ω-3多不饱和脂肪酸在老年胃癌病人术后肠外营养中的应用

目的: 研究在老年病人胃癌根治术后肠外营养(PN)中应用ω-3多不饱和脂肪酸(ω-3 PUFA)的作用. 方法: 将40例老年胃癌切除术后病人随机分为试验组和对照组,每组20例.对照组病人按低氮、低热量原则给予PN治疗,试验组加用ω-3 PUFA.比较两组病人营养指标、免疫指标、肝功能变化、炎性反应指标和并发症的发生率等. 结果: 试验组病人并发症的发生率为5%,对照组为20%,差异有显著性意义(P<0.05).术后经5 d的治疗,试验组病人PA水平、体液免疫和细胞免疫指标、IgA、IgG含量和CD4细胞均显著高于对照组(P<0.05,P<0.01).两组病人术后第1天IL-6、TNF-α和CRP水平均升高.第5天后,试验组IL-6、TNF-α和CRP显著低于对照组(P<0.05).对照组病人肝功指标明显升高,与试验组相比有显著性差异(P<0.05). 结论: ω-3 PUFA可通过阻断过度炎性反应、调节病人免疫功能和保护器官功能等作用,有利于老年胃癌病人术后的康复.     

食管癌病人手术后早期肠内营养研究进展

从术后生理免疫功能的变化、肠内营养(EN)途径、方法、时机及营养制剂的选择和并发症预防等方面对食管癌手术后病人的早期EN支持进行综述,探讨存在的问题,为手术病人提供更好的营养支持,为促进机体康复提供参考.     

ω-3多不饱和脂肪酸在非小细胞肺癌病人中的应用

ω-3多不饱和脂肪酸(n-3 PUFA)是一种人体必需的多不饱和脂肪酸.其能调节炎性反应、增加放化疗的耐受性、改善病人的营养状况、提高病人的生活质量,在非小细胞肺癌治疗中有着重要的作用.以下就n-3 PUFA的代谢途径、n-3 PUFA调节炎性反应和抑制肺癌的分子机制、n-3 PUFA在肺癌术后病人以及放化疗病人中的应用作一综述.     

肿瘤患者术后用特殊配方与标准配方肠内营养二周的效果比较

目的 观察五官科肿瘤病人作喉切术使用肿瘤特异性免疫营养配方肠内营养对患营养、免疫的调理作用。方法 本研究是一个随机、前瞻、控制、双盲的临床研究。40例手术的五官科肿瘤病人随机分为两组：（1）免疫营养组（Supportan n=20)，（2）标准营养组（n=20)，两组使用等热量的肠内营养管饲，均为连续性鼻胃途径泵辅助喂养。手术当天、术后第1天及喂饲结束当天进行体格检查、询问营养史、人体测量、抽取静脉血作实验室分析检测包括TNFα、IgA及血糖等指标。统计学方法：方差分析，对数转化或mann-Whitney U-检验。结果 手术导致大部分的指标参数发生显变化，且两组的变化接近。本研究中Suportan显示了良好的胃肠道耐受性，并显示出营养和免疫的调理作用。     

