepsis. ω3 fatty acid has been reported to suppress sepsis-induced organ dysfunction to a certain degree. The present study aimed to investigate the effects of ω3 fatty acid in septic renal injury. Sprague Dawley rats were used to establish a cecal ligation and puncture (CLP) model in order to mimic the development of septic injury. The rats were treated with dexamethasone and fish oils (FOs) for 4 days prior to CLP. Alterations in the morphology of the tissues, the renal function and the induction of inflammation, oxidative stress and apoptosis were evaluated. The effects of FOs on nuclear factor-κB (NF-κB), JAK2/STAT3 and p38-MAPK were determined. The rats of the CLP model group exhibited low survival rates and increased expression of serum creatine, blood urea nitrogen, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1 and of proinflammatory cytokines. In addition, the levels of the markers of oxidative injury and apoptosis were increased. The induction of renal injury was notably reversed by administration of dexamethasone and FOs. The expression levels of the protein markers involved in inflammation and apoptosis were measured and the results indicated that FOs inhibited JAK/STAT3 and p-38MAPK signaling, while they concomitantly increased the expression of NF-κB. The present study highlighted that FOs improve CLP-induced mortality and renal injury by inhibiting inflammation, oxidative stress and apoptosis.
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Affiliation(s)
- Zhaoheng Lin
- Intensive Care Unit, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, Yunnan 666100, P.R. China
| | - Jing Jin
- Intensive Care Unit, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, Yunnan 666100, P.R. China
| | - Xiyun Shan
- Intensive Care Unit, The People's Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture, Jinghong, Yunnan 666100, P.R. China
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24
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Uhlig C, Rössel T, Denz A, Seifert S, Koch T, Heller AR. Effects of a metabolic optimized fast track concept (MOFA) on bowel function and recovery after surgery in patients undergoing elective colon or liver resection: a randomized controlled trial. BMC Anesthesiol 2019; 19:156. [PMID: 31421670 PMCID: PMC6698338 DOI: 10.1186/s12871-019-0823-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022] Open
Abstract
Background Enhanced recovery after surgery programs (ERAS) using thoracic epidural anesthesia and perioperative patient conditioning with omega-3 fatty acids (n3FA), glucose control (GC) and on-demand fluid therapy, respectively, showed beneficial effects. In the MOFA- study these components were used together in patients undergoing colon or liver surgery. We hypothesized that the use of a perioperative MOFA program improves intestine function represented as time to the first postoperative bowel movement in adult patients compared to standard ERAS. Methods After BfArM and IRB approval 100 patients were enrolled in this prospective randomized controlled trial. All patients received ERAS therapy (control). In addition, the MOFA group received 0.2 g/kg fish oil (Omegaven®), preoperatively, followed by a 48 h continuous infusion of 0.2 g/kg/d n3FA; and GC was kept below < 8 mmol/L. Pre- and postoperatively energy drinks were administered. Results As compared to control group the MOFA concept resulted in an earlier onset of flatulence by 14 h (46.6 ± 25.7, 32.0 ± 17.9, p = 0.030, hours, control vs. MOFA, respectively). Effects on onset of bowel movement were not observed (74.5 ± 30.4, 66.4 ± 29.2, p = 0.163, hours, control vs. MOFA, respectively). The disease severity (SAPS II score; p = 0.720) as well as deployment of resources (TISS 28 score, p = 0.709) did not differ between groups. No statistic significant difference between MOFA and control group regarding inflammation, impairment of coagulation, length of hospital stay or incidence of postoperative surgical complications were observed. Conclusions The MOFA concept did not result in an improvement of intestine function or faster recovery after elective colon or liver surgery compared to standard ERAS therapy. Omega-3 fatty acids showed no impairment of coagulation or improved resolution of inflammation. Further trials in a larger patient collective are needed to investigate potential beneficial effects of omega-3 fatty acids in abdominal surgery. Trial registration This trial was prospectively registered at the European Union Clinical Trials Register (EuDraCT 2005–004814-33, date: 10-05-2005, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2005-004814-33+). Electronic supplementary material The online version of this article (10.1186/s12871-019-0823-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Uhlig
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Thomas Rössel
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Axel Denz
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.,Department of General Surgery, University Hospital of Friedrich-Alexander-University, Erlangen, Germany
| | - Sven Seifert
- Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.,Department of Thorax, Vascular and Endovascular Surgery, Chemnitz Hospital, Chemnitz, Germany
| | - Thea Koch
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Axel Rüdiger Heller
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Anaesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
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25
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Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, de Heer G, Heller AR, Kampa U, Mayer K, Muhl E, Niemann B, Rümelin A, Steiner S, Stoppe C, Weimann A, Bischoff SC. Clinical Nutrition in Critical Care Medicine - Guideline of the German Society for Nutritional Medicine (DGEM). Clin Nutr ESPEN 2019; 33:220-275. [PMID: 31451265 DOI: 10.1016/j.clnesp.2019.05.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Enteral and parenteral nutrition of adult critically ill patients varies in terms of the route of nutrient delivery, the amount and composition of macro- and micronutrients, and the choice of specific, immune-modulating substrates. Variations of clinical nutrition may affect clinical outcomes. The present guideline provides clinicians with updated consensus-based recommendations for clinical nutrition in adult critically ill patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g., mechanical ventilation) to maintain organ function. METHODS The former guidelines of the German Society for Nutritional Medicine (DGEM) were updated according to the current instructions of the Association of the Scientific Medical Societies in Germany (AWMF) valid for a S2k-guideline. According to the S2k-guideline classification, no systematic review of the available evidence was required to make recommendations, which, therefore, do not state evidence- or recommendation grades. Nevertheless, we considered and commented the evidence from randomized-controlled trials, meta-analyses and observational studies with adequate sample size and high methodological quality (until May 2018) as well as from currently valid guidelines of other societies. The liability of each recommendation was described linguistically. Each recommendation was finally validated and consented through a Delphi process. RESULTS In the introduction the guideline describes a) the pathophysiological consequences of critical illness possibly affecting metabolism and nutrition of critically ill patients, b) potential definitions for different disease phases during the course of illness, and c) methodological shortcomings of clinical trials on nutrition. Then, we make 69 consented recommendations for essential, practice-relevant elements of clinical nutrition in critically ill patients. Among others, recommendations include the assessment of nutrition status, the indication for clinical nutrition, the timing and route of nutrient delivery, and the amount and composition of substrates (macro- and micronutrients); furthermore, we discuss distinctive aspects of nutrition therapy in obese critically ill patients and those treated with extracorporeal support devices. CONCLUSION The current guideline provides clinicians with up-to-date recommendations for enteral and parenteral nutrition of adult critically ill patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g., mechanical ventilation) to maintain organ function. The period of validity of the guideline is approximately fixed at five years (2018-2023).
