EFFECT OF A FISH-OIL STRUCTURED LIPID-BASED DIET ON PROSTAGLANDIN RELEASE FROM MONONUCLEAR-CELLS IN CANCER-PATIENTS AFTER SURGERY

Background: The authors compared the effect on eicosanoid production ( prostaglandin E-2[PGE(2)], 6-keto PGF(1 alpha), and thromboxane B-2) f rom peripheral blood mononuclear cells (PBMC) of feeding an enteral di et containing a fish oil/medium-chain triglyceride structured lipid (F OSL-HN) vs an isonitrogenous, isocaloric formula (O-HN) in patients un dergoing major abdominal surgery for upper gastrointestinal malignanci es. A previous study, which used the same formulas and experimental de sign, suggested improved renal and liver function as well as a reduced number of gastrointestinal and infectious complications with the use of fish oil structured lipids. This study sought to investigate the po tential mechanism for these effects by assessing eicosanoid production from PBMC with the two diets. Methods: This prospective, blinded, ran domized trial was conducted in 20 patients who were jejunally fed eith er FOSL-HN or O-HN for 7 days. Serum chemistries, hematology, urinalys is, gastrointestinal complications, liver and renal function, and eico sanoid production from isolated PBMC, either unstimulated or stimulate d with endotoxin, were measured at endotoxin baseline and on day 7. Co mparisons were made in 10 and 8 evaluable patients based a priori on t he ability to reach a tube feeding rate of >40 mL/h. Results: Patients receiving FOSL-HN experienced no untoward side effects compared with patients given O-HN and demonstrated the same general trend toward imp roved hepatic, renal and immune function found in the previous study. There was a significant reduction in PGE(2)(p<.03) and 6-keto PGF(1 al pha)(p<.01) production from PBMC with endotoxin stimulation in patient s receiving FOSL-HN. Conclusions: The results of early enteral feeding with FOSL-HN after surgery in this follow-up study provide further su pport to claims of safety, tolerance, and improved physiologic functio n. There was an associated reduction in eicosanoid production from PBM Cs, which is presumed to be the principal mechanism for these effects.