Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA)
Lipids in critical care medicine
Section snippets
Lipids in clinical nutrition
Nutrition of critical ill patients in intensive care units is a vital element and needs to be reflected. To fully support the caloric expenditure lipids and lipid emulsions play an essential role in the diet not only due to their high caloric content, but also because lipids are crucial for cell membrane composition. Furthermore, fatty acids display modulatory effects on the immune system. Current publications showed beneficial effects for critically ill patients when fish oil is added to their
Biochemical background of lipid mediators based on arachidonic acid (AA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)
Local-acting lipid mediators involved in the regulation of inflammation are derived from the semi-essential polyunsaturated fatty acids AA, EPA and DHA. Oxidation of these substrates by cyclooxygenase, lipoxygenase, and cytochrome P-450 produces prostaglandins, leukotrienes, lipoxins, resolvins and protectins (Fig. 1). These mediators act as intercellular signaling molecules which possess either pro- or anti-inflammatory effects [10], [11]. While most AA-derived mediators aggravate
Resolvins improve course of inflammation and facilitate reconstitution of homeostasis
Resolvins dampen course and enhance resolution of inflammation via several different mechanisms. They reduce neutrophil extravasation and invasion to inflammatory sites by attenuating expression of adhesion molecules and stimulation of endothelial nitric oxide synthase (NOS) [17]. At loci of inflammation the pro-inflammatory impact of neutrophils is alleviated due to a reduced activation of NF-κB. Hence, production of pro-inflammatory cytokines like TNF-α and interleukin 1. Furthermore they are
The benefits of supplemented n-3 lipids in surgical patients
Recent studies promoted the use of n-3 lipids in surgical patients [29], [30], [31]. Checking the safety profile of lipid emulsions containing n-3 fatty acids, 44 patients with abdominal surgery of a single center study received either a lipid emulsion rich in n-6 fatty acids (SO) or SO supplemented with n-3 lipids (FO) for five days after the surgery. Up to a dose of 0.2 g FO/g bodyweight/d no coagulation or platelet abnormalities were triggered [29]. Adding to the safety profile, changes in
Acute lung injury (ALI/ARDS) and n-3 fatty acids
Acute lung injury (ALI) or the more severe form acute respiratory distress syndrome (ARDS) is defined by clinical, radiological and physiological findings. There are bilateral infiltrates in the lung and a pulmonary capillary wedge pressure below 18 mmHg. The differentiation between ALI and ARDS is defined by the oxygenation index of the arterial oxygen partial pressure (PaO2) divided by the inspiratory oxygen concentration (FiO2). In ALI the PaO2/FiO2 displays values less than 300 mmHg, compared
Sepsis and the advantage of employing n-3 fatty acids
Sepsis is a serious and complex inflammatory process that is characterized by a systemic inflammatory response to the presence of an infection. In intensive care units, the disease counts as the leading cause of death. Mortality ranges between 30% and 60% with around 750,000 new diagnosed cases annually in the USA [54], [55], [56]. In the course of the disease, initially a massive hyper-inflammatory response (systemic inflammatory response syndrome—SIRS) triggered not only by the microbial
Conclusion
Expanding knowledge during the past years of the metabolic, biochemical and immunological capacities of lipids and lipid emulsions in patients has driven the development of new mixture lipid emulsions. Up to date various compositions are available. The variable components show different properties that are desirable in diet and treatment of critically ill. Olive Oil, MCT, and FO have the ability to counterbalance the harmful effects of n-6 fatty acids and SO in regard of immunological effects.
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A four-oil intravenous lipid emulsion improves markers of liver function, triglyceride levels and shortens length of hospital stay in adults: a systematic review and meta-analysis
2021, Nutrition ResearchCitation Excerpt :To our knowledge, ω-3 PUFAs using the same metabolic pathways and enzymes that metabolize ω-6 PUFAs into arachidonic acid had the opposite effect. The higher proportions of ω-3 PUFAs possess considerably less potent inflammatory effects by producing intercellular signaling molecules such as prostaglandins, leukotrienes, lipoxins, resolvins and protectins, which possess either pro- or anti-inflammatory effects [38–40]. Honda's study also showed that enriching macrophages with EPA or DHA attenuates inflammatory activity initiated by Toll-like receptor 4 activation by reducing tumor necrosis factor-α (TNF-α) and IL-6 secretion [41].
Meta-analysis of the efficacy and safety of structured triglyceride lipid emulsions in parenteral nutrition therapy in China
2019, Clinical NutritionCitation Excerpt :Lipid emulsions are an important component of parenteral nutrition (PN), as they not only supply both energy and essential fatty acids, but also contribute to cell membrane structure and function, gene expression, and immune regulation [1–3].
Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group
2018, Clinical NutritionLipidomics in translational research and the clinical significance of lipid-based biomarkers
2017, Translational ResearchCitation Excerpt :Lipid molecules are a subset of the metabolome and serve as ubiquitous and multifunctional metabolites that are integral and essential to many diverse functions on both a cellular and organismal level.1-4 Primary functions of the lipidome include1: compartmentalization of cells and organelles via the formation of membranes2; storage of excess calories to provide a reservoir of energy when needed or to act as the primary energy source for high-energy demand organs (eg, heart)3; regulation of biochemical reactions via influencing the activity of transient and permanent membrane protein interaction; and4 function as a reservoir of bioactive lipids that can be utilized in signaling following agonist-induced hydrolysis or enzymatic/non-enzymatic covalent modifications.1-4 Acting as the boundaries of cells and organelles, lipids are directly exposed to biochemical changes in the intracellular and extracellular milieu and as a result undergo chemical and structural modifications themselves.
Structured triglycerides versus physical mixtures of medium- and long-chain triglycerides for parenteral nutrition in surgical or critically ill adult patients: Systematic review and meta-analysis
2017, Clinical NutritionCitation Excerpt :Parenteral nutrition (PN) is indicated in critically ill patients who are malnourished or at risk of malnutrition and have a dysfunctional gastrointestinal (GI)-tract not suitable for adequate enteral feeding [1]. Lipids are an essential component of PN, not only as an energy-dense source of calories within PN formulations but also due to their important metabolic and functional properties, e.g. as building blocks for membrane phospholipids, carriers for fat-soluble vitamins, providers of essential fatty acids, and precursors for important bioactive lipid mediators with the ability to influence inflammation and immunity [2–4]. Triacylglycerols (TGs) consisting of three fatty acids (FA) attached to a glycerol backbone are the primary components of parenteral lipid emulsions.
Guideline for the clinical application of intravenous lipid emulsions with parenteral nutrition in adult patients (2023 edition)
2023, Chinese Journal of Digestive Surgery