Supplementation of arachidonic acid plus docosahexaenoic acid in cirrhotic patients awaiting liver transplantation: a preliminary study.
BACKGROUND
In patients with cirrhotic liver diseases, supplementation of linoleic acid and alpha-linolenic acid often does not alter the levels of arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), suggesting the necessity to directly provide these nutrients.


METHODS
In a double-blind, placebo-controlled fashion, 9 cirrhotic patients listed for liver transplantation at Lahey Clinic Center were given daily supplementation with either 10 gel caps containing 500 mg of AA and 1000 mg of DHA (AA/DHA) or 250 mg of linolenic acid (LA) and 125 mg of oleic acid (OA; OA/LA) for 6 weeks. alpha-Tocopherol at 200 IU was provided daily. No other dietary prescription was made. Plasma fatty acid profiles were determined in triglyceride and phospholipids fractions. Plasma levels of C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin 6 (IL-6), and soluble TNF receptor II (sTNFRII) were also measured.


RESULTS
Four patients receiving OA/LA and 5 patients receiving AA/DHA completed the study without evidence of any adverse effects or intolerance. The supplementation of LA, AA, and DHA effectively raised their levels in either one or both plasma lipid fractions in this limited number of subjects. DHA plus AA also lowered 22:4omega-6, 22:5omega-6, and 22:5omega-3, suggesting that DHA reduced the elongation and desaturation of AA and EPA.


CONCLUSIONS
It is feasible to improve the liver disease-associated deficiency of AA or DHA with modest intakes of AA and DHA. Whether this maneuver will affect the systemic inflammatory responsiveness and ultimately clinical outcome will require a large-scale and well-controlled intervention.
Pazirandeh
Sassan
S
Nutrition/Infection Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ling
Pei-Ra
PR
Ollero
Mario
M
Gordon
Fredric
F
Burns
David L
DL
Bistrian
Bruce R
BR
D016718:Arachidonic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000172:deficiency; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage / Q000009:adverse effects; D000068800:Etanercept; D005227:Fatty Acids / Q000032:analysis*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood* / Q000188:drug therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000032:analysis; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism; D016896:Treatment Outcome; D014280:Triglycerides / Q000032:analysis; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D017962:alpha-Linolenic Acid / Q000008:administration & dosage / Q000009:adverse effects
D005227:Fatty Acids; D007074:Immunoglobulin G; D015850:Interleukin-6; D010743:Phospholipids; D018124:Receptors, Tumor Necrosis Factor; D014280:Triglycerides; D014409:Tumor Necrosis Factor-alpha; D017962:alpha-Linolenic Acid; D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid; D002097:C-Reactive Protein; D015118:Eicosapentaenoic Acid; D000068800:Etanercept