Special nutritional support containing glutamine, arginine, and omega-3 fatty acids has therapeutic and immunomodulatory effects, and can significantly reduce the incidence of postoperative infectious complications and length of hospital stay in surgical patients. This review provides a clinical update regarding the concept and the use of pharmaconutrition and immunonutrition in patients undergoing gastrointestinal surgery.
Arginine ; therapeutic use ; Digestive System Surgical Procedures ; Enteral Nutrition ; Fatty Acids, Omega-3 ; therapeutic use ; Glutamine ; therapeutic use ; Humans

INTRODUCTIONIncidental reports collected in clinical trials suggest that amongst participants, omega-3 fatty acids derived from fish oil ('omega-3') may be difficult to blind.

MATERIALS AND METHODSWe conducted a systematic evaluation of blinding success in a 24-week trial of omega-3 versus an oil-based placebo. Within 1 week of supplement commencement (Week 1), a blinding questionnaire was completed by 131 children enrolled in a trial of omega-3 for the treatment of disruptive behaviour disorders. A version of the questionnaire was also completed by their parents at Week 1, and by the children at the end of supplement administration (Week 24).

RESULTSParticipants were unable to differentiate omega-3 from placebo, and accuracy did not improve as a function of: the confidence of guesses, reason for guesses, notice of any change, beliefs about what should change, or time. Child and parent guesses also showed high concordance.

CONCLUSIONTaken together, these data provide strong evidence that the identity of omega-3 can be blinded to participants.

Adolescent ; Attention Deficit and Disruptive Behavior Disorders ; diet therapy ; Child ; Dietary Supplements ; Fatty Acids, Omega-3 ; therapeutic use ; Female ; Humans ; Male ; Parents ; Single-Blind Method ; Surveys and Questionnaires

Boronic Acids ; adverse effects ; Bortezomib ; Fatty Acids, Omega-3 ; administration & dosage ; therapeutic use ; Fish Oils ; administration & dosage ; therapeutic use ; Humans ; Male ; Middle Aged ; Peripheral Nervous System Diseases ; chemically induced ; drug therapy ; Pyrazines ; adverse effects

OBJECTIVETo evaluate the effects of simvastatin combined with omega-3 fatty acids on high sensitive C-reactive protein (HsCRP), lipidemia, and fibrinolysis in coronary heart disease (CHD) and CHD risk equivalent patients with mixed dyslipidemia.

METHODSA randomized, double-blind placebo controlled and parallel group trial was conducted. Patients with CHD and CHD risk equivalents with mixed dyslipidemia were treated with 10 or 20 mg simvastatin for 6-12 weeks. Following with the treatment of patients whose low-density lipoprotein cholesterol (LDL-ch) reaching goal level (< 100 mg/dL) or close to the goal (< 130 mg/dL), while triglyceride (TG) > or = 200 mg/dL and < 500 mg/dL, was combined with omega-3 fatty acids (3 g/d) or a placebo for 2 months. The effects of the treatment on HsCRP, total cholesterol (TC), LDL-ch, high-density lipoprotein cholesterol (HDL-ch), TG, lipoprotein (a) [LP (a)], apolipoprotein A1 (apoA1), apolipoprotein B (apoB), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (tPA) were investigated. Forty patients finished the study with each group consisting of twenty patients.

RESULTS(1) There were significant reductions of HsCRP, TG, TC, and TC/HDL-ch, which decreased by 2.16 +/- 2.77 mg/L (38.5%), 94.0 +/- 65.4 mg/dL (31.1%), 13.3 +/- 22.3 mg/dL (6.3%), 0.78 +/- 1.60 respectively in the omega-3 fatty acids group (P < 0.01, < 0.001, < 0.05, < 0.05) compared to the baseline. HsCRP and triglyceride reduction were more significant in omega-3 fatty acids group compared to the placebo group (P = 0.021 and 0.011 respectively). (2) In the omega-3 fatty acids group, the values and percentage of TG reduction had a significantly positive relation with HsCRP reduction (r = 0.51 and 0.45, P = 0.021 and 0.047 respectively).

