Influence of a total parenteral nutrition enriched with omega-3 fatty acids on leukotriene synthesis of peripheral leukocytes and systemic cytokine levels in patients with major surgery

Objective: Nutritive immunomodulation of patients after major surgery. Design: Prospective, randomized controlled double-blind study. Patients: Forty patients undergoing major intestinal surgery, Patients were divided into two groups: one received a total parenteral nutrition enriched with omega-3 fatty acids for 5 days postoperatively, the other an isocaloric, control nutrition. Material and Methods: We analyzed the leukocyte ability to release leukotrienes from whole blood leukocytes stimulated with the calcium ionophore A23187 (5 mu mol/L) by reverse phase high-performance liquid chromatography and circulating cytokines by enzyme-linked immunosorbent assay. Results: Leukocytes from patients of the omega-3 fatty acids group generated significantly higher amounts of less biologically active leukotriene B-5 as compared to the control group (p less than or equal to 0.001), This was accompanied by a significant decrease in the generation of proinflammatory leukotriene B-4 (p less than or equal to 0.006) in the study group. In contrast to interleukin-1 beta, interleukin-6, and interleukin-10 systemic levels of tumor necrosis factor-alpha (p less than or equal to 0.05) were postoperatively decreased in the study group. Conclusion: Our data provide evidence that a total parenteral nutrition enriched with omega-3 fatty acids modulates the lipid mediator pattern and systemic tumor necrosis factor-alpha levels.