Nutritive immunomodulation of patients after major surgery.
Prospective, randomized controlled double-blind study.
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.
We analyzed the leukocyte ability to release leukotrienes from whole blood leukocytes stimulated with the calcium ionophore A23187 (5 micromol/L) by reverse phase high-performance liquid chromatography and circulating cytokines by enzyme-linked immunosorbent assay.
Leukocytes from patients of the omega-3 fatty acids group generated significantly higher amounts of less biologically active leukotriene B5 as compared to the control group (p < or = to 0.001). This was accompanied by a significant decrease in the generation of proinflammatory leukotriene B4 (p < or = to 0.006) in the study group. In contrast to interleukin-1beta, interleukin-6, and interleukin-10 systemic levels of tumor necrosis factor-alpha (p < or = to 0.05) were postoperatively decreased in the study group.
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.
From the Department of Microbiology and Immunology, Department of Host Defense Mechanisms(P.W., W.K.), and the Department of Surgery, St. Josef-Hospital (M.S., M.K., M.K.) Ruhr-University Bochum, Bochum, Germany.
This study was supported by Fraunhofer-Gesellschaft, Munich, Germany, and by Deutsche Forschungsgemeinschaft (Ko 1302/2-1).
The results of this paper have been partly presented in abstract form at the ESPEN-Meeting, Rome, Italy, 1995.
Address for reprints: Dr. Manfred Koller, Department of Microbiology and Immunology, Department of Host Defense Mechanisms, Ruhr-University Bochum, Universitatsstr. 150, 44780 Bochum, Germany.