Influence of Intravenous Fish Oil-Enriched Lipid Emulsion on the Inflammatory Response in Children Post Gastrointestinal Surgery
DOI:
https://doi.org/10.3923/pjn.2019.1036.1041Keywords:
Esophageal atresia, fish oil, intestinal atresia, lipid emulsion, parenteral nutritionAbstract
Background and Objective: Surgery can increase morbidity and mortality due to the production of proinflammatory cytokines, such as interleukin (IL)-6 and tumor necrosis factor (TNF)-α. Intravenous fish oil-enriched lipid emulsion (FOLE) contains ω-3, which can reduce the release of proinflammatory cytokines. The influence of FOLE compared to that of the standard medium chain triglyceride (MCT)/long chain triglyceride (LCT) emulsion on the inflammatory response in children post gastrointestinal surgery has never been studied. The current study was designed to explain the influence of FOLE on the inflammatory response in children post gastrointestinal surgery. Materials and Methods: A randomized controlled trial was conducted in August 2018-January 2019 at Dr. Soetomo Hospital in children post gastrointestinal surgery due to esophageal and intestinal atresia that requires parenteral nutrition for at least 3 days. The samples were divided randomly into MCT/LCT and FOLE groups. Laboratory and cytokine parameters were examined before and at 3 days after surgery. Results: Among all patients, 7/14 were male and 7/14 received FOLE. There were no significant differences in Hb, leukocyte, CRP, albumin, SGOT and SGPT levels in either group. The difference in IL-6 levels was significant between the two groups before surgery (p = 0.048), at 3 days after surgery (p = 0.013) and in changes within 3 days (p = 0.003). TNF-α levels were not significantly different compared to MCT/LCT at day 3 post surgery (p = 0.482). Conclusion: FOLE, compared to standard emulsions, can decrease IL-6 in postoperative children.
References
Wang J., J.C. Yu, W.M. Kang and Z.Q. Ma, 2012. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: A randomized clinical trial. Nutrition, 28: 623-629.
Sungurtekin, H., S. Degirmenci, U. Sungurtekin, B.E. Oguz, N. Sabir nd B. Kaptanoglu, 2011. Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis. Nutr. Clin. Pract., 26: 665-671.
Kleka, S., C. Chambrierb, P. Singerc, M. Rubinc and T. Bowling et al., 2013. Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid)-A double-blind, randomised, multicentre study in adults. Clin. Nutr., 32: 224-231.
Wanten, G.J.A. and P.C. Calder, 2007. Immune modulation by parenteral lipid emulsions. Am. J. Clin. Nutr., 85: 1171-1184.
Waitzberg, D.L. and R.S. Torrinhas, 2009. Fish oil lipid emulsions and immune response: What clinicians need to know. Nutr. Clin. Pract., 24: 487-499.
Sala-Vila, A., V.M. Barbosa and P.C. Calder, 2007. Olive oil in parenteral nutrition. Curr. Opin. Clin. Nutr. Metab. Care, 10: 165-174.
Li, N.N., Y. Zhou, X.P. Qin, Y. Chen, D. He, J.Y. Feng and X.T. Wu, 2014. Does intravenous fish oil benefit patients post-surgery? A meta-analysis of randomised controlled trials. Clin. Nutr., 33: 226-239.
Chen, G.Y. and G. Nuñez, 2010. Sterile inflammation: Sensing and reacting to damage. Nat. Rev. Immunol., 10: 826-837.
Han Y.Y., S.L. Lai, W.J. Ko, C.H. Chou and H.S. Lai, 2012. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr. Clin. Pract., 27: 91-98.
Wu, M.H., M.Y. Wang, C.Y. Yang, M.L. Kuo and M.T. Lin, 2014. Randomized clinical trial of new intravenous lipid (SMOFlipid 20%) versus mediumâ€chain triglycerides/longâ€chain triglycerides in adult patients undergoing gastrointestinal surgery. J. Parenteral Enteral Nutr., 38: 800-808.
Nusinovich, Y., M. Revenis and C. Torres, 2013. Long-term outcomes for infants with intestinal atresia studied at children's national medical center. J Pediatr. Gastroenterol. Nutr., 57: 324-329.
Sfeir, R., A. Bonnard, N.K. Dunlop, F. Auber and T. Gelas et al., 2013. Esophageal atresia: Data from a national cohort. J. Pediatric Surg., 48: 1664-1669.
Ghorbani, M., A. Rezaeian, G. Khademi, R. Shojaeian and S.A. Jafari, 2016. Effects of early feeding support on the postoperative weight gain status of infants with Esophageal Atresia. Evidence-Based Care J., 6: 67-74.
