Metabolic effects of parenteral nutrition enriched with n-3 polyunsaturated fatty acids in critically ill patients.
OBJECTIVE
n-3 fatty acids are expected to downregulate the inflammatory responses, and hence may decrease insulin resistance. On the other hand, n-3 fatty acid supplementation has been reported to increase glycemia in type 2 diabetes. We therefore assessed the effect of n-3 fatty acids delivered with parenteral nutrition on glucose metabolism in surgical intensive care patients.


METHODS
Twenty-four surgical intensive care patients were randomized to receive parenteral nutrition providing 1.25 times their fasting energy expenditure, with 0.25 g of either an n-3 fatty acid enriched-or a soy bean-lipid emulsion. Energy metabolism, glucose production, gluconeogenesis and hepatic de novo lipogenesis were evaluated after 4 days.


RESULTS
Total energy expenditure was significantly lower in patients receiving n-3 fatty acids (0.015+/-0.001 vs. 0.019+/-0.001 kcal/kg/min with soy bean lipids (P<0.05)). Glucose oxidation, lipid oxidation, glucose production, gluconeogenesis, hepatic de novo lipogenesis, plasma glucose, insulin and glucagon concentrations did not differ (all P>0.05) in the 2 groups.


CONCLUSIONS
n-3 fatty acids were well tolerated in this group of severely ill patients. They decreased total energy expenditure without adverse metabolic effects.
Tappy
Luc
L
Department of Physiology, University of Lausanne, Switzerland. Luc.Tappy@unil.ch
Berger
Mette Monica
MM
Schwarz
Jean-Marc
JM
Schneiter
Philippe
P
Kim
Seungki
S
Revelly
Jean-Pierre
JP
Chioléro
René
R
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D004734:Energy Metabolism / Q000187:drug effects* / Q000502:physiology; D005217:Fat Emulsions, Intravenous / Q000032:analysis; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D005527:Food, Fortified; D005934:Glucagon / Q000097:blood; D005943:Gluconeogenesis / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007333:Insulin Resistance; D007362:Intensive Care Units; D050356:Lipid Metabolism / Q000187:drug effects; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total
D001786:Blood Glucose; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005934:Glucagon; D006854:Hydrocortisone