Biochemical effects of a diet containing foods enriched with n-3 fatty acids

BACKGROUND: Results of many studies indicate that consumption of n-3 fatty acids can benefit persons with cardiovascular disease and rheumatoid arthritis. However, encapsulated fish oil is unlikely to be suited to lifetime daily use and recommendations to increase fish intake have not been effective. OBJECTIVE: The objective was to examine the effectiveness of a diet that incorporates foods rich in n-3 fatty acids in elevating tissue concentrations of eicosapentaenoic acid and in suppressing the production of inflammatory mediators. DESIGN: Healthy male volunteers were provided with foods that were enriched in alpha-linolenic acid (cooking oil, margarine, salad dressing, and mayonnaise) and eicosapentaenoic and docosahexaenoic acids (sausages and savory dip) and with foods naturally rich in n-3 fatty acids, such as flaxseed meal and fish. Subjects incorporated these products into their food at home for 4 wk. Fatty acid intakes, cellular and plasma fatty acid concentrations, and monocyte-derived eicosanoid and cytokine production were measured. RESULTS: Analyses of dietary records indicated that intake of eicosapentaenoic acid plus docosahexaenoic acid averaged 1.8 g/d and intake of alpha-linolenic acid averaged 9. 0 g/d. These intakes led to an average 3-fold increase in eicosapentaenoic acid in plasma, platelet, and mononuclear cell phospholipids. Thromboxane B(2), prostaglandin E(2), and interleukin 1beta synthesis decreased by 36%, 26%, and 20% (P < 0.05), respectively. CONCLUSIONS: Foods that are strategically or naturally enriched in n-3 fatty acids can be used to achieve desired biochemical effects without the ingestion of supplements or a change in dietary habits. A wide range of n-3-enriched foods could be developed to support large-scale programs on the basis of the therapeutic and disease-preventive effects of n-3 fatty acids.     

Cognitive changes with omega-3 polyunsaturated fatty acids in non-demented older adults with low omega-3 index

Objectives

To investigate the changes in specific domains of cognitive function in older adults reporting subjective memory complaints with a low omega-3 index receiving omega 3 polyunsaturated fatty acid (n-3 PUFA) supplementation or placebo.

Design

This is a secondary exploratory analysis of the Multidomain Alzheimer Preventive Trial (MAPT) using subjects randomized to the n-3 PUFA supplementation or placebo group.

Setting

French community dwellers aged 70 or over reporting subjective memory complaints, but free from clinical dementia.

Participants

A subgroup of MAPT subjects in the lowest quartile of omega-3 index distribution with baseline values ≤ 4.83 % (n = 183).

Intervention

The n-3 PUFA supplementation group consumed a daily dose of DHA (800 mg) and EPA (a maximum amount of 225 mg) for 3 years. The placebo group received identical capsules comprising liquid paraffin oil.

Measurements

Linear mixed-model repeated-measures analyses were used including baseline, 6, 12, 24 and 36-month follow-up data to assess between-group differences in the change in eight cognitive tests over 36 months.

Results

There was less decline on the Controlled Oral Word Association Test (COWAT) in the n-3 PUFA supplementation group compared to placebo (p = 0.009; between group mean difference over 36 months, 2.3; 95% CI, 0.6,4.0). No significant differences for any of the other cognitive tests were found, including other tests of executive functioning, although, numerically all results were in favour of the n-3 PUFA supplementation.

Conclusions

We found some evidence that n-3 PUFAs might be beneficial for the maintenance of executive functioning in older adults at risk of dementia with low omega-3 index, but this exploratory finding requires further confirmation. A larger specifically designed randomised controlled trial could be merited.

     

Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial

OBJECTIVES: To investigate the effects of long-term treatment with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), in comparison with a standard formula, on glycaemic control in tube-fed type II diabetic patients. DESIGN: Randomised, double-blind, controlled, multi-centre trial.Setting:Early rehabilitation centres, primary care and nursing facilities. SUBJECTS:A total of 78 patients with insulin-treated type II diabetes with HbA(1C) > or =7.0% and/or fasting blood glucose >6.66 mmol/l, who required enteral tube feeding due to neurological dysphagia. INTERVENTIONS: Patients received 113 kJ (27 kcal)/kg of body weight of either test feed or an isoenergetic, isonitrogenous enteral formula (control) for 12 weeks. Glycaemic control (total daily insulin dosage (IU), fasting blood glucose, and HbA(1C)) and gastrointestinal tolerance were monitored daily. RESULTS: After 12 weeks, median values for changes from baseline were as follows (test group vs control group, 'data as available' analysis): total daily IUs -6.0 vs 0.0 (P=0.0024), fasting blood glucose (mmol/l) -1.59 vs -0.08 (P=0.0068); HbA(1C) (%) -0.8 vs 0.0 (P=0.0016). Both formulas were tolerated comparably. CONCLUSIONS:This study indicates that in tube-fed insulin-treated type II diabetic patients, the new low-carbohydrate, high MUFA formula results in a more effective glycaemic control than the standard diet, while being comparable in safety.     

Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients

OBJECTIVE: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using a higher dose of arginine-enhanced diet (17 g/day) than previous studies, could improve nutritional variables as well as clinical outcomes, when compared with a control enteral diet. DESIGN: Randomized clinical trial. SETTING: Tertiary care. SUBJECTS: A population of 72 patients with oral and laryngeal cancer was enrolled. INTERVENTIONS: At surgery, patients were randomly allocated to two groups: (a) 35 patients receiving an arginine-enhanced formula with arginine (group I) and (b) 37 patients receiving an isocaloric, isonitrogenous enteral formula (group II). RESULTS: No significant intergroup differences in the trend of the three plasma proteins (albumin, transferrin, prealbumin) and lymphocytes were detected. Episodes of diarrhea rate were equal in both groups (22.8% group I and 21.6% group II: NS). The postoperative infections complications were equal in both groups (5.7% group I and 5.4% group II: NS). Fistula (wound complication) was less frequent in enriched nutrition group (2.8% group I and 18.9% group II: P<0.05), whereas wound infection was similar in both groups. The length of postoperative stay was similar in both (27.9+/-21 vs 28.2+/-12 days; NS). CONCLUSIONS: At this dose, arginine-enhanced formula improves fistula rates in postoperative head and neck cancer patients without a high rate of diarrhea.     

Dietary omega-3 fatty acids and depression in a community sample

To evaluate the association between omega-3 polyunsaturated essential fatty acids and depression, data regarding prevalence rates of self-reported depression and median daily dietary intakes of these fatty acids were obtained from an age-stratified, population-based sample of women (n = 755; 23-97 year) in the Barwon Statistical Division of south-eastern Australia. A self-report questionnaire based on Diagnostic and Statistical Manual-IV criteria was utilised to determine 12-month prevalence rates of depression in this sample, and data from biennial food frequency questionnaires examining seafood and fish oil consumption over a 6-year period were examined. Differences in median dietary intakes of omega-3 fatty acids between the depressed and nondepressed cohorts were analysed and results were adjusted for age, weight and smoking status. No significant differences in median intakes were identified between the two groups of women (median, interquartile range; depressed = 0.09g/day, 0.04-0.18 versus nondepressed = 0.11 g/day, 0.05-0.22, p = 0.3), although overall average intakes of omega-3 fatty acids were lower than recommended and rates of depression within this sample higher than expected, based on previous data. Further research that takes into account ratios of omega-6 to omega-3 polyunsaturated essential fatty acids, as well as other dietary sources of omega-3 fatty acids, is warranted.     

ω-3多不饱和脂肪酸对胃癌病人术后炎性反应和疲劳综合征的影响

目的:研究ω-3多不饱和脂肪酸(PUFA)对胃癌病人术后炎性反应和疲劳综合征的影响. 方法:42例胃癌病人随机分为对照组(n=23)和试验组(n=19).对照组病人按低氮、低热量原则,于术后连续5d行肠外营养(PN)治疗,试验组病人加用ω-3 PUFA.检测两组病人术前和术后第1、3、5天炎症因子IL-1β、IL-2、...     

The emerging role of omega-3 polyunsaturated fatty acids in the management of patients with IgA nephropathy.

Immunoglobulin A nephropathy (IgAN), the most common primary glomerulonephritis in the world, affects mostly young adults, and shows a widely variable clinical course with many patients developing progressive renal disease, culminating in terminal renal failure in 20% to 40% of those afflicted. Until recently, no treatment options have been available for IgAN. Although a cure for the disease remains elusive, drugs that slow disease progression are becoming available, including omega-3 (n-3) fatty acids. The largest long-term clinical trial evaluating n-3 fatty acids in high-risk patients with IgAN showed that early and prolonged treatment with n-3 fatty acids retards renal progression. The rationale for using these fats involves potential mechanisms that reduce renal inflammation and glomerulosclerosis, hallmarks of progressive disease.     

