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      Effects of Perioperative Supplementation with Omega-3 Fatty Acids on Leukotriene B 4 and Leukotriene B 5 Production by Stimulated Neutrophils in Patients with Colorectal Cancer: A Randomized, Placebo-Controlled Intervention Trial

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          Abstract

          Omega-3 fatty acids ( n-3 FA) may have beneficial clinical and immune-modulating effects in surgical patients. In a randomized, double-blind, prospective, placebo-controlled trial, 148 patients referred for elective colorectal cancer surgery received an n-3 FA-enriched oral nutritional supplement (ONS) providing 2.0 g of eicosapentaenoic acid (EPA) and 1.0 g of docosahexaenoic acid (DHA) per day or a standard ONS for seven days before surgery. On the day of operation, there was a significant increase in the production of leukotriene B 5 (LTB 5) ( p < 0.01) and 5-hydroxyeicosapentaenoic acid (5-HEPE) ( p < 0.01), a significant decrease in the production of leukotriene B 4 (LTB 4) ( p < 0.01) and a trend for a decrease in the production of 5-hydroxyeicosatetraenoic acid (5-HETE) ( p < 0.1) from stimulated neutrophils in the active group compared with controls. There was no association between LTB 4 values and postoperative complications. In conclusion, oral n-3 FA exerts anti-inflammatory effects in surgical patients, without reducing the risk of postoperative complications.

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          The modification of mammalian membrane polyunsaturated fatty acid composition in relation to membrane fluidity and function.

          Narelle C Stubbs, J. Smith (1984)
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            ASA classification and perioperative variables as predictors of postoperative outcome.

            T. Wolf, Torsten Schröder, U Wolters … (1996)
            In a prospective study of 6301 surgical patients in a university hospital, we examined the strength of association between ASA physical status classification and perioperative risk factors, and postoperative outcome, using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model. Univariate analysis showed a significant correlation (P < 0.05) between ASA class and perioperative variables (intraoperative blood loss, duration of postoperative ventilation and duration of intensive care stay), postoperative complications and mortality rate. Univariate analysis of individual preoperative risk factors demonstrated their importance in the development of postoperative complications in the related organ systems. Estimating the increased risk odds ratio for single variables, we found that the risk of complication was influenced mainly by ASA class IV (risk odds ratio = 4.2) and ASA class III (risk odds ratio = 2.2). We conclude that ASA physical status classification was a predictor of postoperative outcome.
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              Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial.

              Victoria A Ryan, Deirdre McCormack, Niamh Brannelly … (2009)
              Esophagectomy represents an exemplar of controlled major trauma, with marked metabolic, immunologic, and physiologic changes as well as an associated high incidence of complications. Eicosapentaenoic acid (EPA) enriched enteral nutrition (EN) modulates immune function and limits catabolism in patients with advanced cancer, but its impact in the peri-operative period is unclear. To examine the effects of perioperative EPA enriched EN on the metabolic, nutritional, and immuno-inflammatory response to esophagectomy, and on postoperative complications. In a double-blind design, patients were randomized to a standard EN formula or a formula enriched with 2.2 g EPA/d for 5 days preoperatively (orally) and 21 days postoperatively (jejunostomy). Segmental bioelectrical impedance analysis was performed preoperatively and on POD 21. Postoperative complications were monitored, as well as the acute phase response, coagulation markers, and serum cytokines. Fifty-three patients (28 EPA, 25 standard) completed the study, and both groups were well matched. Serum and peripheral blood mononuclear cell (PBMC) membrane EPA levels were significantly increased in the EPA group. There was no difference in the incidence of major complications. The EPA group maintained all aspects of body composition postoperatively, whereas patients in the standard EN group lost significant amounts of fat-free mass (1.9 kg, P = 0.030) compared with the EPA group [leg (0.3 kg, P = 0.05), arm (0.17 kg, P = 0.01), and trunk (1.44 kg, P = 0.03)]. The EPA group had a significantly (P < 0.05) attenuated stress response for TNFalpha, IL-10, and IL-8 compared with the standard group. EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a standard EN. These properties may merit longer-term study to address its impact on recovery of function and quality of life in models of complex surgery or multimodal cancer treatment regimens.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nutrients
                Journal ID (iso-abbrev): Nutrients
                Journal ID (publisher-id): nutrients
                Title: Nutrients
                Publisher: MDPI
                ISSN (Electronic): 2072-6643
                Publication date (Electronic): 29 September 2014
                Publication date Collection: October 2014
                Volume: 6
                Issue: 10
                Pages: 4043-4057
                Affiliations
                [1 ]Department of Surgical Gastroenterology, Aalborg University Hospital, 9000 Aalborg, Denmark; E-Mail: otu@ 123456rn.dk
                [2 ]Institute of Clinical Medicine, Aarhus University Hospital, Aarhus 8000, Denmark
                [3 ]Center for Nutrition and Bowel Disease, Aalborg University Hospital, 9000 Aalborg, Denmark; E-Mail: hhr@ 123456rn.dk
                [4 ]Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, 9000 Aalborg, Denmark; E-Mails: solc@ 123456rn.dk (S.L.); ebs@ 123456rn.dk (E.B.S.)
                [5 ]National Institute for Health Research Southampton Biomedical Research Center, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK; E-Mail: p.c.calder@ 123456soton.ac.uk
                [6 ]NordSim, Center for Simulation, Skills Training, Science and Innovation, Aalborg University Hospital, 9000 Aalborg, Denmark; E-Mail: kgll@ 123456rn.dk
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: lss@ 123456rn.dk ; Tel.: +45-9766-1188; Fax: +45-9932-2560.
                Article
                Publisher ID: nutrients-06-04043
                DOI: 10.3390/nu6104043
                PMC ID: 4210906
                PubMed ID: 25268838
                SO-VID: 1b91177d-9249-42a5-a1a0-4aafae6629c3
                Copyright © © 2014 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 30 July 2014
                Date revision received : 18 September 2014
                Date accepted : 19 September 2014
                Categories
                Subject: Article

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: colorectal cancer,omega-3 fatty acids,immunomodulation,fish oil,leukotrienes
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: colorectal cancer, omega-3 fatty acids, immunomodulation, fish oil, leukotrienes

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