Enteral feeding with a solution enriched with antioxidant vitamins A, C, and E enhances the resistance to oxidative stress.
OBJECTIVE
To assess whether dietary supplementation with the antioxidant vitamins A, C, and E enhances parameters of oxidative stress and influences the course of critically ill patients.


METHODS
Prospective, randomized, double-blinded, placebo-controlled study.


METHODS
Department of medicosurgical intensive care of an academic hospital.


METHODS
Fifty-one patients expected to require at least 7 days of enteral feeding. Thirty-seven of these patients (age, 57 +/- 7 yrs; Simplified Acute Physiology Score II, 33 +/- 6 points) completed the study.


METHODS
Twenty patients were randomized to receive the formula supplemented with vitamins A (67 microg/dL), C (13.3 mg/ dL), and E (4.94 mg/dL), and 17 patients received an isocaloric and isonitrogenous control solution.


RESULTS
Plasma levels of antioxidant vitamins, lipid peroxidation (estimated by the malonyldialdehyde assay), and low-density lipoprotein (LDL), and erythrocyte resistance to experimental oxidative stress were determined on samples drawn two consecutive days before the initiation of feeding and at the end of the 7-day period. Clinical outcome measures included documented infection and intensive care unit and 28-day survival. Administration of the supplemented solution increased significantly the concentration of plasma beta-carotene (from 0.2 +/- 0.0 microg/mL to 0.6 +/- 0.1 microg/mL; p < 0.01) and plasma and LDL-bound alpha-tocopherol (from 6.0 +/- 0.4 microg/mL and 2.9 +/- 0.9 microg/mL to 9.7 +/- 0.5 microg/mL and 4.3 +/- 1.2 microg/mL, respectively; p < 0.05), and improved LDL resistance to oxidative stress by 21 +/- 4% (p < 0.05). No such change was observed in the control group. There was no significant difference in clinical outcome between the two groups.


CONCLUSIONS
Supplemental antioxidant vitamins added to enteral feeding solutions are well absorbed. Dietary supplementation with vitamins A, C, and E is associated with an improvement in antioxidant defenses, as assessed by ex vivo tests.
Preiser
J C
JC
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium. preiserj@ulb.ac.be
Van Gossum
A
A
Berré
J
J
Vincent
J L
JL
Carpentier
Y
Y
D018806:APACHE; D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000097:blood / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004311:Double-Blind Method; D016903:Drug Monitoring; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007113:Immunity, Innate / Q000187:drug effects; D015227:Lipid Peroxidation / Q000187:drug effects; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects / Q000276:immunology; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014801:Vitamin A / Q000097:blood / Q000627:therapeutic use*; D014810:Vitamin E / Q000097:blood / Q000627:therapeutic use*
D000975:Antioxidants; D008078:Cholesterol, LDL; D014801:Vitamin A; D014810:Vitamin E; D008315:Malondialdehyde; D001205:Ascorbic Acid