Lin, E. and S.F. Lowry, 1998. The human response to endotoxin. Sepsis, 2: 255-262.
Wacthler, P., W. Konig, M. Senkal, M. Kemen and M. Koller, 1997. Influence of a total parenteral nutrition enriched with omega-3 fatty acids on leukotriene synthesis of peripheral leukocytes and systemic cytokine levels in patients with major surgery. J. Trauma, 42: 191-198.
Weiss, G., F. Meyer, B. Matthies, M. Pross, W. Koenig and H. Lippert, 2002. Immunomodulation by perioperative administration of n-3 fatty acids. Br. J. Nutr., 87: S89-S94.
Grimm, H., N. Mertes, C. Goeters, E. Schlotzer, K. Mayer, F. Grimminger and P. Furst, 2006. Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients. Eur. J. Nutr., 45: 55-60.
Mertes, N., H. Grimm, P. Fürst and P. Stehle, 2006. Safety and efficacy of a new parenteral lipid emulsion (SMOFlipid) in surgical patients: a randomized, double-blind, multicenter study. Ann. Nutr. Metab., 50: 253-259.
Senkal, M., B. Geler, M. Hannemann, T. Deska, J. Linseisen, G. Wolfram and M. Adolph, 2007. Supplementation of Ωâ€3 fatty acids in parenteral nutrition beneficially alters phospholipid fatty acid pattern. J. Parenteral Enteral Nutr., 31: 12-17.
Berger, M.M., L. Tappy, J.P. Revelly, B.V. Koletzko and J. Gepert et al., 2008. Fish oil after abdominal aorta aneurysm surgery. Eur. J. Clin. Nutr., 62: 1116-1122.
Puiggròs, C., J. Sánchez, P. Chacón, P. SabÃn, J. Roselló, R. Bou and M. Planas 2009. Evolution of lipid profile, liver function, and pattern of plasma fatty acids according to the type of lipid emulsion administered in parenteral nutrition in the early postoperative period after digestive surgery. J. Parenteral Enteral Nutr., 33: 501-512.
Hallay, J., A.V. Olah, B. Fulesdi, M. Kocsor and T. Vegh et al., 2010. Hepatobiliary response in postoperative lipid therapy in gastrointestinal surgery. Hepatogastroenterology, 57: 1069-1073.
Ma, C.J., L.C. Sun, F.M. Chen, C.Y. Lu and Y.L. Shih et al., 2012. A doubleâ€blind randomized study comparing the efficacy and safety of a composite vs a conventional intravenous fat emulsion in postsurgical gastrointestinal tumor patients. Nutr. Clin. Pract., 27: 410-415.
Zhu, M.W., D.N. Tang, J. Hou, J.M. Wei, B. Hua and J.H. Sun, 2012. Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery. Chin. Med. J., 125: 178-181.
Grau-Carmona, T., A. Bonet-Saris, A. GarcÃa-de-Lorenzo, C. Sánchez-Alvarez and A. RodrÃguez-Pozo et al., 2015. Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU lipids study. Crit. Care Med., 43: 31-39.
Jiang, Z.M., D.W. Wilmore, X.R. Wang, J.M. Wei and Z.T. Zhang et al., 2010. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br. J. Surg., 97: 804-809.
Wichmann, M., P. Thul, H.D. Czarnetzki, B. Morlion, M. Kemen and K.W. Jauch, 2007. Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): Data from a prospective, randomized, multicenter trial. Crit. Care Med., 35: 700-706.
Ma, C.J., J.M. Wu, H.L. Tsai, C.W. Huang and C.Y. Lu, 2015. Prospective double-blind randomized study on the efficacy and safety of an n-3 fatty acid enriched intravenous fat emulsion in postsurgical gastric and colorectal cancer patients. Nutr. J.
Delgado, S., A. Lacy, X. Filella, A. Castells and J. GarcÃa-Valdecasas et al., 2001. Acute phase response in laparoscopic and open colectomy in colon cancer: Randomized study. Dis. Colon Rectum, 44: 638-646.
Schietroma, M., F. Carlei, L. Franchi, C. Mazzotta, A. Sozio, N.J. Lygidakis and G. Amicucci, 2004. A comparison of serum interleukin-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Hepatogastroenterology, 51: 1595-1599.
Oliver, J.C., L.A. Bland, C.W. Oettinger, M.J. Arduino, S.K. McAllister, S.M. Aguero and M.S. Favero, 1993. Cytokine kinetics in an in vitro whole blood model following an endotoxin challenge. Lymphokine Cytokine Res., 12: 115-120.
Downloads
Published
Issue
Section
License
Copyright (c) 2019 The Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
