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Enteral Support and N-3 Fatty Acids in Critically Ill Elderly Patients

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Diet and Nutrition in Critical Care

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Abstract

Ageing is characterized by a series of physiological and psychological changes that are related, in turn, with alterations in the nutritional status. The human immune system progressively deteriorates with age, leading to a greater incidence or the reactivation of infectious diseases, as well as to the development of autoimmune disorders and cancer.

The critically ill elderly are more likely to suffer an exacerbated inflammatory response increasing the susceptibility of infection, sepsis, septic shock and multiple organ failure development, which are related to a longer hospitalization period and elevated risk of mortality.

The relationship between inflammatory response and polyunsaturated fatty acids (PUFA)–enriched diets has been investigated in last years. Several studies have shown that PUFA can modify immunological and inflammatory reactions and can be used as a complementary therapy in chronic diseases. Enteral formulas supplied with specific pharmaconutrients can help offset tissue damage and moderate the inflammation.

In this sense, n-3 PUFA intake can alter the fatty acid composition in membranes of cells involved in immune inflammatory responses and leading to better outcomes. Several clinical studies have shown that the administration of n-3 PUFA can blunt the inflammatory response in critically ill patients.

Although n-3 PUFA as pharmaconutrition appears to exert beneficial effects with no side effects, enteral supplementation of this fatty acid has presented conflicting data in the literature. These discordant data are most likely due to different routes of administration (enteral or parenteral), dose, duration of administration, timing of onset in relation to stage of the inflammatory response and differences in the nutrient combinations used. Further researches are necessary before any definitive recommendations can be made about enteral n-3 PUFA supplementation in critically ill patients, mainly in special populations, such as the elderly.

This chapter will focus on the literature review about the critically ill elderly, inflammation, fatty acids and n-3 PUFA supplementation in enteral nutrition.

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Abbreviations

AA:

Arachidonic acid

ALA:

α-linolenic acid

APC:

Antigen presenting cells

ASPEN:

American society of parenteral and enteral nutrition

CVD:

Cardiovascular disease

D5D:

Delta-5-desaturases enzyme

D6D:

Delta-6-desaturases enzyme

DHA:

Docosapentaenoic acid

EFSA:

European Food and Safety Authority (EFSA)

EPA:

Eicosapentaenoic acid

ESPEN:

European society of parenteral and enteral nutrition

FA:

Fatty acids

FDA:

Food and Drug Administration

GLA:

Gamma linolenic acid

ICAM:

Intercellular adhesion molecule

ICU:

Intensive care unit

IL:

Interleukin

LA:

Linoleic acid

NHF:

National heart foundation

NHMRC:

National Healthy of Medical Research Council (NHMRC)

PC:

Plasma phosphatidylcholine

PUFA:

Polyunsaturated fatty acids

ROS:

Reactive oxygen species

SNP:

Single nucleotide polymorphism

TNF:

Tumor necrose factor

References

  • Barros KV, Cassulino AP, Schalch L, et al. Supplemental intravenous n-3 fatty acids and n-3 fatty acid status and outcome in critically ill elderly patients in the ICU receiving enteral nutrition. Clin Nutr. 2012;32(4):599–605.

    Article  PubMed  Google Scholar 

  • Barros KV, Cassulino AP, Schalch L, et al. Pharmaconutrition: Acute fatty acid modulation of circulating cytokines in elderly patients in the ICU. JPEN J Parenter Enteral Nutr. 2014; 38(4):467–74

    Google Scholar 

  • Bokor S, Dumont J, Spinneker A, HELENA Study Group, et al. Single nucleotide polymorphisms in the FADS gene cluster are associated with delta-5 and delta-6 desaturase activities estimated by serum fatty acid ratios. J Lipid Res. 2010;51(8):2325–33.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Bottoni A, Bottoni A, Cassulino AP, et al. Impact of nutrition support teams on hospitals’ nutritional support in the largest South American city and its metropolitan area. Nutrition. 2008;24(3):224–32.

