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. 2004;39(12):1147–1161. doi: 10.1007/s11745-004-1342-z

n−3 Fatty acids, inflammation, and immunity— Relevance to postsurgical and critically III patients

Philip C Calder 1,✉
PMCID: PMC7101959  PMID: 15736910

Abstract

Excessive or inappropriate inflammation and immunosuppression are components of the response to surgery, trauma, injury, and infection in some individuals and these can lead, progressively, to sepsis and septic shock. The hyperinflammation is characterized by the production of inflammatory cytokines, arachidonic acid-derived eicosanoids, and other inflammatory mediators, while the immunosuppression is characterized by impairment of antigen presentation and of T helper cell type-1 responses. Long-chain n−3 FA from fish oil decrease the production of inflammatory cytokines and eicosanoids. They act both directly (by replacing arachidonic acid as an eicosanoid substrate and by inhibiting arachidonic acid metabolism) and indirectly (by altering the expression of inflammatory genes through effects on transcription factor activation). Thus, long-chain n−3 FA are potentially useful anti-inflammatory agents and may be of benefit in patients at risk of developing sepsis. As such, an emerging application of n−3 FA is in surgical or critically ill patients where they may be added to parenteral or enteral formulas. Parenteral or enteral nutrition including n−3 FA appears to preserve immune function better than standard formulas and appears to partly prevent some aspects of the inflammatory response. Studies to date are suggestive of clinical benefits from these approaches, especially in postsurgical patients.

Keywords: Arachidonic Acid, Septic Shock, Enteral Nutrition, Eicosanoid, Total Parenteral Nutrition

Abbreviations

COX

cyclooxygenase

DHA

docosahexaenoic acid

EPA

eicosapentaenoic acid

HEPE

hydroxyeicosapentaenoic acid

HETE

hydroxyeicosatetraenoic acid

HLA

human leukocyte antigen

IFN

interferon

IkB

inhibitory subunit of nuclear factor kappa B

IL

interleukin

IL-1ra

interleukin-1 receptor antagonist

LOX

lipoxygenase

LT

leukotriene

NFkB

nuclear factor kappa B

PG

prostaglandin

SNPs

single nucleotide polymorphisms

Th

T helper

TNF

tumor necrosis factor

TX

thromboxane

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