CONCLUSIONIn CHD and CHD risk equivalent patients with mixed dyslipidemia, dyslipidemia's therapeutic effect using simvastatin and omega-3 fatty acids may result from not only the combination of lipid adjustment, but also enhancement of their own nonlipid influences.

Aged ; C-Reactive Protein ; metabolism ; Coronary Disease ; blood ; Double-Blind Method ; Drug Therapy, Combination ; Fatty Acids, Omega-3 ; therapeutic use ; Fibrinolysis ; drug effects ; Humans ; Hypolipidemic Agents ; therapeutic use ; Lipids ; blood ; Male ; Middle Aged ; Simvastatin ; therapeutic use ; Triglycerides ; blood

OBJECTIVETo explore the influence of immune-enhanced enteral diet on postoperative metabolism and immunological function in colorectal tumor patient.

METHODSSeventy-two patients with colorectal cancer were enrolled in this study. Immune-enhanced enteral diet was administrated in 36 cases (study group), while regular enteral nutrition (EN) was given in 36 cases (control group). The immunological function, inflammatory function and nutrition index were evaluated before operation and on postoperative day 1 and day 8.

RESULTSSerum levels of glutamine, asparagines, CD4 (+), NK, IgG, IgM were higher in the study group than those in the control group. The levels of IL- 6, TNF-alpha in the study group were lower than those in the control group. The difference was statistically significant (P< 0.05).

CONCLUSIONSImmune-enhanced enteral diet can ameliorate the cell immunological and fluid immunological function in the patients with colorectal cancer after the procedures.

Adult ; Aged ; Aged, 80 and over ; Arginine ; therapeutic use ; Colorectal Neoplasms ; diet therapy ; immunology ; Enteral Nutrition ; Fatty Acids, Omega-3 ; therapeutic use ; Female ; Glutamine ; therapeutic use ; Humans ; Male ; Middle Aged ; Postoperative Period

C-Reactive Protein ; metabolism ; Diabetes Mellitus, Type 2 ; drug therapy ; Dietary Supplements ; Fatty Acids, Omega-3 ; therapeutic use ; Female ; Humans ; Inflammation ; prevention & control ; Interleukin-2 ; blood ; Male ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVEThe aim of this review is to objectively access the trial evidence on the role of omega-3, red yeast rice and garlic in preventing clinical cardiovascular events. Given the large number of clinical trials favoring statin use in cardiovascular disease, it is important to see if evidence is available for these supplements and whether they could replace statin therapy.

DATA SOURCEA PubMed search was conducted using the keywords 'trial, omega-3, red yeast rice, xuezhikang, garlic, cholesterol, cardiovascular, outcomes'; the resulting trials were reviewed together with the references quoted in the papers obtained.

STUDY SELECTIONThe studies selected are prospective, randomized, placebo-controlled studies with predefined clinical cardiovascular end-points recruiting at least 2000 patients, with a follow-up over 2 years.

RESULTSModest dose omega-3 fatty acid has been shown in GISSI-P (11 324 patients, follow-up 3.5 years) to produce a reduction in sudden death of 45%, and in cardiac death of 35%, acting probably via an anti-arrhythmic effect. In JELIS (18 645 patients, follow-up 4.6 years), high dose omega-3 given to Japanese patients on a high fish diet and already on statin treatment produced further benefit with a 19% reduction of nonfatal cardiovascular outcomes; fatal cardiac events are not affected. CCSPS (4870 patients, follow-up 4 years), a secondary prevention trial using xuezhikang, a commercial red yeast rice preparation, produced a 46% reduction in nonfatal myocardial infarction and coronary death. There has been no trial to show that garlic reduces clinical cardiovascular outcomes. A rigorous trial with constant assessment of chemicals in the study material in 192 patients found that over a 6-month follow-up, raw garlic and 2 commercial preparations do not significantly affect lipid levels.

