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Importance of n-3 Polyunsaturated Fatty Acids in Critical Care

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Diet and Nutrition in Critical Care

Abstract

N-3 polyunsaturated fatty acids (PUFAs) include alpha-linolenic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), among others. Alpha-linolenic acid is found in flaxseed oil. EPA and DHA are found in blueback fish oil. It has been suggested that n-3 PUFAs have nutritional benefits including suppression of inflammation and decreased total mortality. Therefore, we pose the question: are n-3 PUFAs effective in the treatment of critical care patients?

The following beneficial effects of n-3 PUFAs in critical care have been suggested: reduced postoperative atrial fibrillation (AF), protection against ischemia-reperfusion injury, prevention of some cancers, and decreased risk of developing sepsis. The underlying mechanisms might relate to the effect of n-3 PUFAs on immune system regulation.

The importance of n-3 PUFAs has been suggested by guidelines issued by the European Society for Clinical Nutrition and Metabolism (ESPEN). For example, diets containing n-3 PUFAs, often described as “immunonutrition,” aim at enhancing the immune function in surgical patients. However, there is limited evidence describing the criteria for the use of n-3 PUFAs in critical care; therefore, additional research is needed.

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Abbreviations

AA:

Arachidonic acid

AF:

Atrial fibrillation

CABG:

Coronary artery bypass grafting

CVD:

Cardiovascular disease

DHA:

Docosahexaenoic acid

EPA:

Eicosapentaenoic acid

ESPEN:

European Society for Clinical Nutrition and Metabolism

ICU:

Intensive care unit

IPC:

Ischemic preconditioning

LT:

Leukotriene

PEG:

Percutaneous endoscopic gastrostomy

PG:

Prostaglandin

PN:

Parenteral nutrition

PPAR:

Peroxisome proliferator-activated receptor

PUFA:

Polyunsaturated fatty acid

QOL:

Quality of life

RBC:

Red blood cell

SREBP:

Sterol regulatory element-binding protein

TG:

Triacylglycerol

TX:

Thromboxane

UCP:

Uncoupling protein

WBC:

White blood cell

References

  • Abdukeyum GG, Owen AJ, McLennan PL. Dietary (n-3) long-chain polyunsaturated fatty acids inhibit ischemia and reperfusion arrhythmias and infarction in rat heart not enhanced by ischemic preconditioning. J Nutr. 2008;138:1902–9.

    CAS  PubMed  Google Scholar 

  • Arakawa K, Himeno H, Otomo F, Matsushita K, Nakahashi H, Shimizu S, et al. N-3 polyunsaturated fatty acids as a predictor of ischemia/reperfusion injury immediately after myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction. Eur Heart J. 2013;34:1299.

    Article  Google Scholar 

  • Benedetto U, Melina G, di Bartolomeo R, Angeloni E, Sansone D, Falaschi G, et al. n-3 polyunsaturated fatty acids after coronary artery bypass grafting. Ann Thorac Surg. 2011;91:1169–75.

    Article  PubMed  Google Scholar 

  • Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28:378–86.

    Article  CAS  PubMed  Google Scholar 

  • Calder PC. n-3 fatty acids, inflammation, and immunity – relevance to postsurgical and critically ill patients. Lipids. 2004;39:1147–61.

    Article  CAS  PubMed  Google Scholar 

  • Calder PC. Rationale and use of n-3 fatty acids in artificial nutrition. Proc Nutr Soc. 2010;69:565–73.

    Article  CAS  PubMed  Google Scholar 

  • Cartwright IJ, Pockley AG, Galloway JH, Greaves M, Preston FE. The effects of ω-3 polyunsaturated fatty acids on erythrocyte membrane phospholipids, erythrocyte deformability and blood viscosity in healthy volunteers. Atherosclerosis. 1985;55:267–81.

    Article  CAS  PubMed  Google Scholar 

  • Colomer R, Moreno-Nougueira JM, García-Luna PP, García-Peris P, García-de Lorenzo A, Zarazaga A, et al. N-3 fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr. 2007;97:823–31.

