Journal Article

Superiority of a fish oil–enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: A randomized clinical trial

Wang, Jin, Ma, Zhi-Qiang, Yu, Jian-Chun, Kang, Wei-Ming

2012

Overview

Compared with soybean oil, a fish oil–enriched emulsion can improve the clinical outcomes of patients requiring parenteral nutrition. However, the superiority of fish oil emulsion to medium-chain triacylglycerols/long-chain triacylglycerols for short-term administration has seldom been discussed. Sixty-four adult patients with gastrointestinal diseases were randomly assigned to receive isocaloric and isonitrogenous total parenteral nutrition with an ω-3 fatty acid–enriched emulsion (Lipoplus; study group, n = 32) or medium-chain triacylglycerols/long-chain triacylglycerols (Lipofundin; control group, n = 32) for 5 d after surgery. Safety and efficacy parameters were assessed on postoperative days 1, 3, and 6. Clinical outcomes including infectious complications and systemic inflammatory response syndrome were comparable between the two groups. Total bilirubin decreased over time in the study group versus an increase in the control group (P = 0.017). Activated partial thromboplastin time in the study group was prolonged significantly compared with the control group from days 1 to 3 (P = 0.002), although the prolongation stopped at the study termination. There were no differences in changes of C-reactive protein, interleukin (IL)-1, IL-8, IL-10, vascular endothelial growth factor (VEGF), and the distribution of the T-cell subpopulation between the two groups. However, fish oil consumption led to an increase in leukotriene B5/ leukotriene B4 and significant decreases in IL-6, tumor necrosis factor-α, and nuclear factor-κB. Furthermore, the overall changes in tumor necrosis factor-α and nuclear factor-κB were positively associated (R2 = 0.295, P < 0.001). Gastrointestinal surgery patients benefited from a fish oil–enriched emulsion rather than medium-chain triacylglycerols/long-chain triacylglycerols in the amelioration of liver function and immune status. The positive association of tumor necrosis factor-α and nuclear factor-κB might be involved in the potential anti-inflammation mechanism of fish oil.

• Publisher: Elsevier Inc,Elsevier,Elsevier Limited
• Subject: Adult / Aged / analogs & derivatives / Anti-Inflammatory Agents / Anti-Inflammatory Agents - pharmacology / bilirubin / Bilirubin - blood / Biological and medical sciences / blood / C-reactive protein / chemistry / Cholesterol / Cross Infection / Cross Infection - blood / Cross Infection - prevention & control / Cytokines / Dietary Fats / Dietary Fats - pharmacology / Dietary Fats - therapeutic use / digestive system diseases / drug effects / Eicosapentaenoic Acid / Eicosapentaenoic Acid - analogs & derivatives / Eicosapentaenoic Acid - blood / Emulsions / etiology / Fat Emulsions, Intravenous / Fat Emulsions, Intravenous - chemistry / Fat Emulsions, Intravenous - pharmacology / Fat Emulsions, Intravenous - therapeutic use / Fatty acids / Fatty Acids, Omega-3 / Fatty Acids, Omega-3 - pharmacology / Feeding. Feeding behavior / Female / Fish / fish consumption / Fish oil / Fish oils / Fish Oils - pharmacology / Fish Oils - therapeutic use / Fundamental and applied biological sciences. Psychology / Gastroenterology and Hepatology / Gastrointestinal Diseases / Gastrointestinal Diseases - surgery / Humans / Immune status / Immunity / Immunity - drug effects / Inflammation / Inflammation - blood / Inflammation - etiology / Inflammation - prevention & control / Inflammation Mediators / Inflammation Mediators - blood / interleukins / Leukotriene B4 / Leukotriene B4 - analogs & derivatives / Leukotriene B4 - blood / Lipids / Liver / Liver - drug effects / Liver function / Male / Medium-chain triacylglycerols/long-chain triacylglycerols / Middle Aged / NF-kappa B / NF-kappa B - blood / Parenteral Nutrition / Partial Thromboplastin Time / patients / pharmacology / Postoperative Complications / Postoperative Complications - blood / Postoperative Complications - prevention & control / prevention & control / randomized clinical trials / Soybean oil / Soybeans / surgery / Systemic Inflammatory Response Syndrome / Systemic Inflammatory Response Syndrome - blood / Systemic Inflammatory Response Syndrome - prevention & control / therapeutic use / total parenteral nutrition / triacylglycerols / Triglycerides / Triglycerides - pharmacology / Triglycerides - therapeutic use / Tumor Necrosis Factor-alpha / Tumor Necrosis Factor-alpha - blood / vascular endothelial growth factors / Vertebrates: anatomy and physiology, studies on body, several organs or systems