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The Use of an Inflammation-Modulating Diet in Patients With Acute Lung Injury or Acute Respiratory Distress Syndrome: A Meta-Analysis of Outcome Data

From ¹ Intensive Care Department, Fernandes Távora Hospital, Fortaleza, Ceará, Brazil;² Research and Development, Abbott Nutrition, Abbott Laboratories, Columbus, Ohio; ³ Department of General Intensive Care, Rabin Medical Center, Tel Aviv, Israel.

Address correspondence to: Alessandro Pontes-Arruda, MD, MSc, PhD, Intensive Care Department, Fernandes Távora Hospital, Rua Ildefonso Albano 777/403, Fortaleza, Ceará, Brazil 60.115-000; e-mail: pontes-arruda{at}secrel.com.br.

Background: This meta-analysis of clinical trials compares an inflammation-modulating diet enriched with eicosapentaenoic acid (EPA), -linolenic acid (GLA), and elevated antioxidants (EPA + GLA) vs a control diet to determine the effectiveness of this specialized diet on oxygenation and clinical outcomes in mechanically ventilated patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Methods: MEDLINE, EMBASE, Cochrane Clinical Trials Register, and the U.S. National Institute of Health Clinical Trials databases were searched. The outcome measures assessed were 28-day in-hospital mortality, 28-day ventilator-free and intensive care unit (ICU)-free days, and the development of new organ failures. An evaluation of oxygenation and ventilatory variables was also performed. Outcomes were analyzed using both fixed-effects and random-effects models. Results: Three randomized controlled studies (n = 411 patients) were included in this meta-analysis. Among the most important findings of this evaluation is a significant reduction in the risk of mortality (odds ratio [OR] = 0.40; 95% confidence interval [CI] = 0.24–0.68; P = .001), with significant reductions in the risk of developing new organ failures (OR = 0.17; 95% CI = 0.08–0.34; P < .0001), time on mechanical ventilation (standardized mean difference [SMD] = 0.56; 95% CI = 0.32–0.79; P < .0001), and ICU stay (SMD = 0.51; 95% CI = 0.27–0.74; P < .0001) in patients who received EPA + GLA. Conclusions: The meta-analysis showed a significant reduction in the risk of mortality as well as relevant improvements in oxygenation and clinical outcomes of ventilated patients with ALI/ARDS given EPA + GLA.

Key Words: meta-analysis • eicosapentaenoic acid • -linolenic acid • ARDS • ALI • sepsis • inflammation • borage oil • fish oil • critical care • omega-3 fatty acids

Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 6, 596-605 (2008)
DOI: 10.1177/0148607108324203


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