    Article  PubMed  Google Scholar 

  • Burr GO, Burr MM. A new deficiency disease produced by the rigid exclusion of fat from the diet. Nutr Rev. 1973;31:248–9.

    CAS  PubMed  Google Scholar 

  • Calder PC. Immunomodulation by omega-3 fatty acids. Prostaglandins Leukot Essent Fatty Acids. 2007;77:327–35.

    Article  CAS  PubMed  Google Scholar 

  • Calder PC. The 2008 ESPEN Sir David Cuthbertson lecture: fatty acids and inflammation: from the membrane to the nucleus and from the laboratory bench to the clinic. Clin Nutr. 2010;29:5–12.

    Article  CAS  PubMed  Google Scholar 

  • Calder PC. Fatty acids and inflammation: the cutting edge between food and pharma. Eur J Pharmacol. 2011;668:S50–8.

    Article  CAS  PubMed  Google Scholar 

  • Calder PC. Long-chain fatty acids and inflammation. Proc Nutr Soc. 2012;71:284–9.

    Article  PubMed  Google Scholar 

  • Calder PC, Jensen GL, Koletzko BV, et al. Lipid emulsion in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med. 2009;36:735–49.

    Article  Google Scholar 

  • Carvalho-Silva DR, Santos FR, Rocha J, Pena SD. The phytogeography of Brazilian Y-chromosome lineages. Am J Hum Genet. 2001;68:281–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Cederholm T, Persson M, Anderson P, et al. Polymorphisms in cytokine genes influence long-term survival differently in elderly male and female patients. J Intern Med. 2007;262:215–23.

    Article  CAS  PubMed  Google Scholar 

  • Chan LY, Moran JL, Clarke C, et al. Mortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital. Anaesth Intensive Care. 2009;37:773–83.

    CAS  PubMed  Google Scholar 

  • Chernoff R. Physiologic aging and nutritional status. Nutr Clin Pract. 1990;5:8–13.

    Article  CAS  PubMed  Google Scholar 

  • Cormier H, Rudkowska I, Paradis AM, et al. Association between polymorphisms in the fatty acid desaturase gene cluster and the plasma triacylglycerol response to an n-3 PUFA supplementation. Nutrients. 2012;4(8):1026–41.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) (2010) Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010; 8(3):1461 [107 pp.]. http://www.efsa.europa.eu/en/efsajournal/pub/1461.htm

  • Fülöp T, Larbi A, Hirokawa K, et al. Immunosupportive therapies in aging. Clin Interv Aging. 2007;2(1):33–54.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gadek JE, DeMichele SJ, Karistad MD, et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linoleic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral nutrition in ARDS Study Group. Crit Care Med. 1999;27:1409–20.

    Article  CAS  PubMed  Google Scholar 

  • Glaser C, Lattka E, Rzehak P, et al. Genetic variation in polyunsaturated fatty acid metabolism and its potential relevance for human development and health. Matern Child Nutr. 2011;7 Suppl 2:27–40.

    Article  PubMed  Google Scholar 

  • Graf C. Functional decline in hospitalized older adults. Am Nurs J. 2006;106(1):58–67.

    Article  Google Scholar 

  • Grau-Carmona T, Morán-García V, García-de-Lorenzo A, et al. Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clin Nutr. 2011;30(5):578–84.

    Article  CAS  PubMed  Google Scholar 

  • Hegazi RA, Wischmeyer PE. Clinical review: optimizing enteral nutrition for critically ill patients-a simple data-driven formula. Crit Care. 2011;15(6):234.

    Article  PubMed Central  PubMed  Google Scholar 

  • Heller AR, Rossler S, Litz RJ, et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med. 2006;34:972–9.

    Article  CAS  PubMed  Google Scholar 

  • Hensen AE, Haggard ME, Boelsche NA, et al. Essential fatty acids in infant nutrition. J Nutr. 1958;66:565–76.

    Google Scholar 

  • Heyland DK, Schroter-Noppe D, Drover JW, et al. Nutrition support in the critical care setting: current practice in Canadian ICUs-opportunities for improvement? J Parenter Enteral Nutr. 2003;27(1):74–83.

