Rationale and use of n-3 fatty acids in artificial nutrition

Abstract

Lipids traditionally used in artificial nutrition are based on n-6 fatty acid-rich vegetable oils like soyabean oil. This may not be optimal because it may present an excessive supply of linoleic acid. One alternative to the use of soyabean oil is its partial replacement by fish oil, which contains n-3 fatty acids. These fatty acids influence inflammatory and immune responses and so may be useful in particular situations where those responses are not optimal. Fish oil-containing lipid emulsions have been used in parenteral nutrition in adult patients post-surgery (mainly gastrointestinal). This has been associated with alterations in patterns of inflammatory mediators and in immune function and, in some studies, a reduction in length of intensive care unit (ICU) and hospital stay. Perioperative administration of fish oil may be superior to post-operative. Parenteral fish oil has been used in critically ill adults. Here the influence on inflammatory processes, immune function and clinical endpoints is not clear, since there are too few studies and those that are available report contradictory findings. Fish oil is included in combination with other nutrients in various enteral formulas. In post-surgical patients and in those with mild sepsis or trauma, there is clinical benefit from a formula including fish oil and arginine. A formula including fish oil, borage oil and antioxidants has demonstrated marked benefits on gas exchange, ventilation requirement, new organ failures, ICU stay and mortality in patients with acute respiratory distress syndrome, acute lung injury or severe sepsis.

Monoacylglycerol-enriched oil increases EPA/DHA delivery to circulatory system in humans with induced lipid malabsorption conditions

“…The absorption of fat is compromised and, in such conditions, it is of great importance to ensure that EFAs are delivered to the body (8). The above conditions can be caused by different diseases and related risk factors, such as chronic pancreatitis, Crohn's disease, cystic fibrosis, Shwachman-Diamond syndrome, or history of previous surgery (e.g., ileal resection, bariatric surgery) on the gastrointestinal (GI) tract (9)(10)(11). Because of the modified anatomy in some bariatric surgery procedures (e.g., biliopancreatic diversion) or extensive resection of the small bowel, both digestion and absorption of nutrients is altered and can lead to a delayed mixing of fat with pancreatic enzymes and bile salts, thereby lowering levels of some nutrients, such as fat-soluble vitamins (12)(13)(14).…”

“…In subjects who have undergone major GI surgery, LC-PUFA supplementation has been shown to reduce concentrations of inflammatory biomarkers and to shorten hospital length of stay (11,12). According to previous studies, EFAs delivered as MAG have been reported to be better absorbed than EFAs delivered as TAG (18)(19)(20)(21).…”

The Pharmacology of the Cytochrome P450 Epoxygenase/Soluble Epoxide Hydrolase Axis in the Vasculature and Cardiovascular Disease

“…Given that 9,10-DiHOME production is catalyzed by the sEH, it is not surprising that sEH inhibitors were able to provide protection in such a situation. However, a simpler approach was simply to reduce the concentration of linoleic acid in the parenteral nutrition given to patients, an intervention that resulted in marked benefits in gas exchange, ventilation requirement, and mortality (Calder, 2010).…”

Docosahexaenoic Acid

“…There are 2 prescription formulations of n-3 LCPUFAs available in the United States: the v-3 acid ethyl esters (LOVAZA) and the icosapent ethyl (VASCEPA). Some formulas designed for enteral or parenteral use contain n-3 LCPUFAs (1,8).…”