The effects of omega-3 polyunsaturated fatty acids on blood pressure: a methodologic analysis of the evidence

The potentially beneficial blood pressure (BP)-lowering effects of marine omega-3 polyunsaturated fatty acids (omega-3-PUFAs) remain controversial. The objective of this qualitative and quantitative (meta-analysis) analysis was to evaluate the results of all available randomized controlled trials that studied the effect of omega-3-PUFAs on BP response. A comprehensive search of the English literature from 1970 to 1988 disclosed only six randomized controlled investigations out of 22 published reports. Four of these were evaluable and therefore eligible for this analysis. Of these, only one evaluated hypertensive subjects. In two trials, there were statistically significant reductions in BP; the one reporting an investigation of hypertensive subjects showed the greatest reduction. Using established methodologic criteria, the quality of each report was evaluated by independent observers. Following this appraisal, the outcomes of each investigation were reanalyzed and pooled using a meta-analysis. There was no statistically significant difference between the omega-3-PUFA groups and the control groups, possibly because of failure to include hypertensive subjects in all but one trial. Despite the positive effects in two studies, little scientifically valid evidence is available to demonstrate a significant BP-lowering effect of omega-3-PUFAs. Areas needing more attention in future research are identified and methods to improve study designs are suggested.     

Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients

AIMS: To determine whether a specific high-protein enteral formula with a similar caloric percentage of fat and carbohydrates achieves greater control over glycemic levels and reduces insulin requirements in hyperglycemic critically ill patients when compared to a control high-protein enteral formula. DESIGN: A prospective, randomized, controlled, single-blind trial in two University Hospital Intensive Care Units in Spain. METHODS: We enrolled 50 patients with diabetes mellitus or stress hyperglycemia with basal glycemia > or =160 mg/dl and indication for enteral nutrition > or =5 days. Patients with severe kidney failure, liver failure or obesity were excluded from the study. In the first 48 h of admission, after randomization, 26 patients received the study diet and 24 patients received the control diet. The variables were monitored for 14 days. The Harris-Benedict formula with a fixed stress factor of 1.2 was used to calculate caloric needs. Insulin was administered by continuous infusion. An intention-to-treat analysis was performed. RESULTS: On admission, there were no differences between the study and control group in plasma glucose levels (mg/dl) (190.9+/-45 vs 210.3+/-63) and capillary glucose levels (mg/dl) (226.1+/-73 vs 213.8+/-67). After the feeding trial, there were differences between the study and control group in plasma glucose levels (mg/dl) (176.8+/-44 vs 222.8+/-47, P=0.001), capillary glucose levels (mg/dl) (163.1+/-45 vs 216.4+/-56, P=0.001), insulin requirements/day (IU) 8.73 (2.3-27.5) vs 30.2 (21.5-57.1) (P=0.001), insulin/received carbohydrates (UI/g) 0.07 (0.02-0.22) vs 0.18 (0.11-0.35) (P=0.02) and insulin/received carbohydrates/kg 0.98 (0.26-3.59) vs 2.13 (1.44-4.58) (P=0.04). These differences remain in a day-to-day comparison. There were no differences in the analytical tests, or in digestive or infectious complications. Intensive Care Unit length of stay, mechanical ventilation and mortality were similar in both groups. CONCLUSIONS: Hyperglycemic critically ill patients fed with a high-protein diet with a similar caloric percentage of fat and carbohydrates show a significant reduction in plasma glucose levels, capillary glucose levels and insulin requirements in comparison to patients on a conventional high-protein diet. This better glycemic control do not modify Intensive Care Unit length of stay, infectious complications, mechanical ventilation and mortality.     

