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Nutrition Intervention: A Strategy Against Systemic Inflammatory Syndrome

From the ¹ Center for Oral Health Research, University of Kentucky Medical Center, Lexington, Kentucky;² Department of Pharmacology and Toxicology, University of Louisville Medical School, Louisville, Kentucky; and³ In Vitro Drug Safety and Biotechnology, Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Helieh S. Oz, DVM, PhD, Center for Oral Health Research, College of Dentistry and Department of Internal Medicine, School of Medicine, University of Kentucky Medical Center, 800 Rose St, Lexington, KY 40536; e-mail: Helieh.oz{at}uky.edu.

Background: Sepsis and septic shock syndrome are the leading causes of death in critically ill patients. Lipopolysaccharide (LPS) released by the colonic microorganisms may translocate across a compromised lumen, leading to upregulated reactive oxidative stress, inflammation, and sepsis. The authors examined an enteral formula high in cysteine (antioxidant precursor), -3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and prebiotic fructooligosaccharides (FOS) against systemic inflammatory syndrome. Methods: Rats were allocated to (1) standard soy-based diet high in cysteine and crude fiber and devoid of EPA-DHA (CHOW); (2) whey-peptide-based liquid diet high in cysteine, EPA-DHA, and FOS (CYSPUFA); or (3) casein-based liquid isonitrogenous diet, low in cysteine and devoid of EPA-DHA-FOS (CASN). Liquid diets provided 25% and CHOW, 23% of calories as protein. After 6 days on diets, rats received an intraperitoneal injection of LPS or saline. Animals gained weight on their respective diets and lost weight after LPS administration. The CYSPUFA group lost considerably less weight (vs CASN or CHOW, P < .05). Inflammatory cytokines significantly increased by 4 hours and subsided 18 hours after assault. The CASN group showed elevated liver enzyme alanine aminotransferase release from damaged hepatocytes and developed severe hepatic pathology with low hematocrit. The CHOW group developed more severe hepatic lesions compared with those on liquid diets. Concentration of liver enzyme and pathology were improved in rats receiving CYSPUFA. Conclusions: Data indicate that CYSPUFA, a diet rich in EPA-DHA-FOS, protects against LPS-induced systemic inflammatory responses and warrants clinical studies in critically ill patients.

Key Words: sepsis • cysteine • eicosapentaenoic acid • docosahexaenoic acid • probiotic fructooligosaccharides • enteral formula

This version was published on July 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 4, 380-389 (2009)
DOI: 10.1177/0148607108327194


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