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Affiliation(s)
- Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 12, 24105, Kiel, Germany.
| | - Wolfgang H Hartl
- Department of Surgery, University School of Medicine, Grosshadern Campus, Ludwig-Maximilian University, Marchioninistr. 15, 81377 Munich, Germany.
| | | | - Michael Adolph
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Thomas W Felbinger
- Department of Anesthesiology, Critical Care and Pain Medicine, Neuperlach and Harlaching Medical Center, The Munich Municipal Hospitals Ltd, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany.
| | - Tobias Graf
- Medical Clinic II, University Heart Center Lübeck, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Geraldine de Heer
- Center for Anesthesiology and Intensive Care Medicine, Clinic for Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Axel R Heller
- Clinic for Anesthesiology and Surgical Intensive Care Medicine, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Ulrich Kampa
- Clinic for Anesthesiology, Lutheran Hospital Hattingen, Bredenscheider Strasse 54, 45525, Hattingen, Germany.
| | - Konstantin Mayer
- Department of Internal Medicine, Justus-Liebig University Giessen, University of Giessen and Marburg Lung Center, Klinikstr. 36, 35392, Gießen, Germany.
| | - Elke Muhl
- Eichhörnchenweg 7, 23627, Gross Grönau, Germany.
| | - Bernd Niemann
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Rudolf-Buchheim-Str. 7, 35392, Gießen, Germany.
| | - Andreas Rümelin
- Clinic for Anesthesia and Surgical Intensive Care Medicine, HELIOS St. Elisabeth Hospital Bad Kissingen, Kissinger Straße 150, 97688, Bad Kissingen, Germany.
| | - Stephan Steiner
- Department of Cardiology, Pneumology and Intensive Care Medicine, St Vincenz Hospital Limburg, Auf dem Schafsberg, 65549, Limburg, Germany.
| | - Christian Stoppe
- Department of Intensive Care Medicine and Intermediate Care, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Delitzscher Straße 141, 04129, Leipzig, Germany.
| | - Stephan C Bischoff
- Department for Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599, Stuttgart, Germany.
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Feguri GR, Lima PRLD, Franco AC, Cruz FRHDL, Borges DC, Toledo LR, Segri NJ, Aguilar-Nascimento JED. Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion During CABG: a Double-Blind Controlled Randomized Trial. Braz J Cardiovasc Surg 2019; 34:125-135. [PMID: 30916121 PMCID: PMC6436776 DOI: 10.21470/1678-9741-2018-0336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To assess postoperative clinical data considering the association of
preoperative fasting with carbohydrate (CHO) loading and intraoperative
infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods 57 patients undergoing coronary artery bypass grafting (CABG) were randomly
assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia),
(CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5%
maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of
ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before
anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3,
n=14). The need for vasoactive drugs was analyzed, in addition to
postoperative inflammation and metabolic control. Results There were two deaths (3.5%). Patients in CHO groups presented a lower
incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94;
P=0.023), needed fewer vasoactive drugs during surgery
and ICU stay (P<0.05); and had better blood glucose
levels in the first six hours of recovery (P=0.015),
requiring less exogenous insulin (P=0.018). Incidence of
postoperative atrial fibrillation (POAF) varied significantly among groups
(P=0.009). Subjects who receive ω-3 PUFA groups
had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02;
P=0.001). Patients in the W3 group had lower
ultrasensitive-CRP levels at 36 h postoperatively
(P=0.008). Interleukin-10 levels varied among groups
(P=0.013), with the highest levels observed in the
postoperative of patients who received intraoperative infusion of ω-3
PUFA (P=0.049). Conclusion Fasting abbreviation with carbohydrate loading and intraoperative infusion of
ω-3 PUFA is safe and supports faster postoperative recovery in
patients undergoing on-pump CABG.
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Affiliation(s)
- Gibran Roder Feguri
- Department of Cardiology and Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Paulo Ruiz Lúcio de Lima
- Department of Cardiology and Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Anna Carolina Franco
- Department of Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | | | - Danilo Cerqueira Borges
- Department of Cardiology and Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Laura Ramos Toledo
- Department of Physical Therapy, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Neuber José Segri
- Department of Statistics, Universidade Federal do Mato Grosso (UFMT), Cuiabá, MT, Brazil
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Bae HJ, Lee GY, Seong JM, Gwak HS. Outcomes with perioperative fat emulsions containing omega-3 fatty acid: A meta-analysis of randomized controlled trials. Am J Health Syst Pharm 2019; 74:904-918. [PMID: 28596227 DOI: 10.2146/ajhp151015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of a meta-analysis of data from clinical studies comparing patient outcomes and hospital length of stay (LOS) in surgical patients receiving fish oil (FO)-containing i.v. fat emulsions (IVFEs) versus non-FO-containing IVFEs are presented. METHODS Computerized searches of the MEDLINE, Embase, and Coch rane CENTRAL databases were performed in August 2014 to identify English-language articles on randomized controlled trials (RCTs) comparing FO-containing and non-FO-containing IVFEs in adult surgical patients receiving parenteral nutrition. Selected articles were analyzed for methodological and publication bias and study heterogeneity (I2 statistic). RESULTS Data from 19 RCTs (total n = 1,167) were included in the meta-analysis. Compared with use of non-FO-containing IVFEs (products based in soybean oil [SO], medium-chain triglycerides, or olive oil), use of FO-containing IVFEs was associated with reduced infectious morbidity (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.30-0.65; p < 0.0001; I2 = 0%); the effect size was greatest for FO-containing versus SO-based IVFEs. Relative to use of SO-based IVFEs, use of FO-containing IVFEs was associated with a significant reduction in hospital LOS (weighted mean difference, -2.70 days; 95% CI, -3.60 to -1.79 days; p < 0.00001; I2 = 0%). CONCLUSION The results of the meta-analysis indicated that FO-containing IVFEs could improve infectious morbidity and LOS. The overall effect of reducing infectious morbidity and LOS was found to be the greatest in comparison with the SO-based IVFEs.
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Affiliation(s)
- Hye Jung Bae
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Gwan Young Lee
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Jong-Mi Seong
- Office of Drug Safety Information, Korea Institute of Drug Safety and Risk Management, Anyang, South Korea
| | - Hye Sun Gwak
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea.
