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Parenteral and Enteral Nutrition with Omega-3 Fatty Acids

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Diet and Nutrition in Critical Care

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Abstract

Critically ill patients, especially those with sepsis and acute lung injury, often experience massive and uncontrolled inflammation. It is hypothesized that omega-3 fatty acids may help reduce inflammation in critically ill patients. Supplementation of omega-3 fatty acids provided in continuous enteral nutritional formulas, as enteral bolus doses separate from feedings, and in parenteral nutrition lipid emulsions is reviewed in this chapter. With the research available to date, there may be some benefit to providing omega-3 fatty acids in enteral nutrition formulas delivered continuously. However, there is not enough evidence to support enteral bolus dosing or inclusion of omega-3 fatty acids in parenteral lipid emulsions. More research is needed before definitive recommendations can be made regarding the use of omega-3 fatty acids in critically ill patients.

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Abbreviations

AA:

Arachidonic acid

APACHE:

Acute physiology and chronic health evaluation

ARDS:

Acute respiratory distress syndrome

DHA:

Docosahexaenoic acid

EN:

Enteral nutrition

EPA:

Eicosapentaenoic acid

FA:

Fatty acid

FO:

Fish oil

GLA:

Gamma-linolenic acid

ICU:

Intensive care unit

IL:

Interleukin

LCT:

Long-chain triglyceride

LE:

Lipid emulsion

MCT:

Medium-chain triglyceride

PN:

Parenteral nutrition

PUFA:

Polyunsaturated fatty acid

RCT:

Randomized clinical trial

SIRS:

Systemic inflammatory response syndrome

TNF:

Tumor necrosis factor

References

  • Abbott Nutrition Adult Product Guide. 2013. Available from: http://abbottnutrition.com/product/product-handbook-landing. Updated 5 Feb 2013.

  • Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

    Article  PubMed  CAS  Google Scholar 

  • Barbosa VM, Miles EA, Calhau C, et al. Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial. Crit Care. 2010;14(1):R5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bulger EM, Maier RV. Lipid mediators in the pathophysiology of critical illness. Crit Care Med. 2000;28(4 Suppl):N27–36.

    Article  PubMed  CAS  Google Scholar 

  • Calder PC. N-3 polyunsaturated fatty acids and inflammation: from molecular biology to the clinic. Lipids. 2003;38(4):343–52.

    Article  PubMed  CAS  Google Scholar 

  • Calder PC. Immunonutrition in surgical and critically ill patients. Br J Nutr. 2007;98 Suppl 1:S133–9.

    PubMed  CAS  Google Scholar 

  • Calder PC. The relationship between the fatty acid composition of immune cells and their function. Prostaglandins Leukot Essent Fatty Acids. 2008;79(3–5):101–8.

    Article  PubMed  CAS  Google Scholar 

  • Calder PC. Hot topics in parenteral nutrition. Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults. Proc Nutr Soc. 2009;68(3):252–60.

    Article  PubMed  CAS  Google Scholar 

  • Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010;2(3):355–74.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Canadian Clinical Practice Guidelines. Section 4.1(b) Composition of enteral nutrition: fish oils. 2009. 5 May 2013; 31 Jan 31 2009. Available from: http://www.criticalcarenutrition.com/docs/cpg/4.1bfish%20oils_FINAL.pdf

  • Canadian Clinical Practice Guidelines. Section 4.1b i) Fish oils, borage oils and antioxidants. 2013. 26 May 2013; April 2013. Available from: http://www.criticalcarenutrition.com/docs/cpgs2012/4.1b(i).pdf

  • Canadian Clinical Practice Guidelines. Section 9.2 composition of parenteral nutrition, type of lipids. 2013. 5 May 2013. Available from: http://www.criticalcarenutrition.com/docs/cpgs2012/9.2_Mar-2013.pdf

  • Cohen J. The immunopathogenesis of sepsis. Nature. 2002;420(6917):885–91.

    Article  PubMed  CAS  Google Scholar 

  • Fan YY, Chapkin RS. Importance of dietary gamma-linolenic acid in human health and nutrition. J Nutr. 1998;128(9):1411–4.

    PubMed  CAS  Google Scholar 

  • Friesecke S, Lotze C, Kohler J, et al. Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial. Intensive Care Med. 2008;34(8):1411–20.

    Article  PubMed  CAS  Google Scholar 

  • Gadek JE, DeMichele SJ, Karlstad MD, et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med. 1999;27(8):1409–20.

    Article  PubMed  CAS  Google Scholar 

  • Golman DW, Pickett WC, Goetzl EJ. Human neutrophil chemotactic and degranulating activities of leukotriene B5 (LTB5) derived from eicosapentaenoic acid. Biochem Biophys Res Commun. 1983;117:282–8.