    Article  Google Scholar 

  • Heyland DK, Cahill N, Day AG. Optimal amount of calories for critically ill patients: depends on how you slice the cake! Crit Care Med. 2011;39(12):2619–26.

    PubMed  Google Scholar 

  • Holman RT. The slow discovery of the importance of n-3 essential fatty acids in human health. J Nutr. 1998;128:427S–33.

    CAS  PubMed  Google Scholar 

  • Innis SM. Essential fatty acids in growth and development. Prog Lipid Res. 1991;30:39–108.

    Article  CAS  PubMed  Google Scholar 

  • Jeejeebhoy KN. Enteral nutrition versus parenteral nutrition–the risks and benefits. Nat Clin Pract Gastroenterol Hepatol. 2007;4(5):260–5.

    Article  PubMed  Google Scholar 

  • Kinsella JE. Lipids, membrane receptors, and enzymes: effects of dietary fatty acids. J Parenter Enteral Nutr. 1990;14(5 Suppl):200S–17.

    Article  CAS  Google Scholar 

  • Kreymann KG, Berger MM, Deutz NEP, et al. ESPEN guidelines on enteral nutrition. Intensive care. Clin Nutr. 2006;25:210–23.

    Article  CAS  PubMed  Google Scholar 

  • Makinodan T, Kay MM. Age influence on the immune system. Adv Immunol. 1980;29:287–330.

    Article  CAS  PubMed  Google Scholar 

  • Marik PE. Management of the critically ill geriatric patients. Crit Care Med. 2006;34(9S):S176–82.

    Article  PubMed  Google Scholar 

  • McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Board of Directors and the American College of Critical Care Medicine. J Parenter Enteral Nutr. 2009;33:277–316.

    Article  Google Scholar 

  • Mira JP, Cariou A, Grall F, et al. Association of TNF2, a TNF-α promoter polymorphism, with septic shock susceptibility and mortality: a multicenter study. JAMA. 1999;282(6):561–68.

    Article  CAS  PubMed  Google Scholar 

  • Nakada T, Hirasawa H, Oda S, et al. Influence of toll-like receptor 4, CD14, tumor necrosis factor, and interleukine-10 gene polymorphisms on clinical outcome in Japanese critically ill patients. J Surg Res. 2005;129:322–8.

    Article  CAS  PubMed  Google Scholar 

  • National Heart Foundation of Australia. Position statement on Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health, 2008. http://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdf

  • Paoloni-Giacobino A, Grimble R, Pichard C. Genomic interactions with disease and nutrition. Clin Nutr. 2003;22(6):507–14.

    Article  CAS  PubMed  Google Scholar 

  • Peuhkuri K, Vapaatalo H, Korpela R. Even low-grade inflammation impacts on small intestinal function. World J Gastroenterol. 2010;16(9):1057–62.

    Article  PubMed Central  PubMed  Google Scholar 

  • Pontes-Arruda A, Demichele S, Seth A, Singer P. The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of outcome data. J Parenter Enteral Nutr. 2008;32(6):596–605.

    Article  CAS  Google Scholar 

  • Rangel-Huerta OD, Aguilera CM, Mesa MD, Angel GA. Omega-3 long-chain polyunsaturated fatty acids supplementation on inflammatory biomarkers: a systematic review of randomized clinical trials. Br J Nutr. 2012;107:S159–70.

    Article  CAS  PubMed  Google Scholar 

  • Rankin JA. Biological mediators of acute inflammation. AACN Clin Issues. 2004;15(1):3–17.

    Article  PubMed  Google Scholar 

  • Rice TW, Wheeler AP, Thompson BT, NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators, et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574–581.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Rymkiewicz PD, Heng YX, Vasudev A, Larbi A. The immune system in the aging human. Immunol Res. 2012;53(1–3):235–50.