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Mayer K, Sommer N, Hache K, Hecker A, Reiche S, Schneck E, Weissmann N, Seeger W, Hecker M. Resolvin E1 Improves Mitochondrial Function in Human Alveolar Epithelial Cells during Severe Inflammation. Lipids 2019; 54:53-65. [DOI: 10.1002/lipd.12119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Konstantin Mayer
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
| | - Natascha Sommer
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
| | - Karl Hache
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
| | - Andreas Hecker
- Department of General and Thoracic Surgery; University Hospital of Giessen, Rudolf-Buchheim-Str. 7; 35392 Giessen Germany
| | - Sylvia Reiche
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine; University Hospital of Giessen, Rudolf-Buchheim-Str. 7; 35392 Giessen Germany
| | - Norbert Weissmann
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
| | - Werner Seeger
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
- Max Planck Institute for Heart and Lung Research, Department of Lung Development and Remodelling, Ludwigstr. 43; 61231 Bad Nauheim Germany
| | - Matthias Hecker
- Medical Clinic II, University of Giessen and Marburg Lung Center (UGMLC); Justus-Liebig-University; Klinikstr. 33, 35392 Giessen Germany
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Donoghue V, Schleicher GK, Spruyt MGL, Malan L, Nel DG, Calder PC, Blaauw R. Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact). Clin Nutr 2018; 38:2583-2591. [PMID: 30638739 DOI: 10.1016/j.clnu.2018.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Data in critically ill patients on the effect of intravenous lipid emulsions (LEs), containing omega-3 polyunsaturated fatty acids (PUFAs), in parenteral nutrition (PN) are scarce and conflicting. This study compared the effects of a four-oil LE (30% soybean oil, 30% medium-chain triglycerides, 25% olive oil and 15% fish oil (FO)) (SMOFlipid®) to those of a 100% soybean oil-based LE in critically ill adult intensive care unit (ICU) patients. METHODS In this double-blind, randomised study, patients (n = 75) predicted to need PN for more than 5 days were randomised to receive either a four-oil LE (Study Group (SG)) or a 100% soybean oil LE (Control Group (CG)). Isocaloric, isonitrogenous PN was administered continuously for 5 days. FO was provided at a dose of 0.09-0.22 g/kg body weight. Measurements included biochemical parameters and sequential organ failure assessment (SOFA) score daily and plasma total phospholipid fatty acids (FAs) and cytokine levels on days 1, 3, 6. Days on mechanical ventilation, length of stay and mortality were also recorded. ANOVA was used to compare response variables between the two groups over the time and Pearson correlation was used to measure relationships between continuous variables. RESULTS 68 patients completed the study (n = 35 SG, n = 33 CG), with male predominance (66% SG, 56% CG). Average age was 60.8 ± 13.9 years (SG) versus 55.7 ± 14.8 (CG) (p = 0.143). The majority were surgical admissions (85% SG versus 91% CG) followed by medical. Plasma phospholipid oleic acid (p = 0.022) and alpha-linolenic acid (p<0.0005) increased in both groups. In the SG, plasma phospholipid EPA and DHA increased (both p<0.001), whereas the omega-6:omega-3 PUFA (n-6:n-3 PUFA) ratio decreased (p < 0.001). Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin decreased in both treatment groups. Considering only the change from day 1 to day 6 there was a bigger decrease in AST, ALT and bilirubin levels in the SG. Concentrations of TNF-α decreased from day 1 to day 6 in the SG, whereas they increased in the CG, but the change was not statistically significant (p = 0.112). A significant negative correlation was found between EPA provision on day 3 and the SOFA score (r = -0.4047, p = 0.018). Days on mechanical ventilation (1.24 ± 0.83 days in SG versus 0.88 ± 1.63 days in CG, p = 0.385) and ICU LOS (9.5 ± 7.09 days in SG versus 10.7 ± 7.6 days in CG, p = 0.490) were not different between groups. CONCLUSION PN containing a four-oil LE increased plasma EPA and DHA, decreased n-6:n-3 PUFA ratio, and was safe and well tolerated. The negative relationship between day 3 EPA and SOFA score seems promising, but EPA intake and effects may have been diluted by enteral nutrition which was started in more than half of patients on day 4. There was no significant difference in terms of other biochemical measurements, SOFA score, length of ICU stay and mortality. More research is needed in this patient population, particularly regarding dose, duration and timing of FO and the effects on clinical outcomes.
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Affiliation(s)
- V Donoghue
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - G K Schleicher
- Wits Donald Gordon Medical Centre ICU, Parktown, Johannesburg, South Africa
| | - M G L Spruyt
- Critical Care, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - L Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, South Africa
| | - D G Nel
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - P C Calder
- Faculty of Medicine, University of Southampton, UK and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - R Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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30
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Meng Z, Dong Y, Gao H, Yao D, Gong Y, Meng Q, Zheng T, Cui X, Su X, Tian Y. The effects of ω-3 fish oil emulsion-based parenteral nutrition plus combination treatment for acute paraquat poisoning. J Int Med Res 2018; 47:600-614. [PMID: 30392424 PMCID: PMC6381463 DOI: 10.1177/0300060518806110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate the effects of parenteral nutrition (PN) including ω-3 fish-oil emulsion on nutritional state, inflammatory response, and prognosis in patients with acute paraquat poisoning. Methods Patients randomized to receive medium chain triglycerides (MCT)/long chain triglycerides (LCT)-based PN (control group) or MCT/LCT-based PN containing ω-3 fish-oil emulsion (intervention group) were compared for 90-day survival and short-term treatment efficacy. Results Tumour necrosis factor-α levels were significantly lower in the intervention group (n = 101) versus controls (n = 73) on treatment days 4 and 7. Intervention group C-reactive protein (CRP) levels were significantly increased on day 4, decreased to baseline (day 1) levels on day 7, and were significantly lower than baseline on day 10. Control group CRP levels were significantly increased on days 4 and 7 versus baseline, and returned to baseline levels on day 10. On day 7, retinol binding protein had recovered to baseline levels in the intervention group only. Intervention group mortality rate (36.6%) was significantly lower than controls (57.5%). ω-3 fish-oil PN was associated with reduced risk of death (hazard ratio 0.52; 95% confidence interval 0.33, 0.82). Conclusion In patients with acute paraquat poisoning, MCT/LCT with ω-3 fish-oil emulsion PN plus combination treatment advantageously attenuated the inflammatory response, modified the nutritional state, and was associated with significantly improved 90-day survival versus treatment without ω-3 fish oil.
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Affiliation(s)
- Zhaohua Meng
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Yanling Dong
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Hengbo Gao
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Dongqi Yao
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Yu Gong
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Qingbing Meng
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Tuokang Zheng
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Xiaolei Cui
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Xiaoyun Su
- 2 Division of Health Care, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
| | - Yingping Tian
- 1 Emergency Department, Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, China
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Shih JM, Shih YM, Hou YC, Pai MH, Yeh CL, Yeh SL. Effects of fish oil-based lipid emulsion on inflammation and kidney injury in mice subjected to unilateral hind limb ischemia/reperfusion. Cytokine 2018; 111:49-57. [DOI: 10.1016/j.cyto.2018.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/24/2018] [Accepted: 07/31/2018] [Indexed: 02/08/2023]
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Hecker M, Sommer N, Foch S, Hecker A, Hackstein H, Witzenrath M, Weissmann N, Seeger W, Mayer K. Resolvin E1 and its precursor 18R-HEPE restore mitochondrial function in inflammation. Biochim Biophys Acta Mol Cell Biol Lipids 2018; 1863:1016-1028. [DOI: 10.1016/j.bbalip.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/10/2018] [Accepted: 06/10/2018] [Indexed: 01/14/2023]
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Safety and efficacy of n-3 fatty acid-based parenteral nutrition in patients with obstructive jaundice: a propensity-matched study. Eur J Clin Nutr 2018; 72:1159-1166. [PMID: 30006616 PMCID: PMC6085574 DOI: 10.1038/s41430-018-0256-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
Background It is reported that lipid emulsion enriched in n-3 fatty acids (FAs) helps us to improve postoperative recovery for surgical patients with biliary tract disease. Its role for postoperative patients with obstructive jaundice is as yet unclear. The object of this study was to evaluate the safety and efficacy of n-3 fatty acid-based parenteral nutrition (PN) for patients with obstructive jaundice following surgical procedures. Methods Data were collected from patients with obstructive jaundice who received PN, including n-3 PUFA-enriched lipid emulsions and standard non-enriched lipid emulsions (e.g., soybean oil). We then calculated a propensity score, the probability of receiving different PN, by the propensity score matched (PSM) method. After matching, we compared isonitrogenous total PN with 20% Structolipid and 10% n-3 fatty acid (Omegaven, Fresenius-Kabi, Germany) (treatment group) to Structolipid alone (control group) for 5 days postoperatively, in the absence of enteral nutrition. Results Before the propensity score matching, there were 226 patients enrolled. After propensity score stratification, 108 cases remained, and all covariates were balanced. Among matched patients with PN, patients in the control group were at a higher risk for long-term jaundice recovery (12.9 ± 8.5 VS 16.4 ± 7.9 P = 0.029), lower velocity of reduction in jaundice (P = 0.045), and lower pre-albumin (P = 0.002). No significant difference as found in terms of comorbidities, white blood cell (WBC), albumin and other aspects. Conclusion PN with n-3 PUFA-enriched lipid emulsions was safe and effective in accelerating jaundice recovery for patients after surgical procedures. This trial was registered at clinicaltrials.gov as NCT03376945.