CONCLUSIONSOmega-3 in modest doses reduces cardiac deaths, and in high doses reduces nonfatal cardiovascular events. Red yeast rice reduces adverse cardiac events to a similar degree as the statins. It is unlikely that garlic is useful in preventing cardiovascular disease.

Biological Products ; administration & dosage ; Cardiovascular Diseases ; prevention & control ; Fatty Acids, Omega-3 ; administration & dosage ; Garlic ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Phytotherapy ; Prospective Studies ; Randomized Controlled Trials as Topic

Nonalcoholic steatohepatitis (NASH) can progress into liver cirrhosis; however, no definite treatment is available. Omega-3 polyunsaturated fatty acid (omega-3) has been reported to alleviate experimental NASH, although its beneficial effect was not evident when tested clinically. Thus, this study aimed to investigate the additive effect of omega-3 and ursodeoxycholic acid (UDCA) on diet-induced NASH in mice. C57BL/6 mice were given a high-fat diet (HFD) for 24 weeks, at which point the mice were divided into three groups and fed HFD alone, HFD with omega-3 or HFD with omega-3 in combination with UDCA for another 24 weeks. Feeding mice an HFD and administering omega-3 improved histologically assessed liver fibrosis, and UDCA in combination with omega-3 further attenuated this disease. The assessment of collagen alpha1(I) expression agreed with the histological evaluation. Omega-3 in combination with UDCA resulted in a significant attenuation of inflammation whereas administering omega-3 alone failed to improve histologically assessed liver inflammation. Quantitative analysis of tumor necrosis factor alpha showed an additive effect of omega-3 and UDCA on liver inflammation. HFD-induced hepatic triglyceride accumulation was attenuated by omega-3 and adding UDCA accentuated this effect. In accordance with this result, the expression of sterol regulatory binding protein-1c decreased after omega-3 administration and adding UDCA further diminished SREBP-1c expression. The expression of inducible nitric oxide synthase (iNOS), which may reflect oxidative stress-induced tissue damage, was suppressed by omega-3 administration and adding UDCA further attenuated iNOS expression. These results demonstrated an additive effect of omega-3 and UDCA for alleviating fibrosis, inflammation and steatosis in diet-induced NASH.
Animals ; Cholagogues and Choleretics/pharmacology/*therapeutic use ; Diet, High-Fat/adverse effects ; Drug Synergism ; Fatty Acids, Omega-3/pharmacology/*therapeutic use ; Fibrosis/drug therapy/etiology/immunology/pathology ; Inflammation/drug therapy/etiology/immunology/pathology ; Liver/*drug effects/immunology/pathology ; Male ; Mice, Inbred C57BL ; Non-alcoholic Fatty Liver Disease/*drug therapy/etiology/immunology/pathology ; Ursodeoxycholic Acid/pharmacology/*therapeutic use

OBJECTIVETo study the effect of omega-3 polyunsaturated fatty acids (omega-3 PUFA) on inflammation in lung tissue of rats with severe scald and its mechanism.

METHODSSeventy-two adult SD rats were divided into sham scald group (SS, n = 8), treatment group 1 (T1, n = 32), treatment group 2 (T2, n = 32) according to the random number table. Rats in T1 group and T2 group were inflicted with 30% TBSA full-thickness scald, and then they were respectively injected with 100 g/L omega-3 PUFA (1 mL/kg) and 200 g/L long-chain fatty acid (2 mL/kg) via tail vein within 5 minutes after burn. The above two fatty acids with equivalent calories were continuously injected for 10 days (once a day). On post burn day (PBD) 1, 4, 7, and 10, serum level of TNF-alpha and level of macrophage inflammatory protein 1alpha (MIP-lalpha) in lung homogenate of T1 and T2 groups were detected, the levels of NF-kappaBp65 and macrophage migration inhibitory factor (MIF) in lung tissue of T1 and T2 groups were observed with immunohistochemical staining (recorded as score). Above-mentioned parameters were also determined in SS group. Data were processed with t test.