    Article  CAS  PubMed  Google Scholar 

  • Rzehak P, Heinrich J, Klopp N, et al. Evidence for an association between genetic variants of the fatty acid desaturase 1 fatty acid desaturase 2 (FADS1 FADS2) gene cluster and the fatty acid composition of erythrocyte membranes. Br J Nutr. 2009;101(1):20–6.

    Article  CAS  PubMed  Google Scholar 

  • Sala-Vila A, Miles EA, Calder PC. Fatty acid composition abnormalities in atopic disease: evidence explored and role in the disease process examined. Clin Exp Allergy. 2008;38(9):1432–50.

    Article  CAS  PubMed  Google Scholar 

  • Semplicini A, Valle R. Fish oils and their possible role in the treatment of cardiovascular diseases. Pharmacol Ther. 1994;61(3):385–97.

    Article  CAS  PubMed  Google Scholar 

  • Serhan CN. Novel chemical mediators in the resolution of inflammation: resolvins and protectins. Anesthesiol Clin. 2006;24:341–64.

    Article  CAS  PubMed  Google Scholar 

  • Shimaoka M, Park EJ. The compensatory anti-inflammatory response syndrome (CARS) in critically ill patients. Clin Chest Med. 2008;29:617–27.

    Article  Google Scholar 

  • Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21:495–505.

    Article  CAS  PubMed  Google Scholar 

  • Simopoulos AP. The importance of the Omega-6/Omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008;233:674–88.

    Article  CAS  Google Scholar 

  • Singer P, Cohen J. Nutrition is metabolism. J Parenter Enteral Nutr. 2010;34(5):471–2.

    Article  Google Scholar 

  • Singer P, Theilla M, Fisher H, et al. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med. 2006;34:1861.

    Article  CAS  Google Scholar 

  • Stapleton RD, Martin JM, Mayer K. Fish oil critical illness: mechanisms and clinical applications. Crit Care Clin. 2010;26:501–14.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Theilla M, Singer P, Cohen J, Dekeyser F. A diet enriched in eicosapentanoic acid, gamma-linolenic acid and antioxidants in the prevention of new pressure ulcer formation in critically ill patients with acute lung injury: a randomized, prospective, controlled study. Clin Nutr. 2007;26(6):752–7.

    Article  CAS  PubMed  Google Scholar 

  • Villani AM, Crotty M, Cleland LG. Fish oil administration in older adults: is there potential for adverse events? A systematic review of the literature. BMC Geriatr. 2013;13(1):41.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Visentainer JEL, Lieber SR, Persoli LBL, et al. Serum cytokine levels and acute graft-versus-host disease after HLA-identical hematopoietic stem cell transplantation. Exp Hematol. 2003;31:1044–50.

    Article  CAS  PubMed  Google Scholar 

  • Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Crit Care Med. 2007;35:1928–36.

    Article  PubMed  Google Scholar 

  • Weiss G, Meyer F, Mathies B, et al. Immunomodulation by preoperative administration of n-3 fatty acids. Br J Nutr. 2002;87:S89–94.

    Article  CAS  PubMed  Google Scholar 

  • Wick G, Jansen-Dürr P, Berger P, et al. Diseases of aging. Vaccine. 2000;18:1567–83.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departamento de Fisiologia, Universidade Federal de São Paulo-Campus São Paulo, Rua Botucatu, 862 Vila Clementino, São Paulo, SP, CEP 04023-900, Brazil

    Karina V. Barros & Ana Paula Cassulino

  2. Departamento de Ciências Biológicas, Universidade Federal de São Paulo-Campus Diadema, Rua Prof. Artur Riedel 275, Eldorado, Diadema, SP, CEP 09972-270, Brazil

    Vera Lúcia Flor Silveira

Authors
  1. Karina V. Barros
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  2. Ana Paula Cassulino
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  3. Vera Lúcia Flor Silveira
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Correspondence to Vera Lúcia Flor Silveira .

Editor information

Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Barros, K.V., Cassulino, A.P., Silveira, V.L.F. (2014). Enteral Support and N-3 Fatty Acids in Critically Ill Elderly Patients. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_55-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_55-1

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