Effects of fish oil on inflammatory modulation in surgical intensive care unit patients.
BACKGROUND
The benefit of ω-3 fatty acids in fat emulsion remains controversial. This study evaluated the effect of ω-3 fatty acids on immune and inflammatory modulation in surgical intensive care unit (SICU) patients.


METHODS
Thirty-eight patients admitted to the SICU after major surgery were enrolled in this prospective controlled study and randomized to receive parenteral nutrition (PN) with equal volume and calories from glucose, nitrogen, and fat but different lipid components for 7 postoperative days. Group A (n = 12) received a mixture of soybean and medium-chain triglyceride oils; group B (n = 18) received a fat emulsion with part of the lipid replaced by fish oil. Blood tests, including lipid profile, routine biochemistry, inflammatory cytokines, and lymphocyte subpopulations, were evaluated preoperatively and on postoperative days 4 and 7.


RESULTS
Both lipid regimens were well tolerated. There was a trend toward reduced serum inflammatory cytokines in group B vs group A with significant differences regarding interleukin (IL)-1, IL-8, and interferon (IFN)-γ on postoperative day 4 (P < .05) and IL-1, IL-8, IFN-γ, IL-6, and tumor necrosis factor-α on postoperative day 7 (P < .05). There was a reduction in postoperative liver dysfunction (A vs B: 50% vs 33.3%) and infection rate (A vs B: 41.7% vs 27.8%) in group B, although this was not statistically significant. There was no mortality in either group.


CONCLUSIONS
This study suggests that supplementation of parenteral ω-3 fatty acids in PN is safe and may improve immune and hyperinflammatory response for SICU patients after major surgery.
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan.
Yin-Yi
YY
Han
Shou-Lun
SL
Lai
Wen-Je
WJ
Ko
Chia-Hung
CH
Chou
Hong-Shiee
HS
Lai
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control; D016207:Cytokines / Q000097:blood*; D004041:Dietary Fats / Q000008:administration & dosage; D004311:Double-Blind Method; D005217:Fat Emulsions, Intravenous / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005395:Fish Oils / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood*; D007362:Intensive Care Units; D008099:Liver / Q000187:drug effects; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013024:Soybean Oil / Q000494:pharmacology / Q000627:therapeutic use; D014280:Triglycerides / Q000494:pharmacology / Q000627:therapeutic use; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D018836:Inflammation Mediators; D014280:Triglycerides; D013024:Soybean Oil