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

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  • Published: December 2004
  • Volume 39, pages 1147–1161, (2004)
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Lipids
n−3 Fatty acids, inflammation, and immunity— Relevance to postsurgical and critically III patients
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  • Philip C. Calder1 

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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.

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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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Authors and Affiliations

  1. Institute of Human Nutrition, School of Medicine, University of Southampton, Bassett Crescent East, SO16 7PX, Southampton, UK

    Philip C. Calder

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  1. Philip C. Calder
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Correspondence to Philip C. Calder.

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Calder, P.C. n−3 Fatty acids, inflammation, and immunity— Relevance to postsurgical and critically III patients. Lipids 39, 1147–1161 (2004). https://doi.org/10.1007/s11745-004-1342-z

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  • Received: 30 July 2004

  • Accepted: 26 November 2004

  • Issue Date: December 2004

  • DOI: https://doi.org/10.1007/s11745-004-1342-z

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Keywords

  • Arachidonic Acid
  • Septic Shock
  • Enteral Nutrition
  • Eicosanoid
  • Total Parenteral Nutrition
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