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Supplementation of  -3 Fatty Acids in Parenteral Nutrition Beneficially Alters Phospholipid Fatty Acid Pattern
Metin Senkal, MD*,
Bruno Geier, MD*,
Martin Hannemann, MD*,
Thomas Deska, MD*,
Jakob Linseisen, PhD ,
Günther Wolfram, MD and
Michael Adolph, MD
From the * Department of Surgery, Ruhr-University
Bochum, St. Josef Hospital, Bochum, Germany;
German Cancer Research Center, Heidelberg,
Germany; Department of Nutrition and Food
Sciences, Technical University Munich, Freising, Germany; and the
Department of Anesthesiology and Intensive Care
Medicine, Tuebingen University Hospital, Tuebingen, Germany
Correspondence: Metin Senkal, MD, Department of Surgery, Marienhospital
Witten, Marienplatz 2, 58452 Witten, Germany. Electronic mail may be sent to
Senkal{at}Marien-Hospital-Witten.de.
Background: The clinical safety and the uptake of  -3
polyunsaturated fatty acids (PUFA) into the serum phospholipids and
erythrocyte membranes after administration of fish-oil-supplemented parenteral
nutrition (PN) was investigated in colorectal surgical patients.
Methods: Forty patients undergoing colorectal surgery (n = 40) and
with an indication for PN were enrolled in a prospective, double-blind,
randomized study to receive an -3 PUFA-supplemented 20% lipid emulsion
(Lipoplus; B. Braun Melsungen, Melsungen, Germany; test group, n = 19) for 5
days postoperatively. The control group received a standard 20% fat emulsion
(Lipofundin MCT/LCT, B. Braun Melsungen, Melsungen, Germany, control group, n
= 21). Clinical outcome parameters and safety were assessed by means of
adverse events recording clinical parameters and hematologic analyses. The
contents of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as
well as arachidonic acid (AA), in phospholipid fractions in plasma and in
erythrocytes were analyzed preoperatively, on postoperative days 1, 6, and 10
using liquid gas chromatography. Results: Both fat emulsions were
well tolerated, and none of the adverse events was considered to be related to
treatment. Postoperative infectious complications occurred in 4 patients of
the -3 PUFA group vs 7 patients in the control group. As
compared with the control group, the -3 PUFA group had significantly
increased levels of EPA in the membranes of the erythrocytes in postoperative
day 6 (2.0% ± 0.9% vs 0.8% ± 0.5% fatty acid methyl
esters, [FAME]) and postoperative day 10 (2.1% ± 0.8% vs 0.9%
± 0.7% FAME, p < .05). Also, the EPA levels in the serum
phospholipids were significantly higher than in the control group on the same
postoperative days (7.0% ± 2.6% vs 1.3% ± 0.8% and 3.6%
± 1.0% vs 1.0% ± 0.4% FAME, p < .05). The
DHA levels in the serum phospholipids were significantly higher in the
-3 PUFA group compared with the control on postoperative days 6 and 10
(11.8% ± 1.9% vs 8.4% ± 1.5% and 11.2% ± 1.6%
vs 8.5% ± 1.4% FAME, p < .05). AA levels were not
significantly different in the both groups. Conclusions:
 -3-fatty-acids-supplemented fat emulsions for parenteral administration
are safe and very well tolerated. This study demonstrates that parenteral
administration of -3-PUFA-enriched fat emulsions leads to increased
incorporation of EPA and DHA into phospholipids in serum and erythrocytes,
whereas AA levels remain unchanged. Thus, postoperative parenteral
administration of -3-PUFA-enriched lipid emulsions could have an impact
on the postoperative inflammatory response after abdominal surgery and could
be used in standard postoperative care when PN is indicated.
Journal of Parenteral and Enteral Nutrition, Vol. 31, No. 1,
12-17 (2007)
DOI: 10.1177/014860710703100112
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[Abstract]
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