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Zhao Y, Wang C. Effect of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition on inflammatory and immune function in postoperative patients with gastrointestinal malignancy: A meta-analysis of randomized control trials in China. Medicine (Baltimore) 2018; 97:e0472. [PMID: 29668624 PMCID: PMC5916652 DOI: 10.1097/md.0000000000010472] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There are no consensus regarding the efficacy of omega-3polyunsaturated fatty acids (PUFAs) on inflammatory and immune function in postoperative patients with gastrointestinal malignancy. METHODS The literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. RESULTS Sixteen RCTs involving 1008 patients (506 in the omega-3 group, 502 in the control group) were enrolled into the analysis. The results of meta-analysis: the cell immunity: The proportions of CD3, CD4, CD4/CD8 in the omega-3 group were significantly higher than those in the control group (CD3: WMD = 4.48; 95% CI, 3.34-5.62; P < .00001; I = 0%; CD4: WMD = 5.55; 95% CI, 4.75-6.34; P < .00001; I = 0%; CD4/CD8: WMD = .28; 95% CI, 0.13-0.44; P = .0004; I = 81%). In the humoral immunity: The levels of IgA, IgM and IgG in the omega-3 group were significantly higher than those in the control group (IgA: WMD = 0.31; 95% CI, 0.25-0.37; P < .00001; I = 0%; IgM: WMD = 0.12; 95% CI, 0.06-1.81; P < .00001; I = 0%; IgG: WMD = 1.19; 95% CI, 0.80-1.58; P < .00001; I = 0%). The count of lymphocyte in the omega-3 group was significantly higher than that in the control group (WMD = 0.22; 95% CI, 0.12-0.33; P < .0001; I = 40%). In the postoperative inflammatory cytokine: The levels of interleukin-6, tumor necrosis factor (TNF)-α and C-reactive protein in the omega-3 group were significantly lower than those in the control group (IL-6: WMD = -3.09; 95% CI, -3.91 to 2.27; P < .00001; I = 45%; TNF-α: WMD = -1.65; 95% CI, -2.05 to 1.25; P < .00001; I = 28%; CRP: WMD = -4.28; 95% CI, -5.26 to 3.30; P < .00001; I = 37%). The rate of postoperative infective complications in the omega-3 group was significantly lower than that in the control group (OR = 0.36; 95% CI, 0.20-0.66; P = .0008; I = 0%). CONCLUSION This meta-kanalysis confirmed that early intervention with Omega -3 fatty acid emulsion in gastrointestinal cancer can not only improve the postoperative indicators of immune function, reduce inflammatory reaction, and improve the postoperative curative effect but also improve the immune suppression induced by conventional PN or tumor. Therefore, postoperative patients with gastrointestinal cancer should add omega-3 unsaturated fatty acids in their PN formula. Further high-quality RCTs are needed to verify its efficacy.
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Potentially Important Therapeutic Interactions between Antibiotics, and a Specially Engineered Emulsion Drug Vehicle Containing Krill-Oil-Based Phospholipids and Omega-3 Fatty Acids. Antibiotics (Basel) 2018. [PMID: 29534425 PMCID: PMC5872133 DOI: 10.3390/antibiotics7010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of antimicrobial resistance (AMR) worldwide is increasing as the pipeline for the development of new chemotherapeutic entities is decreasing. Clearly, overexposure to antibiotics, including excessive dosing, is a key factor that fuels AMR. In fact, most of the new antibacterial agents under development are derivatives of existing classes of antibiotics. Novel approaches involving unique antimicrobial combinations, targets, and/or delivery systems are under intense investigation. An innovative combination of active pharmaceutical ingredients (APIs) consisting of antimicrobial drug(s), krill-oil-based phospholipids, and omega-3 fatty acid triglycerides, that may extend the therapeutic viability of currently effective antibiotics, at least until new chemical entities are introduced, is described.
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Saito G, Zapata R, Rivera R, Zambrano H, Rojas D, Acevedo H, Ravera F, Mosquera J, Vásquez JE, Mura J. Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: A randomized pilot trial of pharmaconutrition. Surg Neurol Int 2017; 8:304. [PMID: 29404191 PMCID: PMC5764917 DOI: 10.4103/sni.sni_266_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Functional recovery after aneurysmal subarachnoid hemorrhage (SAH) remains a significant problem. We tested a novel therapeutic approach with long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) to assess the safety and feasibility of an effectiveness trial. METHODS We conducted a multicentre, parallel, randomized, open-label pilot trial. Patients admitted within 72 hours after SAH with modified Fisher scale scores of 3 or 4 who were selected for scheduled aneurysm clipping were allocated to receive either n-3 PUFA treatment (parenteral perioperative: 5 days; oral: 8 weeks) plus usual care or usual care alone. Exploratory outcome measures included major postoperative intracranial bleeding complications (PIBCs), cerebral infarction caused by delayed cerebral ischemia, shunt-dependent hydrocephalus, and consent rate. The computed tomography evaluator was blinded to the group assignment. RESULTS Forty-one patients were randomized, but one patient had to be excluded after allocation. Twenty patients remained for intention to treat analysis in each trial arm. No PIBs (95% confidence interval [CI]: 0.00 to 0.16) or other unexpected harm were observed in the intervention group (IG). No patient suspended the intervention due to side effects. There was a trend towards improvements in all benefit-related outcomes in the IG. The overall consent rate was 0.91 (95% CI: 0.78 to 0.96), and there was no consent withdrawal. CONCLUSIONS Although the balance between the benefit and harm of the intervention appears highly favourable, further testing on SAH patients is required. We recommend proceeding with amendments in a dose-finding trial to determine the optimal duration of parenteral treatment.