Decreased oxidative stress in patients with ulcerative colitis supplemented with fish oil omega-3 fatty acids

OBJECTIVE: The potential pathogenicity of free radicals may have a pivotal role in ulcerative colitis. Fish oil omega-3 fatty acids exert anti-inflammatory effects on patients with ulcerative colitis (UC), but the precise mechanism of the action of fish oil on oxidative stress is still controversial. The aim of the present work was to verify the blood oxidative stress in patients with UC and determine whether the association of sulfasalazine to fish oil omega-3 fatty acids is more effective than isolated use of sulfasalazine to reduce the oxidative stress. METHODS: Nine patients (seven female and two male; mean age = 40 +/- 11 y) with mild or moderate active UC were studied in a randomized crossover design. In addition to their usual medication (2 g/d of sulfasalazine), they received fish oil omega-3 fatty acids (4.5 g/d) or placebo for 2-mo treatment periods that were separated by 2 mo, when they only received sulfasalazine. Nine healthy individuals served as control subjects to study the oxidative stress status. Disease activity was assessed by laboratory indicators (C-reactive protein, alpha1-acid glycoprotein, alpha1-antitrypsin, erythrocyte sedimentation rate, albumin, hemoglobin, and platelet count), sigmoidoscopy, and histology scores. Analysis of oxidative stress was assessed by plasma chemiluminescence and erythrocyte lipid peroxidation, both induced by tert butyl hydroperoxide (t-BuOOH) and by plasma malondialdehyde. Antioxidant status was assayed by total plasma antioxidant capacity (TRAP) and microsomal lipid peroxidation inhibition (LPI). Superoxide dismutase (SOD) and catalase erythrocyte enzymatic activities were also determined. RESULTS: No significant changes were observed in any laboratory indicator or in the sigmoidoscopy or histology scores, with the exception of erythrocyte sedimentation rate, which decreased with both treatments. Oxidative stress was demonstrated by significant decreases in TRAP and LPI levels, increased chemiluminescence induced by t-BuOOH, and higher SOD activity in patients with UC. Treatment with fish oil omega-3 fatty acids reverted the chemiluminescence induced by t-BuOOH and LPI to baseline levels but that did not occur when patients received only sulfasalazine. Levels of plasma malondialdehyde, erythrocyte lipid peroxidation, and catalase were not different from those in the control group. CONCLUSIONS: The results indicated that plasma oxidative stress occurs in patients with UC, and there was a significant decrease when the patients used sulfasalazine plus fish oil omega-3 fatty acids. However, there was no improvement in most laboratory indicators, sigmoidoscopy, and histology scores. The results suggested that omega-3 fatty acids may act as free radical scavengers protecting the patients against the overall effect of oxidative stress.     

Protective effects of omega-3 essential fatty acids against formaldehyde-induced cerebellar damage in rats

This study aimed to investigate changes in the cerebellum of formaldehyde-exposed rats and the effects of omega-3 fatty acids on these changes. The study involved 21 male Wistar-Albino rats which were divided into three groups. The rats in Group I comprised the control group. The rats in Group II were injected with intraperitoneal 10% formaldehyde every other day. The rats in Group III received omega-3 fatty acids daily while exposed to formaldehyde. At the end of the 14-day experimental period, all rats were killed by decapitation and the cerebellum removed. The activities of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), xanthine oxidase (XO), and malondialdehyde (MDA) levels were determined in cerebellum specimens by using spectrophotometric methods. In our study, levels of SOD and CAT were significantly decreased, and GSH-Px, XO, MDA levels were significantly increased in rats treated with formaldehyde compared with those of the controls. Whereas, it was seen that there was an increase in SOD and CAT enzyme activities and decrease in MDA, XO, and GSH-Px levels in rats administered to omega-3 fatty acids with exposure of formaldehyde. It was determined that exposure of formaldehyde increased free radicals in cerebellum of rats and this increase was prevented by administration of omega-3 fatty acids.