    Article  Google Scholar 

  • Grau-Carmona T, Moran-Garcia V, Garcia-de-Lorenzo A, et al. Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clin Nutr. 2011;30(5):578–84.

    Article  PubMed  CAS  Google Scholar 

  • Grecu I, Mirea L, Grintescu I. Parenteral fish oil supplementation in patients with abdominal sepsis [abstract]. Clin Nutr. 2003;22:23.

    Article  Google Scholar 

  • Gupta A, Govil D, Bhatnagar S, et al. Efficacy and safety of parenteral omega 3 fatty acids in ventilated patients with acute lung injury. Indian J Crit Care Med. 2011;15(2):108–13.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Harris SG, Padilla J, Koumas L, et al. Prostaglandins as modulators of immunity. Trends Immunol. 2002;23(3):144–50.

    Article  PubMed  CAS  Google Scholar 

  • Heyland DK, MacDonald S, Keefe L, et al. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA. 1998;280(23):2013–9.

    Article  PubMed  CAS  Google Scholar 

  • Heyland DK, Novak F, Drover JW, et al. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA. 2001;286(8):944–53.

    Article  PubMed  CAS  Google Scholar 

  • Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348(2):138–50.

    Article  PubMed  CAS  Google Scholar 

  • Khor BS, Liaw SJ, Shih HC, et al. Randomized, double blind, placebo-controlled trial of fish-oil-based lipid emulsion infusion for treatment of critically ill patients with severe sepsis. Asian J Surg Asian Surg Assoc. 2011;34(1):1–10.

    Article  Google Scholar 

  • Kreymann KG, Berger MM, Deutz NE, et al. ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr. 2006;25(2):210–23.

    Article  PubMed  CAS  Google Scholar 

  • Kumar A, Takada Y, Boriek AM, et al. Nuclear factor-kappa B: its role in health and disease. J Mol Med. 2004;82(7):434–48.

    Article  PubMed  CAS  Google Scholar 

  • Lee TH, Menica-Huerta JM, Shih C, et al. Characterization and biologic properties of 5,12-dihydroxy derivatives of eicosapentaenoic acid, including leukotriene B5 and the double lipoxygenase product. J Biol Chem. 1984;259(4):2383–9.

    PubMed  CAS  Google Scholar 

  • Mancuso P, Whelan J, DeMichele SJ, et al. Dietary fish oil and fish and borage oil suppress intrapulmonary proinflammatory eicosanoid biosynthesis and attenuate pulmonary neutrophil accumulation in endotoxic rats. Crit Care Med. 1997;25(7):1198–206.

    Article  PubMed  CAS  Google Scholar 

  • Manzanares W, Dhaliwal R, Jurewitsch B, Stapleton RD, Jeejeebhoy KN, Heyland DK. Parenteral Fish Oil Lipid Emulsions in the Critically Ill: A Systematic Review and Meta-analysis. JPEN J Parenter Enteral Nutr. 2014;38(1):20–8

    Google Scholar 

  • Marangoni F, Angeli MT, Colli S, et al. Changes of n-3 and n-6 fatty acids in plasma and circulating cells of normal subjects, after prolonged administration of 20:5 (EPA) and 22:6 (DHA) ethyl esters and prolonged washout. Biochim Biophys Acta. 1993;1210(1):55–62.

    Article  PubMed  CAS  Google Scholar 

  • Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med. 2008;34(11):1980–90.

    Article  PubMed  Google Scholar 

  • Mayer K, Fegbeutel C, Hattar K, et al. Omega-3 vs. omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation. Intensive Care Med. 2003a;29(9):1472–81.

    Article  PubMed  Google Scholar 

  • Mayer K, Gokorsch S, Fegbeutel C, et al. Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis. Am J Respir Crit Care Med. 2003b;167(10):1321–8.

    Article  PubMed  Google Scholar 

  • McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enter Nutr. 2009;33(3):277–316.

    Article  Google Scholar 

  • Munroe C, Frantz D, Martindale RG, et al. The optimal lipid formulation in enteral feeding in critical illness: clinical update and review of the literature. Curr Gastroenterol Rep. 2011;13(4):368–75.

    Article  PubMed  Google Scholar 

  • Murphy MG. Dietary fatty acids and membrane protein function. J Nutr Biochem. 1990;1(2):68–79.

    Article  PubMed  CAS  Google Scholar 

  • Nelson JL, DeMichele SJ, Pacht ER, et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants on antioxidant status in patients with acute respiratory distress syndrome. JPEN J Parenter Enter Nutr. 2003;27(2):98–104.

    Article  CAS  Google Scholar 

  • Ott J, Hiesgen C, Mayer K. Lipids in critical care medicine. Prostaglandins Leukot Essent Fatty Acids. 2011;85(5):267–73.