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Affiliation(s)
- Geisi Saito
- Department of Anaesthesiology, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Rodrigo Zapata
- Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - Rodrigo Rivera
- Chief of Neuroradiology Service, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Héctor Zambrano
- Neurology Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - David Rojas
- Department of Neurological Sciences, Universidad de Chile, Santiago, Chile
- Neurosurgery Service, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Hernán Acevedo
- Neurosurgery Service, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
| | - Franco Ravera
- Chief of Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, and Department of Neurosurgery, Universidad de Chile, Santiago, Chile
| | - John Mosquera
- Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - Juan E. Vásquez
- Neurosurgery Service, Hospital Regional Libertador Bernardo O’Higgins, Rancagua, Santiago, Chile
| | - Jorge Mura
- Department of Neurological Sciences, Universidad de Chile, Santiago, Chile
- Chief of Cerebrovascular and Skull Base Surgery, Instituto de Neurocirugía Asenjo, Providencia, Santiago, Chile
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Boivin A, Burban M, Clere-Jehl R, Le Borgne P, Merdji H, Auger C, Schini-Kerth V, Meziani F, Helms J. Docosahexaenoic acid, but not eicosapentaenoic acid, improves septic shock-induced arterial dysfunction in rats. PLoS One 2017; 12:e0189658. [PMID: 29261735 PMCID: PMC5738044 DOI: 10.1371/journal.pone.0189658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Long chain n-3 fatty acid supplementation may modulate septic shock-induced host response to pathogen-induced sepsis. The composition of lipid emulsions for parenteral nutrition however remains a real challenge in intensive care, depending on their fatty acid content. Because they have not been assessed yet, we aimed at determining the respective effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) during septic shock-induced vascular dysfunction. Methods In a peritonitis-induced septic shock model, rats were infused with EPA, DHA, an EPA/DHA mixture or 5% dextrose (D5) during 22 hours. From H18, rats were resuscitated and monitored during 4 hours. At H22, plasma, aorta and mesenteric resistance arteries were collected to perform ex vivo experiments. Results We have shown that septic rats needed an active resuscitation with fluid challenge and norepinephrine treatment, while SHAM rats did not. In septic rats, norepinephrine requirements were significantly decreased in DHA and EPA/DHA groups (10.6±12.0 and 3.7±8.0 μg/kg/min respectively versus 17.4±19.3 μg/kg/min in D5 group, p<0.05) and DHA infusion significantly improved contractile response to phenylephrine through nitric oxide pathway inhibition. DHA moreover significantly reduced vascular oxidative stress and nitric oxide production, phosphorylated IκB expression and vasodilative prostaglandin production. DHA also significantly decreased polyunsaturated fatty acid pro-inflammatory mediators and significantly increased several anti-inflammatory metabolites. Conclusions DHA infusion in septic rats improved hemodynamic dysfunction through decreased vascular oxidative stress and inflammation, while EPA infusion did not have beneficial effects.
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Affiliation(s)
- Alexandra Boivin
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Mélanie Burban
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
| | - Raphaël Clere-Jehl
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Pierrick Le Borgne
- Service d'accueil des Urgences, Hôpital de Hautepierre, CHU de Strasbourg, 1, Strasbourg, France
| | - Hamid Merdji
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Cyril Auger
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
| | - Valérie Schini-Kerth
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
| | - Ferhat Meziani
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, nouvel hôpital civil, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Julie Helms
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
- Université de Strasbourg, INSERM, EFS Grand Est, BPPS UMR-S 949, FMTS, Strasbourg, France
- * E-mail:
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Abbasoglu O, Hardy G, Manzanares W, Pontes-Arruda A. Fish Oil-Containing Lipid Emulsions in Adult Parenteral Nutrition: A Review of the Evidence. JPEN J Parenter Enteral Nutr 2017; 43:458-470. [PMID: 28792885 DOI: 10.1177/0148607117721907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is evidence from laboratory and animal studies that fish oil-containing intravenous lipid emulsions (FOC-IVLEs) have a beneficial effect on inflammation and the immune response, suggesting a possible clinical benefit. Clinical studies of FOC-IVLEs have reported mixed results. The aim of this review is to present findings from recent randomized controlled clinical trials and other quality clinical studies investigating the effects of administering intravenous fish oil alone or as part of a multilipid emulsion and to examine the quality of these studies in an objective, evidence-based manner. METHODS Studies comparing FOC-IVLEs with other IVLEs in adults were included. Thirty-four clinical studies were evaluated: 19 investigated levels of inflammatory and immune markers as an endpoint; 13 investigated rates of infection or sepsis; 3 investigated clinical outcomes in septic patients; and 29 investigated general clinical outcomes. RESULTS There was conflicting evidence for a beneficial effect of fish oil on levels of inflammatory and immune markers and some evidence that fish oil decreased the rate of postoperative atrial fibrillation. Studies generally reported few statistical differences in clinical outcomes and rates of infection and sepsis with FOC-IVLEs as compared with other IVLEs. The quality of reporting was generally poor, and the presented evidence for comparisons between FOC-IVLEs and other IVLEs was inconclusive or weak. CONCLUSIONS There is very little high-quality evidence that FOC-IVLEs have a more beneficial effect than other IVLEs on clinical outcomes in adult patients.
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Affiliation(s)
- Osman Abbasoglu
- Division of Nutrition Support, Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gil Hardy
- College of Health, Massey University, Auckland, New Zealand
| | - William Manzanares
- Intensive Care Unit, Department of Critical Care, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
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Effects of ω-3 Fatty Acids on Toll-like Receptor 4 and Nuclear Factor κB p56 in the Pancreas of Rats With Severe Acute Pancreatitis. Pancreas 2017; 46:1267-1274. [PMID: 28984787 DOI: 10.1097/mpa.0000000000000935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aims of this study were to determine the effects of ω-3 fatty acids (ω-3FAs) on the Toll-like receptor 4 (TLR4)/nuclear factor κB p56 (NF-κBp56) signaling pathway in the pancreas of rats with severe acute pancreatitis (SAP). METHODS Sixty-four Sprague-Dawley rats were randomly divided into 4 groups: the control, SAP-saline, SAP-soybean oil, and SAP-ω-FA groups. Severe acute pancreatitis was induced by the retrograde infusion of sodium taurocholate into the pancreatic duct. The expression of TLR4 and NF-κBp56 in the pancreas was evaluated by immunohistochemistry and Western blot analysis. The levels of the proinflammatory cytokines interleukin 6 and tumor necrosis factor α in the pancreas were measured by enzyme-linked immunosorbent assays. RESULTS Toll-like receptor 4, NF-κBp56, and inflammatory cytokine expression in the pancreas was increased significantly in the SAP group compared with that in the control group (P < 0.05), but was significantly decreased in the ω-3FA group compared with that in the soybean oil group at 24 and 48 hours (P < 0.05). CONCLUSIONS Our results suggest that during the initial stage of SAP ω-3FAs could efficiently lower the inflammatory response by activating the TLR4/NF-κBp56 signaling pathway.
