Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial.
OBJECTIVE
To test whether supplementation of parenteral nutrition with fish oil - aimed at increasing the n-3:n-6 ratio of polyunsaturated fatty acids (PUFA) to 1:2 - affects systemic inflammation and clinical outcome compared to standard parenteral nutrition with an n-3/n-6 ratio of 1:7 in medical intensive care unit (ICU) patients.


METHODS
Single-centre, placebo-controlled, double-blind, randomised clinical trial.


METHODS
Twelve-bed medical ICU of a university hospital.


METHODS
A total of 166 consecutive patients anticipated to need parenteral nutrition for more than 6 days. Patients were stratified for the presence of systemic inflammatory response syndrome (SIRS) at baseline (115 SIRS, 51 non-SIRS).


METHODS
Patients were randomly assigned to receive either a 1:1-mixture of medium-chain triglycerides (MCT) and long-chain triglycerides (LCT) with an n-3/n-6 PUFA ratio of 1:7, or the same MCT/LCT emulsion supplemented with fish oil (resulting in an n-3/n-6 ratio of 1:2).


RESULTS
Primary endpoints were changes in interleukin 6 (IL-6) and monocyte HLA-DR expression relative to baseline. Secondary endpoints were incidence of nosocomial infections, duration of mechanical ventilation, length of ICU stay, and 28-day mortality. Bleeding complications were recorded as a possible side effect of fish oil. Between standard and intervention groups, overall as well as stratified for SIRS or non-SIRS, no significant difference was detected in any of the endpoints or frequency and severity of bleeding events.


CONCLUSIONS
In unselected critically ill medical patients, fish oil supplementation that increased the n-3/n-6 PUFA ratio to 1:2 did not affect inflammation or clinical outcome, compared to parenteral lipid nutrition with an MCT/LCT emulsion.
Friesecke
Sigrun
S
Department of Internal Medicine, Ernst Moritz Arndt University of Greifswald, 17475, Greifswald, Germany. sigrun.friesecke@uni-greifswald.de
Lotze
Christian
C
Köhler
Jenny
J
Heinrich
Annegret
A
Felix
Stephan B
SB
Abel
Peter
P
D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage / Q000627:therapeutic use*; D006684:HLA-DR Antigens / Q000097:blood; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications / Q000178:diet therapy*
D005395:Fish Oils; D006684:HLA-DR Antigens; D015850:Interleukin-6