n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis

Abstract

IntroductionPrevious studies and a meta-analysis in surgical patients indicate that supplementing parenteral nutrition regimens with n-3 polyunsaturated fatty acids (PUFAs), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is associated with improved laboratory and clinical outcomes in the setting of hyper-inflammatory conditions. Refined or synthetic fish oils are commonly used as a source of EPA and DHA. The objective of the present meta-analysis was to evaluate n-3 PUFA-enriched parenteral nutrition regimens in elective surgical and intensive care unit (ICU) patients.MethodsMedline was searched for randomized controlled trials comparing n-3 PUFA-enriched lipid emulsions with standard non-enriched lipid emulsions (i.e. soybean oil, MCT/LCT or olive/soybean oil emulsions) in surgical and ICU patients receiving parenteral nutrition. Extracted data were pooled by means of both random and fixed effects models, and subgroup analyses were carried forward to compare findings in ICU versus non-ICU patients.ResultsA total of 23 studies (n = 1502 patients: n = 762 admitted to the ICU) were included. No statistically significant difference in mortality rate was found between patients receiving n-3 PUFA-enriched lipid emulsions and those receiving standard lipid emulsions (RR= 0.89; 0.59, 1.33), possibly reflecting a relatively low underlying mortality risk. However, n-3 PUFA-enriched emulsions are associated with a statistically and clinically significant reduction in the infection rate (RR =0.61; 0.45, 0.84) and the lengths of stay, both in the ICU (-1.92; -3.27, -0.58) and in hospital overall (-3.29; -5.13, -1.45). Other beneficial effects included reduced markers of inflammation, improved lung gas exchange, liver function, antioxidant status and fatty acid composition of plasma phospholipids, and a trend towards less impairment of kidney function.ConclusionsThese results confirm and extend previous findings, indicating that n-3 PUFAs-enriched parenteral nutrition regimens are safe and effective in reducing the infection rate and hospital/ICU stay in surgical and ICU patients.

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

“…These data from a recent systematic analysis in 23 RCTs, including 1502 surgical and intensive care unit (ICU) patients, demonstrated that fish oil containing lipids reduced LOS and infectious complications versus traditional soy-only lipids. 99 …”

Role of Arginine and Omega-3 Fatty Acids in Wound Healing and Infection

“…The least antibiotic demand was seen in patients receiving 0.15-0.2 g/kg/day of the fish oil. Pradelli et al 54 performed a metaanalysis of controlled trials of surgical and intensive care unit (ICU) patients receiving parenteral nutrition who were randomized to receive omega-3 PUFA-enriched lipid emulsions or not. A total of 23 studies involving 1,502 patients were analyzed.…”

Selección De Emulsiones Lipídicas en Nutrición Parenteral: Parametros Bioquimicos Y Hematológicos.

“…En un metaanálisis de Pradelli y cols. (25) concluyeron que, en pacientes críticos y quirúrgicos, la administración de EL con AP se asocia con una reducción significativa de infecciones y de días de estancia hospitalaria. En otro metaanálisis en paciente crítico, Palmer y cols.…”