RESULTSThe levels of 4 parameters in T1 and T2 groups on PBD 1, 4, 7, 10 were higher than those in SS group (with t values from 3.411 to 8.782, P values all below 0.01), and those in T1 group on PBD 4, 7, 10 were lower than those in T2 group (with t values from 2. 321 to 2.785, P values all below 0.05). The serum level of TNF-alpha and levels of MIP-1alpha, NF-kappaBp65, and MIF in lung tissue in SS group was respectively (0.96 +/- 0.32) ng/mL, (76 +/- 16) pg/mL, 0.24 +/- 0.03, 1.31 +/- 0.03, and those in T1 and T2 groups all peaked on PBD 7 [(2.43 +/- 0.32) ng/mL, (210 +/- 56) pg/mL, 4.23 +/- 2.15, 4.69 +/- 1.83; (3.15 +/- 0.54) ng/mL, (274 +/- 64) pg/mL, 5.15 +/- 2.31, 5.37 +/- 2.16].

CONCLUSIONSOmega-3 PUFA can effectively reduce serum level of TNF-alpha and levels of MIP-1alpha, NF-kappaBp65, and MIF in lung tissue of rats with severe scald, showing that it has a protective effect against injury of lung tissue.

Animals ; Burns ; metabolism ; pathology ; therapy ; Chemokine CCL3 ; metabolism ; Fatty Acids, Omega-3 ; therapeutic use ; Female ; Inflammation ; metabolism ; Intramolecular Oxidoreductases ; metabolism ; Lung ; metabolism ; Macrophage Migration-Inhibitory Factors ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Transcription Factor RelA ; metabolism ; Tumor Necrosis Factor-alpha ; blood

INTRODUCTIONConsumption of omega-3 fatty acids can alter the inflammatory response in diabetic patients. This study aimed to determine the effects of omega-3 fatty acid supplementation on the serum levels of C-reactive protein (CRP), interleukin (IL)-2 and tumour necrosis factor-alpha (TNF-α) in type 2 diabetes mellitus patients.

METHODSA randomised, double-blind, placebo-controlled clinical trial was conducted on 84 subjects aged 45-85 years with at least a two-year history of type 2 diabetes mellitus. Participants were randomly assigned to the treatment or control group. Each subject in the treatment group received three omega-3 capsules per day (eicosapentaenoic acid 1,548 mg; docosahexaenoic acid 828 mg; other omega-3 fatty acids 338 mg), while each subject in the control group received three placebo capsules (sunflower oil 2,100 mg) for a period of eight weeks. At the beginning of the study and post intervention, fasting blood samples were taken and serum concentrations of IL-2, TNF-α and CRP were assessed and compared.

RESULTSSerum IL-2 and TNF-α levels were significantly reduced in the treatment group compared to the controls (p < 0.01). There was no significant change in serum CRP levels.

CONCLUSIONShort-term omega-3 fatty acid supplementation (3 g/day for eight weeks) can decrease the serum levels of TNF-α and IL-2 in diabetic patients, with no change in CRP levels. Consumption of omega-3 fatty acid supplements is highly recommended to alleviate inflammation caused by type 2 diabetes mellitus.

Aged ; Aged, 80 and over ; Biomarkers ; blood ; C-Reactive Protein ; drug effects ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; immunology ; Dietary Supplements ; Double-Blind Method ; Fatty Acids, Omega-3 ; pharmacology ; therapeutic use ; Female ; Humans ; Inflammation ; blood ; prevention & control ; Interleukin-2 ; blood ; Male ; Middle Aged ; Tumor Necrosis Factor-alpha ; blood ; drug effects