Effect of enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with sepsis-induced acute respiratory distress syndrome

Kunihiro Shirai,Shinji Ogura,Izumi Toyoda,Naoki Matsumaru,Shozo Yoshida

doi:10.1186/s40560-015-0087-2

Abstract

BackgroundIn this study, the effects of an enteral diet enriched with eicosapentaenoic acid (EPA), γ-linolenic acid (GLA), and antioxidants were compared with a standard enteral diet in critically ill patients with sepsis-induced acute respiratory distress syndrome (ARDS).MethodsThis study was a single-center, prospective, randomized, single-blind, controlled trial in our Advanced Critical Care Center. Patients were randomized to receive a continuous EPA, GLA, and antioxidant-enriched diet (study group), or an isocaloric standard diet (control group).ResultsTwenty-three of 46 patients were in the study group, and the other 23 were in the control group. Duration of mechanical ventilation, incidence of new nosocomial infections, changes over time in Sequential Organ Failure Assessment (SOFA) scores, and 60-day mortality were not significantly different between the two groups. The ratio of partial pressure of oxygen to fraction of inspired oxygen on day 7 was significantly higher in the study group (233.0 [185.5–282.8] vs. 274.0 [225.5–310.8], p = 0.021). Duration of ICU stay was significantly shorter in the study group than in the control group (24.0 [20.0–30.0] vs. 15.0 [11.0–24.0], p = 0.008).ConclusionsAn enteral diet enriched with EPA, GLA, and antioxidants did not improve duration of mechanical ventilation, SOFA score, incidence of new nosocomial infections, or mortality but did favorably influence duration of ICU stay in critically ill patients with sepsis-induced ARDS.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-015-0087-2) contains supplementary material, which is available to authorized users.

Highlights

In this study, the effects of an enteral diet enriched with eicosapentaenoic acid (EPA), γ-linolenic acid (GLA), and antioxidants were compared with a standard enteral diet in critically ill patients with sepsis-induced acute respiratory distress syndrome (ARDS)
Competing with arachidonic acid (AA) are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which originate from n-3 fatty acids and produce eicosanoids that are less markedly inflammatory and even anti-inflammatory [5]
The median Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were not significantly different, and the number of organ failures was similar in the two groups

Summary

Introduction

The effects of an enteral diet enriched with eicosapentaenoic acid (EPA), γ-linolenic acid (GLA), and antioxidants were compared with a standard enteral diet in critically ill patients with sepsis-induced acute respiratory distress syndrome (ARDS). Eicosanoids play a role in both pro- and anti-inflammatory reactions, depending on the original fatty acids [4]. Pro-inflammatory eicosanoids originate from n-6 fatty acids such as arachidonic acid (AA). Competing with AA are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which originate from n-3 fatty acids and produce eicosanoids that are less markedly inflammatory and even anti-inflammatory [5]. Supplementation with n-3 fatty acids (fish oil) reportedly improves clinical outcomes in critically ill patients [4,6]. Γ-linolenic acid (GLA) and dihomo-GLA supplements reduce synthesis of pro-inflammatory AA metabolites [7]. Strong promotion of oxidation occurs during development of sepsis and ARDS

Objectives

Methods

Results

Discussion

Conclusion