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Calder PC, Adolph M, Deutz NE, Grau T, Innes JK, Klek S, Lev S, Mayer K, Michael-Titus AT, Pradelli L, Puder M, Vlaardingerbroek H, Singer P. Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group. Clin Nutr 2017; 37:1-18. [PMID: 28935438 DOI: 10.1016/j.clnu.2017.08.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
This article summarizes the presentations given at an ESPEN Workshop on "Lipids in the ICU" held in Tel Aviv, Israel in November 2014 and subsequent discussions and updates. Lipids are an important component of enteral and parenteral nutrition support and provide essential fatty acids, a concentrated source of calories and building blocks for cell membranes. Whilst linoleic acid-rich vegetable oil-based enteral and parenteral nutrition is still widely used, newer lipid components such as medium-chain triglycerides and olive oil are safe and well tolerated. Fish oil (FO)-enriched enteral and parenteral nutrition appears to be well tolerated and confers additional clinical benefits, particularly in surgical patients, due to its anti-inflammatory and immune-modulating effects. Whilst the evidence base is not conclusive, there appears to be a potential for FO-enriched nutrition, particularly administered peri-operatively, to reduce the rate of complications and intensive care unit (ICU) and hospital stay in surgical ICU patients. The evidence for FO-enriched nutrition in non-surgical ICU patients is less clear regarding its clinical benefits and additional, well-designed large-scale clinical trials need to be conducted in this area. The ESPEN Expert Group supports the use of olive oil and FO in nutrition support in surgical and non-surgical ICU patients but considers that further research is required to provide a more robust evidence base.
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Affiliation(s)
- Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, United Kingdom.
| | - Michael Adolph
- Department of Anesthesiology and Intensive Care Medicine, Nutrition Support Team, University Clinic Tübingen, 72074 Tübingen, Germany
| | - Nicolaas E Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Teodoro Grau
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Jacqueline K Innes
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Stanislaw Klek
- General and Oncology Surgery Unit, Intestinal Failure Center, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Shaul Lev
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Hasharon Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Konstantin Mayer
- Department of Internal Medicine, Med. Clinik II, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Adina T Michael-Titus
- Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Lorenzo Pradelli
- AdRes Health Economics and Outcomes Research, 10121 Turin, Italy
| | - Mark Puder
- Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Hester Vlaardingerbroek
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Hasharon Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kreymann KG, Heyland DK, de Heer G, Elke G. Intravenous fish oil in critically ill and surgical patients - Historical remarks and critical appraisal. Clin Nutr 2017; 37:1075-1081. [PMID: 28747247 DOI: 10.1016/j.clnu.2017.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 05/15/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022]
Abstract
The purpose of this review is to explain the historical and clinical background for intravenous fish oil administration, to evaluate its results by using a product specific metaanalysis, and to stimulate further research in the immune-modulatory potential of fish oil. Concerning the immune-modulatory effects of fatty acids, a study revealed that ω-3 as well as ω-6 fatty acids would prolong transplant survival, and only a mixture with an ω-6:ω-3 ratio of 2.1:1 would give immune-neutral results. In 1998, the label of a newly registered fish oil emulsion also acknowledged this immune-neutral ratio in conjunction with ω-6 lipids. Also, two fish oil-supplemented fat emulsions, registered in 2004, used a similar ω-6:ω-3 ratio. Such an immune-neutral ω-6:ω-3 ratio denoted progress for most patients compared to pure ω-6 lipid emulsions. However, this immune-neutrality might on the other hand be responsible for the limited positive clinical results gained so far in critically ill and surgical patients where in most cases significance could only be shown for the pooled effect of numerous trials. Our product specific metaanalysis also did not reveal any differences, neither in infections rates nor in ICU or hospital length of stay. To evaluate the immune-modulatory effect of fish oil administered alone, new dose finding studies, reporting relevant clinical outcome parameters, are required. Precise mechanistic or physiological biomarkers for the indication of such a therapy should also be developed and validated.
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Affiliation(s)
- K Georg Kreymann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany.
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Geraldine de Heer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany.
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
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Lu C, Sharma S, McIntyre L, Rhodes A, Evans L, Almenawer S, Leduc L, Angus DC, Alhazzani W. Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials. Ann Intensive Care 2017; 7:58. [PMID: 28585162 PMCID: PMC5459780 DOI: 10.1186/s13613-017-0282-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear. METHODS We searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome. RESULTS A total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) -3.79 days; 95% CI -5.49, -2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD -2.27 days; 95% CI -4.27, -0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results. CONCLUSION Omega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.
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Affiliation(s)
- Clara Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sunjay Sharma
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Andrew Rhodes
- Department of Intensive Care Medicine, St George's Hospital, Blackshaw Road, London, UK
| | - Laura Evans
- Department of Medicine, Division of Pulmonary Medicine and Critical Care, New York University, New York City, NY, USA
| | - Saleh Almenawer
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Lori Leduc
- St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, L8N 4A6, Hamilton, ON, Canada
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Waleed Alhazzani
- St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, L8N 4A6, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada. .,Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.
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Bonaterra GA, Driscoll D, Schwarzbach H, Kinscherf R. Krill Oil-In-Water Emulsion Protects against Lipopolysaccharide-Induced Proinflammatory Activation of Macrophages In Vitro. Mar Drugs 2017; 15:md15030074. [PMID: 28294970 PMCID: PMC5367031 DOI: 10.3390/md15030074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/07/2017] [Accepted: 03/10/2017] [Indexed: 12/29/2022] Open
Abstract
Background: Parenteral nutrition is often a mandatory therapeutic strategy for cases of septicemia. Likewise, therapeutic application of anti-oxidants, anti-inflammatory therapy, and endotoxin lowering, by removal or inactivation, might be beneficial to ameliorate the systemic inflammatory response during the acute phases of critical illness. Concerning anti-inflammatory properties in this setting, omega-3 fatty acids of marine origin have been frequently described. This study investigated the anti-inflammatory and LPS-inactivating properties of krill oil (KO)-in-water emulsion in human macrophages in vitro. Materials and Methods: Differentiated THP-1 macrophages were activated using specific ultrapure-LPS that binds only on the toll-like receptor 4 (TLR4) in order to determine the inhibitory properties of the KO emulsion on the LPS-binding capacity, and the subsequent release of TNF-α. Results: KO emulsion inhibited the macrophage binding of LPS to the TLR4 by 50% (at 12.5 µg/mL) and 75% (at 25 µg/mL), whereas, at 50 µg/mL, completely abolished the LPS binding. Moreover, KO (12.5 µg/mL, 25 µg/mL, or 50 µg/mL) also inhibited (30%, 40%, or 75%, respectively) the TNF-α release after activation with 0.01 µg/mL LPS in comparison with LPS treatment alone. Conclusion: KO emulsion influences the LPS-induced pro-inflammatory activation of macrophages, possibly due to inactivation of the LPS binding capacity.