    Article  CAS  PubMed  Google Scholar 

  • Ezaki O, Sato S, Sakono M, Miyake Y, Mito N, Umesawa M. Concept of reference intake of n-3 polyunsaturated fatty acids in the Japanese population. J Jpn Soc Nutr Food Sci. 2006;59:123–58.

    Article  CAS  Google Scholar 

  • Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.

    Article  PubMed  Google Scholar 

  • Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. 2012. World J Surg. 2013;37:259–284.

    Article  CAS  PubMed  Google Scholar 

  • Hayashi N, Tashiro T, Yamamori H, Takagi K, Morishita Y, Otsubo Y, et al. Effect of intravenous omega-6 and omega-3 fat emulsions on nitrogen retention and protein kinetics in burned rats. Nutrition. 1999;15:135–9.

    Article  CAS  PubMed  Google Scholar 

  • Jung UJ, Torrejon C, Tighe AP, Deckelbaum RJ. n-3 fatty acids and cardiovascular disease: mechanisms underlying beneficial effects. Am J Clin Nutr. 2008;87:2003S–9.

    CAS  PubMed  Google Scholar 

  • Kim HJ, Takahashi M, Ezaki O. Fish oil feeding decreases mature sterol regulatory element-binding protein 1 (SREBP-1) by down regulation of SREBP-1C mRNA in mouse liver. A possible mechanism for down-regulation of lipogenic enzyme mRNAs. J Biol Chem. 1999;274:25892–8.

    Article  CAS  PubMed  Google Scholar 

  • Lauritzen L, Hansen HS. Which of the n-3 FA should be called essential? Lipids. 2003;38:889–91.

    Article  CAS  PubMed  Google Scholar 

  • Laviano A, Rianda S, Molfino A, Rossi FF. Omega-3 fatty acids in cancer. Curr Opin Clin Nutr Metab Care. 2013;16:156–61.

    Article  CAS  PubMed  Google Scholar 

  • Lee TH, Sethi T, Crea AE, Peters W, Arm JP, Horton CE, et al. Characterization of leukotriene B3: comparison of its biological activities with leukotriene B4 and leukotriene B5 in complement receptor enhancement, lysozyme release and chemotaxis of human neutrophils. Clin Sci. 1988;74:467–75.

    Article  CAS  PubMed  Google Scholar 

  • Liu GS, Thornton J, Van Winkle DM, Stanley AW, Olsson RA, Downey JM. Protection against infarction afforded by preconditioning is mediated by A1 adenosine receptors in rabbit heart. Circulation. 1991;84:350–6.

    Article  CAS  PubMed  Google Scholar 

  • Marchioli R, Mozaffarian D, Silletta G, Macchia A, Ferrazzi P, Gardner T, et al. Fish oil for the prevention of post-operative atrial fibrillation – The omega-3 fatty acids for prevention of post-operative atrial fibrillation (OPERA) trial. Circulation. 2012;126:2781.

    Google Scholar 

  • Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006;296:1885–99.

    Article  CAS  PubMed  Google Scholar 

  • Muakkassa FF, Koruda MJ, Ramadan FM, Kawakami M, Meyer AA. Effect of dietary fish oil on plasma thromboxane B2 and 6-keto-prostaglandin F1 alpha levels in septic rats. Arch Surg. 1991;126:179–82.

    Article  CAS  PubMed  Google Scholar 

  • Nakatani T, Tsuboyama-Kasaoka N, Takahashi M, Miura S, Ezaki O. Mechanism for PPARα activator-induced up-regulation of UCP2 mRNA in rodent hepatocytes. J Biol Chem. 2002;277:9562–9.

    Article  CAS  PubMed  Google Scholar 

  • Nieuwenhuys CMA, Hornstra G. The effects of purified eicosapentaenoic and docosahexaenoic acids on arterial thrombosis tendency and platelet function in rats. Biochim Biophys Acta. 1998;1390:313–22.

    Article  CAS  PubMed  Google Scholar 

  • Pachikian BD, Neyrinck AM, Cani PD, Portois L, Deldicque L, De Backer FC, et al. Hepatic steatosis in n-3 fatty acid depleted mice: focus on metabolic alterations related to tissue fatty acid composition. BMC Physiol. 2008;8:21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Riediger ND, Othaman R, Fitz E, Pierce GN, Suh M, Moghadasian MH. Low n-6: n-3 fatty acid ratio, with fish- or flaxseed oil, in a high fat diet improves plasma lipids and beneficially alters tissue fatty acid composition in mice. Eur J Nutr. 2008;47:153–60.

