, Volume 39, Issue 12, pp 1147–1161

n−3 Fatty acids, inflammation, and immunity— Relevance to postsurgical and critically III patients



Excessive or inappropriate inflammation and immunosuppression are components of the response to surgery, trauma, injury, and infection in some individuals and these can lead, progressively, to sepsis and septic shock. The hyperinflammation is characterized by the production of inflammatory cytokines, arachidonic acid-derived eicosanoids, and other inflammatory mediators, while the immunosuppression is characterized by impairment of antigen presentation and of T helper cell type-1 responses. Long-chain n−3 FA from fish oil decrease the production of inflammatory cytokines and eicosanoids. They act both directly (by replacing arachidonic acid as an eicosanoid substrate and by inhibiting arachidonic acid metabolism) and indirectly (by altering the expression of inflammatory genes through effects on transcription factor activation). Thus, long-chain n−3 FA are potentially useful anti-inflammatory agents and may be of benefit in patients at risk of developing sepsis. As such, an emerging application of n−3 FA is in surgical or critically ill patients where they may be added to parenteral or enteral formulas. Parenteral or enteral nutrition including n−3 FA appears to preserve immune function better than standard formulas and appears to partly prevent some aspects of the inflammatory response. Studies to date are suggestive of clinical benefits from these approaches, especially in postsurgical patients.





docosahexaenoic acid


eicosapentaenoic acid


hydroxyeicosapentaenoic acid


hydroxyeicosatetraenoic acid


human leukocyte antigen




inhibitory subunit of nuclear factor kappa B




interleukin-1 receptor antagonist






nuclear factor kappa B




single nucleotide polymorphisms


T helper


tumor necrosis factor




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Copyright information

© AOCS Press 2004

Authors and Affiliations

  1. 1.Institute of Human Nutrition, School of MedicineUniversity of SouthamptonSouthamptonUK

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