Fish Oil-Supplemented Parenteral Nutrition in Severe Acute Pancreatitis Patients and Effects on Immune Function and Infectious Risk: A Randomized Controlled Trial

Abstract

The human leukocyte antigen (HLA)-DR expression on monocytes and plasma Interleukin (IL)-10 levels are key indicators of immune response during the acute phase of severe acute pancreatitis (SAP). We designed a pilot study to investigate whether omega-3 fatty acids (FAs) supplemented parenteral nutrition (PN) could improve immune response in SAP patients. Fifty-six SAP patients were enrolled (28 patients in each group) and received isocaloric and isonitrogenous parenteral nutrition, providing 1.0 g/kg/day standard soybean-oil based fat (omega-6 FAs group) or 0.8 g/kg/day soybean oil +0.2 g/kg/day omega-3 FAs based fat (omega-3 FAs group). IL-10, HLA-DR and the ratio of CD4(+) to CD8(+) were determined before PN treatment and on day 6 after starting PN. The infection and surgery rates were recorded until hospital discharge. A significant IL-10 increase was associated with the administration of omega-3 FAs (p = 0.04, vs omega-6 FAs group). Monocyte HLA-DR expression improved in both groups after 5 days of PN treatment. This increase was significantly higher in the omega-3 FAs group compared to omega-6 FAs (p = 0.01). There was no significant difference of CD4(+)/CD8(+), infection and surgery rates between the two groups. In conclusion, omega-3 FAs supplemented PN can elevate the IL-10 level and HLA-DR expression in SAP patients. A larger trial is required to see whether omega-3 FAs supplemented PN treatment in SAP patients would result in better clinical outcomes than omega-6 FAs.

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

“…Of these, we excluded 40 trials due to the following reasons: 22 trials [14,15,16,17,18,19,20,21,22,23,24,25,26,27, 28,29,30,31,32,33,34,35] trials did not include ICU patients (mostly elective surgery and cancer patients), 12 trials [36,37,38,39,40,41,42,43,44,45,46,47] did not evaluate clinically important outcomes; 2 trials [48,49] did not include SO-based LE in the control group; 1 trial [50] compared LCT vs. another LCT emulsion without reduction in SO; 1 trial [51] was conducted in a pediatric population; 1 trial[52] had a short duration of intervention (12 hour of lipid emulsion infusion during the first day); 1 trial included patients with poisoning and not representative of ICU patients[53]. In the end, 12 RCTs [54,55,56,57,58,59,60,61,62,63,64,65] enrolling a total of 806 patients met the inclusion criteria and were included in this systematic review (see Table 1 and 2). The authors reached 100% agreement for inclusion of relevant trials in this review.…”

Fatty Acid Composition of Plasma Lipid Classes in Chronic Alcoholic Pancreatitis

“…By the end of the 5-day-long study period, the C-reactive protein level was significantly lower and the oxygenation index significantly higher in AP patients receiving n–3 LCPUFA supplementation than in the control group [6]. In a further similar study from the same group on patients with CP [7], interleukin-10 concentrations and human leukocyte antigen-DR expression, both considered as indicators of immune response in AP, increased to a significantly greater extent in patients receiving n–3 LCPUFA than in those receiving n–6 PUFA [7]. The aforementioned data indicating some beneficial effects of n–3 LCPUFA supplementation in AP gave rise to considerations on the potential role of n–3 LCPUFA in CP.…”

“…In AP the first differences if fatty acid status between patients and controls had been outlined [4], thereafter some clinical benefits of enteral [5] as well as parenteral [6,7] administration n–3 LCPUFA were demonstrated in randomized controlled trials. However, the role of an enhanced supply of n–3 LCPUFAs in the treatment of AP remains to be controversial.…”

Immunonutrition: a South African perspective

“…Although there was some indication of a reduction in mortality, no effect on infectious complications was documented. [90][91][92][93] A significant reduction in procalcitonin levels was found in the study by Khor et al, suggesting that fish oil attenuates the inflammatory process. 92 A small study (n = 16) compared a standard PN lipid emulsion to a lipid emulsion containing ω-3 FAs in patients with ARDS.…”