    Article  CAS  PubMed  Google Scholar 

  • Rosman C, Grond J, Buurman WA, de Smet BJ, de Jonge R, Sietsma M, et al. Fish oil increases the release of tumour necrosis factor and interleukin-6, and has no effect on the incidence of multiple organ failure in rats with peritonitis. Eur J Surg. 1993;159:563–70.

    CAS  PubMed  Google Scholar 

  • Rousseau AF, Losser MR, Ichai C, Berger MM. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32:497–502.

    Article  PubMed  Google Scholar 

  • Sijben JW, Calder PC. Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease. Proc Nutr Soc. 2007;66:237–59.

    Article  CAS  PubMed  Google Scholar 

  • Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21:495–505.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Skuladottir GV, Heidarsdottir R, Arnar DO, Torfason B, Edvardsson V, Gottskalksson G, et al. Plasma n-3 and n-6 fatty acids and the incidence of atrial fibrillation following coronary artery bypass graft surgery. Eur J Clin Invest. 2011;41:995–1003.

    Article  CAS  PubMed  Google Scholar 

  • Takada H, Ogura T, Okuno M, Mori A, Kitade H, Ueda S, et al. n-3 polyunsaturated fatty acid and cancer. J JSMUFF. 2003;1:165–71.

    Google Scholar 

  • Tashiro T, Sano W, Chiku T, Tamamori H. Effects of n-3 polyunsaturated fatty acids in immunosuppression caused by surgical stress. J JSMUFF. 2003;1:135–44.

    Google Scholar 

  • Terano T, Hirai A, Hamazaki T, Kobayashi S, Fujita T, Tamura Y, et al. Effect of oral administration of highly purified eicosapentaenoic acid on platelet function, blood viscosity and red blood cell deformability in healthy human subjects. Atherosclerosis. 1983;46:321–31.

    Article  CAS  PubMed  Google Scholar 

  • Thomas Brenna J et al. Fats and fatty acids in human nutrition –report of an expert consultation, FAO Food and Nutrition Paper 91. 10–14 Nov 2008; Geneva, p 30.

    Google Scholar 

  • Watanabe N, Funayama K, Kimura F, Endo Y, Fujimoto K, Kikuchi Y. Effect of dietary supplementation of n-3 polyunsaturated fatty acids (PUFA) on red blood cell deformability and blood viscosity in rats. J Oleo Sci. 2003;52:397–406.

    Article  CAS  Google Scholar 

  • Watanabe N, Watanabe Y, Kumagai M, Fujimoto K. Administration of dietary fish oil capsules in healthy middle-aged Japanese men with a high level of fish consumption. Int J Food Sci Nutr. 2009;60:136–42.

    Article  CAS  PubMed  Google Scholar 

  • Watanabe N, Onuma K, Fujimoto K, Miyake S, Nakamura T. Long-term effect of an enteral diet with a different n-6/n-3 ratio on fatty acid composition and blood parameters in rats. J Oleo Sci. 2011;60:109–15.

    Article  CAS  PubMed  Google Scholar 

  • Zeghichi-Hamri S, de Lorgeril M, Salen P, Chibane M, de Leiris J, Boucher F, et al. Protective effect of dietary n-3 polyunsaturated fatty acids on myocardial resistance to ischemia-reperfusion injury in rats. Nutr Res. 2010;30:849–57.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Food Science and Nutrition, Showa Women’s University, 1-7 Taishido, 154-8533, Tokyo, Japan

    Nakamichi Watanabe

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  1. Nakamichi Watanabe
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Correspondence to Nakamichi Watanabe .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Watanabe, N. (2015). Importance of n-3 Polyunsaturated Fatty Acids in Critical Care. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_118

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  • DOI: https://doi.org/10.1007/978-1-4614-7836-2_118

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7837-9

  • Online ISBN: 978-1-4614-7836-2

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