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Affiliation(s)
- Gabriel A Bonaterra
- Department of Medical Cell Biology, Philipps-University Marburg, Robert-Koch-Straße 8, 35032 Marburg, Germany.
| | - David Driscoll
- Stable Solutions LLC, Easton Industrial Park, 19 Norfolk Avenue, South Easton, MA 02375, USA.
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - Hans Schwarzbach
- Department of Medical Cell Biology, Philipps-University Marburg, Robert-Koch-Straße 8, 35032 Marburg, Germany.
| | - Ralf Kinscherf
- Department of Medical Cell Biology, Philipps-University Marburg, Robert-Koch-Straße 8, 35032 Marburg, Germany.
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Al-Biltagi MAM, Abo-Elezz AAE, Abd-Elhafez MA, Mabrouk MM, Suliman GA. Beneficial Effects of Omega-3 Supplement to the Enteral Feeding in Children With Mild to Moderate Sepsis. J Intensive Care Med 2017; 32:212-217. [PMID: 26704762 DOI: 10.1177/0885066615623927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective was to investigate the benefits of supplementing enteral feeding with omega-3 fatty acids in children with mild to moderate sepsis and its effects on acute-phase reactants and interleukin 6 (IL-6) level. METHODS The study was a prospective randomized, double-blind, placebo-controlled study from January 2012 to June 2014, which included 2 groups of children with mild to moderate sepsis tolerating enteral feeding. Group A included 60 children supplemented with omega-3 fatty acids, whereas group B included 60 children who received enteral feeding without omega-3 supplementation. Both groups had complete blood pictures, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum albumin, and IL-6 before and after 7 days from supplementation. RESULTS There was a significant improvement in hemoglobin percentage ( P < .0001), total white blood cell (WBC) count ( P < .0001), and platelet count ( P < .0001) and significant decrease in CRP ( P < .0001), ESR ( P < .0001), IL-6 ( P < .0001), and albumin level ( P < .001) in the supplemented group than the nonsupplemented group. The supplemented group also had a significantly shorter duration of stay in pediatric intensive care unit (PICU; P < .01) and decreased death rate than the nonsupplemented group. CONCLUSION Children with mild to moderate sepsis showed significant improvement in inflammatory markers and had shorter PICU admission when enteral feeding was supplemented with omega-3 essential fatty acids.
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Affiliation(s)
| | | | | | - Maaly Mohamed Mabrouk
- 2 Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Miao HJ, Wang D, Ge XH, Li XN. [Effects of ω-3 polyunsaturated fatty acids on lymphocyte apoptosis rate in rats with sepsis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:355-360. [PMID: 28302212 PMCID: PMC7390154 DOI: 10.7499/j.issn.1008-8830.2017.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the effects of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) on the apoptosis of thymic and splenic lymphocytes in rats with sepsis. METHODS A total of 80 female Sprague-Dawley rats aged 7-8 weeks were randomly divided into model group, conventional lipid emulsion group (0.1 g/kg daily), low-dose ω-3 PUFAs group (0.1 g/kg daily), middle-dose ω-3 PUFAs group (0.2 g/kg daily), and high-dose ω-3 PUFAs group (0.3 g/kg daily). Cecal ligation and puncture were used to establish a rat model of sepsis. The treatment groups were then given tail vein injection of lipid emulsion or glucose diluents of ω-3 PUFAs at different doses, and the model group was given glucose injection via the tail vein at the same dose. According to the time of sacrifice, each group was further divided into 24-hour and 72-hour subgroups, with 8 rats in each subgroup. Hematoxylin and eosin staining was used to observe the pathological changes in the thymus and spleen. TUNEL was used to measure the apoptosis rates of thymic and splenic lymphocytes. RESULTS In the three ω-3 PUFAs groups, the rats had a complete thymic lobular structure and clear structures of the cortex and medulla. In the model and the conventional lipid emulsion groups, the boundaries of the cortex and medulla were unclear and the number of lymphocytes was significantly reduced. In the ω-3 PUFAs groups, the structure of the red and white pulp of the spleen was maintained with the presence of splenic follicles, while in the model and the conventional lipid emulsion groups, the structure of the red and white pulp of the spleen was disordered and splenic follicles were significantly reduced or disappeared. Compared with the model and the conventional lipid emulsion groups, the ω-3 PUFAs groups showed significant reductions in the apoptosis rates of thymic and splenic lymphocytes at 24 and 72 hours (P<0.01). Compared with the low-dose ω-3 PUFAs group, the high-dose ω-3 PUFAs group had significantly reduced apoptosis rates of splenic lymphocytes at 24 and 72 hours (P<0.05). CONCLUSIONS ω-3 PUFAs can reduce the apoptosis of thymic and splenic lymphocytes in rats with sepsis in a dose-dependent manner.
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Affiliation(s)
- Hong-Jun Miao
- Emergency Department, Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
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Effect of Oral ω3-Polyunsaturated Fatty Acids as a Complement Management to Control Fistula Output and Inflammation in Patients With Digestive Fistula. J Gastrointest Surg 2017; 21:453-462. [PMID: 27909869 DOI: 10.1007/s11605-016-3333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/17/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The presence of digestive fistula involves chronic inflammation and fibrosis. It has been reported that ω3-polyunsaturated fatty acids stimulate the resolution of inflammation. AIM Determine if the administration of oral ω3 reduces fistula output and the time required for fistula closure. METHODS Forty-nine patients with postoperative fistula were randomly divided in two groups: 26 received conventional treatment and 23 received the conventional treatment supplemented with ω3 (540 mg eicosapentaenoic acid and 360 mg docosahexaenoic acid) for 35 days. Patients were monitored daily for fistula output and spontaneous closure. Additionally, serum pro-inflammatory cytokines and C-reactive protein were quantified in four patients with conventional and in seven patients with ω3 treatment. RESULTS Patients with ω3 had significantly decreased fistula output from days 2 to 27, compared to control (p < 0.05). Spontaneous fistula closure was achieved in 15 patients (65%) in the ω3 group and in 14 (54%) in the control group. ω3-polyunsaturated fatty intake also decreased the serum concentrations of interleukin-6 and C-reactive protein (p < 0.05). CONCLUSIONS Our results suggest that ω3 supplementation to conventional medical treatment decreases fistula output and reduces inflammation (interleukin-6 and C-reactive protein), and these effects may increase the efficiency of conventional medical treatment.
