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Published ahead of print on February 25, 2003, doi:10.1164/rccm.200207-674OC
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American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 1321-1328, (2003)
© 2003 American Thoracic Society

Parenteral Nutrition with Fish Oil Modulates Cytokine Response in Patients with Sepsis

Konstantin Mayer, Stephanie Gokorsch, Christine Fegbeutel, Katja Hattar, Simone Rosseau, Dieter Walmrath, Werner Seeger and Friedrich Grimminger

Medizinische Klinik II, Justus Liebig University, Giessen; and Medizinische Klinik mit Schwerpunkt Infektiologie, Charité, Humboldt University, Berlin, Germany

Correspondence and requests for reprints should be addressed to Dr. Konstantin Mayer, Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstr. 36, D-35392 Giessen, Germany. E-mail: Konstantin.Mayer{at}innere.med.uni-giessen.de

Infusion of fish oil-based (n-3) lipids may influence leukocyte function and plasma lipids in critical care patients. Twenty-one patients with sepsis requiring parenteral nutrition were randomized to receive an n-3 lipid emulsion rich in eicosapentaenoic acid and docosahexaenoic acid or a conventional (n-6) lipid emulsion (index fatty acid: arachidonic acid) for 5 days. The impact on plasma-free fatty acids, mononuclear leukocyte cytokine generation, and membrane fatty acid composition was examined. Cytokine synthesis by isolated mononuclear leukocyte was elicited by endotoxin. Before the onset of lipid infusion therapy, plasma-free fatty acid concentrations were greatly increased in septic patients, with arachidonic acid by far surpassing eicosapentaenoic acid and docosahexaenoic acid, a feature maintained during conventional lipid infusion. Within 2 days of fish oil infusion, free n-3 fatty acids increased, and the n-3/n-6 ratio was reversed, with rapid incorporation of n-3 fatty acids into mononuclear leukocyte membranes. Generation of proinflammatory cytokines by mononuclear leukocytes was markedly amplified during n-6 and was suppressed during n-3 lipid application. After termination of lipid administration, free n-3 fatty acid concentrations and mononuclear leukocyte cytokine synthesis returned to preinfusion values. Use of lipid infusions might allow us to combine intravenous alimentation with differential impact on inflammatory events and immunologic functions in patients with sepsis.

Key Words: monocyte • eicosapentaenoic acid • arachidonic acid • mononuclear leukocyte




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