    Article  PubMed  CAS  Google Scholar 

  • Palmer AJ, Ho CK, Ajibola O, et al. The role of omega-3 fatty acid supplemented parenteral nutrition in critical illness in adults: a systematic review and meta-analysis. Crit Care Med. 2013;41(1):307–16.

    Article  PubMed  Google Scholar 

  • Palombo JD, Lydon EE, Chen PL, et al. Fatty acid composition of lung, macrophage and surfactant phospholipids after short-term enteral feeding with n-3 lipids. Lipids. 1994;29(9):643–9.

    Article  PubMed  CAS  Google Scholar 

  • Palombo JD, DeMichele SJ, Lydon E, et al. Cyclic vs continuous enteral feeding with omega-3 and gamma-linolenic fatty acids: effects on modulation of phospholipid fatty acids in rat lung and liver immune cells. JPEN J Parenter Enter Nutr. 1997;21(3):123–32.

    Article  CAS  Google Scholar 

  • Petrak RA, Balk RA, Bone RC. Prostaglandins, cyclo-oxygenase inhibitors, and thromboxane synthetase inhibitors in the pathogenesis of multiple systems organ failure. Crit Care Clin. 1989;5(2):303–14.

    PubMed  CAS  Google Scholar 

  • Pontes-Arruda A, Aragao AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med. 2006;34(9):2325–33.

    Article  PubMed  CAS  Google Scholar 

  • Pontes-Arruda A, Demichele S, Seth A, et al. The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of outcome data. JPEN J Parenter Enter Nutr. 2008;32(6):596–605.

    Article  CAS  Google Scholar 

  • Pontes-Arruda A, Martins LF, de Lima SM, et al. Enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study. Crit Care. 2011;15(3):R144.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pradelli L, Mayer K, Muscaritoli M, et al. n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care. 2012;16(5):R184.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rice TW, Wheeler AP, Thompson BT, et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574–81.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol. 2008;8(5):349–61.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999;70(3 Suppl):560S–9.

    PubMed  CAS  Google Scholar 

  • Singer P, Shapiro H. Enteral omega-3 in acute respiratory distress syndrome. Curr Opin Clin Nutr Metab Care. 2009;12(2):123–8.

    Article  PubMed  CAS  Google Scholar 

  • Singer P, Theilla M, Fisher H, et al. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med. 2006;34(4):1033–8.

    Article  PubMed  CAS  Google Scholar 

  • Singer P, Berger MM, Van den Berghe G, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr. 2009;28(4):387–400.

    Article  PubMed  Google Scholar 

  • Stables MJ, Gilroy DW. Old and new generation lipid mediators in acute inflammation and resolution. Prog Lipid Res. 2011;50(1):35–51.

    Article  PubMed  CAS  Google Scholar 

  • Stapleton RD, Martin TR, Weiss NS, et al. A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med. 2011;39(7):1655–62.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Stubbs CD, Smith AD. The modification of mammalian membrane polyunsaturated fatty acid composition in relation to membrane fluidity and function. Biochim Biophys Acta. 1984;779(1):89–137.

    Article  PubMed  CAS  Google Scholar 

  • Suchner U, Katz DP, Furst P, et al. Impact of sepsis, lung injury, and the role of lipid infusion on circulating prostacyclin and thromboxane A(2). Intensive Care Med. 2002;28(2):122–9.

    Article  PubMed  CAS  Google Scholar 

  • Theilla M, Schwartz B, Zimra Y, et al. Enteral n-3 fatty acids and micronutrients enhance percentage of positive neutrophil and lymphocyte adhesion molecules: a potential mediator of pressure ulcer healing in critically ill patients. Br J Nutr. 2012;107(7):1056–61.

    Article  PubMed  CAS  Google Scholar 

  • Tilley SL, Coffman TM, Koller BH. Mixed messages: modulation of inflammation and immune responses by prostaglandins and thromboxanes. J Clin Invest. 2001;108(1):15–23.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  • Wang X, Li W, Zhang F, et al. Fish oil-supplemented parenteral nutrition in severe acute pancreatitis patients and effects on immune function and infectious risk: a randomized controlled trial. Inflammation. 2009;32(5):304–9.

    Article  PubMed  CAS  Google Scholar 

  • Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet. 2007;369(9572):1553–64.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Molecular & Medical Genetics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code L103A, Portland, OR, 97239, USA

    Julie Martin

  2. Division of Pulmonary & Critical Care Medicine, University of Vermont College of Medicine, 149 Beaumont Avenue HSRF 222, Burlington, VT, 05405, USA

    Renee D. Stapleton

Authors
  1. Julie Martin
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  2. Renee D. Stapleton
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Correspondence to Renee D. Stapleton .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Martin, J., Stapleton, R.D. (2014). Parenteral and Enteral Nutrition with Omega-3 Fatty Acids. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_14-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_14-1

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  • Online ISBN: 978-1-4614-8503-2

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