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Pretreatment with Fish Oil-Based Lipid Emulsion Modulates Muscle Leukocyte Chemotaxis in Murine Model of Sublethal Lower Limb Ischemia. Mediators Inflamm 2017; 2017:4929346. [PMID: 28182087 PMCID: PMC5274663 DOI: 10.1155/2017/4929346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/22/2016] [Indexed: 01/02/2023] Open
Abstract
This study investigated the effects of a fish oil- (FO-) based lipid emulsion on muscle leukocyte chemotaxis and inflammatory responses in a murine model of limb ischemia-reperfusion (IR) injury. Mice were assigned randomly to 1 sham (sham) group, 2 ischemic groups, and 2 IR groups. The sham group did not undergo the ischemic procedure. The mice assigned to the ischemic or IR groups were pretreated intraperitoneally with either saline or FO-based lipid emulsion for 3 consecutive days. The IR procedure was induced by applying a 4.5 oz orthodontic rubber band to the left thigh above the greater trochanter for 120 min and then cutting the band to allow reperfusion. The ischemic groups were sacrificed immediately while the IR groups were sacrificed 24 h after reperfusion. Blood, IR-injured gastrocnemius, and lung tissues were collected for analysis. The results showed that FO pretreatment suppressed the local and systemic expression of several IR-induced proinflammatory mediators. Also, the FO-pretreated group had lower blood Ly6ChiCCR2hi monocyte percentage and muscle M1/M2 ratio than the saline group at 24 h after reperfusion. These findings suggest that FO pretreatment may have a protective role in limb IR injury by modulating the expression of proinflammatory mediators and regulating the polarization of macrophage.
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Gura K, Strijbosch R, Arnold S, McPherson C, Puder M. The Role of an Intravenous Fat Emulsion Composed of Fish Oil in a Parenteral Nutrition-Dependent Patient With Hypertriglyceridemia. Nutr Clin Pract 2017; 22:664-72. [DOI: 10.1177/0115426507022006664] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kathleen Gura
- Children's Hospital Boston, Boston, Massachusetts; and the University of North Carolina, Chapel Hill, North Carolina
| | - Robbert Strijbosch
- Children's Hospital Boston, Boston, Massachusetts; and the University of North Carolina, Chapel Hill, North Carolina
| | - Sarah Arnold
- Children's Hospital Boston, Boston, Massachusetts; and the University of North Carolina, Chapel Hill, North Carolina
| | - Christopher McPherson
- Children's Hospital Boston, Boston, Massachusetts; and the University of North Carolina, Chapel Hill, North Carolina
| | - Mark Puder
- Children's Hospital Boston, Boston, Massachusetts; and the University of North Carolina, Chapel Hill, North Carolina
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Ceulemans LJ, Braza F, Monbaliu D, Jochmans I, De Hertogh G, Du Plessis J, Emonds MP, Kitade H, Kawai M, Li Y, Zhao X, Koshiba T, Sprangers B, Brouard S, Waer M, Pirenne J. The Leuven Immunomodulatory Protocol Promotes T-Regulatory Cells and Substantially Prolongs Survival After First Intestinal Transplantation. Am J Transplant 2016; 16:2973-2985. [PMID: 27037650 DOI: 10.1111/ajt.13815] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/20/2016] [Accepted: 03/29/2016] [Indexed: 01/25/2023]
Abstract
Intestinal transplantation (ITx) remains challenged by frequent/severe rejections and immunosuppression-related complications (infections/malignancies/drug toxicity). We developed the Leuven Immunomodulatory Protocol (LIP) in the lab and translated it to the clinics. LIP consists of experimentally proven maneuvers, destined to promote T-regulatory (Tregs)-dependent graft-protective mechanisms: donor-specific blood transfusion (DSBT); avoiding high-dose steroids/calcineurin-inhibitors; and minimizing reperfusion injury and endotoxin translocation. LIP was tested in 13 consecutive ITx from deceased donors (2000-2014) (observational cohort study). Recipient age was 37 years (2.8-57 years). Five-year graft/patient survival was 92%. One patient died at 9 months due to aspergillosis, another at 12 years due to nonsteroidal anti-inflammatory drug-induced enteropathy. Early acute rejection (AR) developed in two (15%); late AR in three (23%); all were reversible. No chronic rejection (CR) occurred. No malignancies developed and estimated glomerular filtration rate remained stable post-Tx. At last follow-up (3.5 years [0.5-12.5 years]), no donor-specific antibodies were detected and 11 survivors were total parenteral nutrition free with a Karnofsky score >90% in 8 recipients (follow-up >1 years). A high frequency of circulating CD4+ CD45RA- Foxp3hi memory Tregs was found (1.8% [1.39-2.21]), comparable to tolerant kidney transplant (KTx) recipients and superior to stable immunosuppression (IS)-KTx, KTx with CR, and healthy volunteers. In this ITx cohort we show that DSBT in a low-inflammatory/pro-regulatory environment activates Tregs at levels similar to tolerant-KTx, without causing sensitization. LIP limits rejection under reduced IS and thereby prolongs long-term survival to an extent not previously attained after ITx.
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Affiliation(s)
- L J Ceulemans
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - F Braza
- Institut de Recherche en Transplantation, Urologie et Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, University of Nantes, Nantes, France
| | - D Monbaliu
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - G De Hertogh
- Translational Cell and Tissue Research, University Hospitals Leuven, and Department of Imaging and Pathology, University of Leuven, KU Leuven, Leuven, Belgium
| | - J Du Plessis
- Division of Hepatology, University Hospitals Leuven, and Department of Clinical and Experimental Medicine, University of Leuven, KU Leuven, Leuven, Belgium
| | - M-P Emonds
- Laboratory for Histocompatibility and Immunogenetics (HILA), Red Cross Flanders, Mechelen, Belgium.,Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - H Kitade
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - M Kawai
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - Y Li
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - X Zhao
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Koshiba
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium.,Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - B Sprangers
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - S Brouard
- Institut de Recherche en Transplantation, Urologie et Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, University of Nantes, Nantes, France
| | - M Waer
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
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Lee YH, Lee SJ, Lee MK, Lee WY, Yong SJ, Kim SH. Serum selenium levels in patients with respiratory diseases: a prospective observational study. J Thorac Dis 2016; 8:2068-78. [PMID: 27621861 DOI: 10.21037/jtd.2016.07.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Serum selenium levels are lower in critically ill patients as compared with healthy controls. However, there is no data about the difference in serum selenium levels depending on the severity of lung diseases. We aimed to identify the factors associated with low serum selenium levels in critically ill patients with respiratory diseases. METHODS A prospective study was performed in 83 patients with respiratory diseases who had admitted to the intensive care unit (ICU) and general wards. We obtained systemic inflammatory markers, nutritional indicators and prognostic factors as the explanatory variables for the outcome of low serum selenium levels. RESULTS Serum selenium levels on admission were lower by 28% in the ICU group as compared with the general ward group (70.0±26.4 and 97.9±20.8 ng/mL, respectively, P<0.001). Low serum selenium levels had a correlation with malnutrition represented by decreases in levels of lymphocyte (R(2)=0.107, P=0.005) and albumin (R(2)=0.174, P<0.001). In addition, low serum selenium levels were associated with an increase in baseline C-reactive protein (CRP) (R(2)=0.059, P=0.041) and APACHE II scores (R(2)=0.209, P<0.001). Lower albumin levels (P=0.032) and higher APACHE II scores (P=0.046) showed a significant correlation with lower serum selenium levels on multivariate analysis. CONCLUSIONS Low serum selenium levels in patients with respiratory diseases have a significant correlation with poor nutritional status and prognosis on admission.
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Affiliation(s)
- Yo-Han Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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