Impact ofn-3 fatty acid supplemented parenteral nutrition on haemostasis patterns after major abdominal surgery

Abstract

In various diseases n-3 fatty acids exert anti-inflammatory properties. These effects seem to be related to the uptake and incorporation of eicosapentaenoic acid (EPA) into the cellular substrate pool after dietary intake of EPA, which is contained in fish oils (FO). In the state of inflammation EPA is released to compete with arachidonic acid (AA) for metabolism at the cyclo-oxygenase and the 5-lipoxygenase level. The metabolites of EPA have less inflammatory and chemotactic potency than the substances derived from AA. In addition to positive effects, early studies pointed towards prolonged bleeding times after dietary intake of n-3 fatty acids. This study was undertaken to address the issue of potential coagulation disturbances associated with postoperative parenteral FO administration. This was a prospective, randomised, double blinded clinical trial, carried out in two operative intensive care units (13 and 16 beds) in a university hospital. Forty-four patients undergoing elective major abdominal surgery participated in the trial. Patients were randomly assigned to receive total parenteral nutrition (TPN) supplemented with either soybean oil (SO, Lipovenoes w 10 % PLR; 1 : 0 g/kgBW per day; n ¼ 20) for five days or with a combination of FO and SO (FO, Omegaven w ; 0 : 2 g/kgBW per day plus SO, Lipovenoes w 10 % PLR; 0 : 8 g/kgBW per day, n ¼ 24), respectively. Blood samples were taken preoperatively (day 21), prior to (day 1) during (days 2 -5) and after TPN (day 6). The coagulation parameters thromboplastin time (Quick), activated partial thromboplastin time (aPTT), fibrinogen and antithrombin III were measured. To differentially assess activation levels of extrinsic and intrinsic coagulation pathway, factors VIIa and XIIa were quantified. Moreover platelet function was determined by resonance thrombography. Baseline values of coagulation and platelet function were comparable in both groups, but coagulation activity dropped after surgery. Over the observation period of 6 days, however, physiological levels were regained. No clinically significant differences were observed between the SO2 and SO 1 FO2 group. These findings suggest that infusion of fish oil in doses up to 0 : 2 g/kgBW per day is safe regarding coagulation and platelet function.

Polyunsaturated Fatty Acids, Ulcerative Colitis and Cancer Prevention

“…Several studies have shown the mechanisms by which genes may influence the metabolism of nutrients, as well as the mechanisms by which nutrients can influence gene expression (Simopoulos et al 2008, Paolini-Giacobini et al 2003, Calder 2007. With advances in science, and emphasis on the study of nutrigenomics and nutrigenetics, it has been shown that certain nutrients can influence the inflammatory response, accelerating or regressing the development of many diseases (Heller et al 2002, Weiss et al 2002, Mayer et al 2003, Paolini-Giacobini et al 2003, Simopoulos et al 2008. Stern et al (2009), from the Singapore Chinese Health Study, through analyses taking into account variants in genes that are relevant for the proposed PUFAs mechanism of actionhypothesised that the genes which play key roles in the pathways that repair PUFA-induced damage might modify the effect of these FA on colorectal cancer.…”

Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients

“…This study did not report clinical outcomes. Recently, the results of three further studies with parenteral fish oil administration have become available (51)(52)(53). In the first of these, patients received total parenteral nutrition that included an 8% soybean oil plus 2% fish oil emulsion (controls received a 10% soybean oil emulsion) for 5 days postsurgery (51).…”

Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients

“…Recently, supplementation with fish oil is supposed to improve standard clinical therapy for chronic hyper-inflammatory diseases such as Crohn' disease [1,5] , rheumatoid arthritis [6] , cancer cachexia [7,8] , and as an adjunct therapeutic measure for trauma, injure, and sepsis [2,[9][10][11][12] . Although several studies have demonstrated the beneficial effects of omega-3 fatty acid supplementation on patient outcome or immune competence, randomized controlled clinical trials focusing on the use of parenteral fish oil are scarce [13][14][15][16][17] . The aim of this study was to assess whether parenteral supplementation of omega-3 fatty acid postoperatively improves the inflammatory and immunological function of colorectal cancer patients and their clinical outcomes.…”