title: Pharmaconutrition: acute fatty acid modulation of circulating cytokines in elderly patients in the ICU.
abstract: BACKGROUND
  Enteral supply of ω-3 polyunsaturated fatty acids has been used in an attempt to modulate inflammation and improve outcome in critically ill patients. However, enteral administration may be slow to change membrane composition and therefore may not be the best route to supply these fatty acids in patients with acute conditions. This study evaluated the effects of short-term intravenous (IV) administration of fish oil-based lipid emulsion (FLE) as pharmaconutrition on cytokine levels in critically ill elderly patients.
  
  
  METHODS
  Enterally fed patients (n = 40; aged 60-80 years) were recruited in the first 48 hours of intensive care unit (ICU) admission. Fifteen patients received IV FLE (0.2 g/kg body weight) over 6 hours for 3 consecutive days, and 25 patients did not receive IV lipid (control). Samples were collected before and 24 hours and 72 hours after the third FLE infusion. Nutrient intakes, clinical parameters, and serum cytokine concentrations were measured.
  
  
  RESULTS
  Compared with the control, FLE resulted in higher energy intake, lower serum tumor necrosis factor-α and interleukin (IL)-8 concentrations, and higher serum IL-10. These differences occurred around 7-9 days of ICU stay at the time of the patient's extubation. ICU stay, mortality, and markers of coagulation and liver function did not differ between groups.
  
  
  CONCLUSIONS
  Short-term IV FLE modulates some inflammatory markers in critically ill elderly patients receiving enteral nutrition (EN), suggesting an anti-inflammatory effect. This may be a benefit and suggests a role for FLE administration as a supplement in elderly ICU patients receiving standard EN.
authors.affiliation: Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Karina V
authors.initials: KV
authors.lastname: Barros
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Cassulino
authors.forename: Lívia
authors.initials: L
authors.lastname: Schalch
authors.forename: Eduardo
authors.initials: E
authors.lastname: Della Valle Munhoz
authors.forename: José Antônio
authors.initials: JA
authors.lastname: Manetta
authors.forename: Philip C
authors.initials: PC
authors.lastname: Calder
authors.forename: Vera L
authors.initials: VL
authors.lastname: Flor Silveira
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D016207:Cytokines / Q000097:blood*; D004655:Emulsions; D002149:Energy Intake; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005395:Fish Oils; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007902:Length of Stay; D008297:Male; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D016207:Cytokines; D004655:Emulsions; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D018836:Inflammation Mediators; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10
keywords: ICU; critical illness; cytokines; fish oil–based lipid emulsion; pharmaconutrition