Fish oil-supplemented parenteral nutrition in severe acute pancreatitis patients and effects on immune function and infectious risk: a randomized controlled trial.
The human leukocyte antigen (HLA)-DR expression on monocytes and plasma Interleukin (IL)-10 levels are key indicators of immune response during the acute phase of severe acute pancreatitis (SAP). We designed a pilot study to investigate whether omega-3 fatty acids (FAs) supplemented parenteral nutrition (PN) could improve immune response in SAP patients. Fifty-six SAP patients were enrolled (28 patients in each group) and received isocaloric and isonitrogenous parenteral nutrition, providing 1.0 g/kg/day standard soybean-oil based fat (omega-6 FAs group) or 0.8 g/kg/day soybean oil +0.2 g/kg/day omega-3 FAs based fat (omega-3 FAs group). IL-10, HLA-DR and the ratio of CD4(+) to CD8(+) were determined before PN treatment and on day 6 after starting PN. The infection and surgery rates were recorded until hospital discharge. A significant IL-10 increase was associated with the administration of omega-3 FAs (p = 0.04, vs omega-6 FAs group). Monocyte HLA-DR expression improved in both groups after 5 days of PN treatment. This increase was significantly higher in the omega-3 FAs group compared to omega-6 FAs (p = 0.01). There was no significant difference of CD4(+)/CD8(+), infection and surgery rates between the two groups. In conclusion, omega-3 FAs supplemented PN can elevate the IL-10 level and HLA-DR expression in SAP patients. A larger trial is required to see whether omega-3 FAs supplemented PN treatment in SAP patients would result in better clinical outcomes than omega-6 FAs.
Wang
Xinying
X
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. wxinying@263.net
Li
Weiqin
W
Zhang
Feng
F
Pan
Liya
L
Li
Ning
N
Li
Jieshou
J
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D019587:Dietary Supplements; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D007107:Immune System / Q000187:drug effects* / Q000378:metabolism; D007239:Infections / Q000628:therapy; D016753:Interleukin-10 / Q000096:biosynthesis / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000628:therapy; D010288:Parenteral Nutrition / Q000379:methods*; D010865:Pilot Projects; D012307:Risk Factors; D012720:Severity of Illness Index; D013024:Soybean Oil / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005395:Fish Oils; D016753:Interleukin-10; D013024:Soybean Oil