INFLUENCE OF A TOTAL PARENTERAL-NUTRITION ENRICHED WITH OMEGA-3-FATTY-ACIDS ON LEUKOTRIENE SYNTHESIS OF PERIPHERAL LEUKOCYTES AND SYSTEMIC CYTOKINE LEVELS IN PATIENTS WITH MAJOR SURGERY

Objective: Nutritive immunomodulation of patients after major surgery. Design: Prospective, randomized controlled double-blind study. Patien ts: Forty patients undergoing major intestinal surgery, Patients were divided into two groups: one received a total parenteral nutrition enr iched with omega-3 fatty acids for 5 days postoperatively, the other a n isocaloric, control nutrition. Material and Methods: We analyzed the leukocyte ability to release leukotrienes from whole blood leukocytes stimulated with the calcium ionophore A23187 (5 mu mol/L) by reverse phase high-performance liquid chromatography and circulating cytokines by enzyme-linked immunosorbent assay. Results: Leukocytes from patien ts of the omega-3 fatty acids group generated significantly higher amo unts of less biologically active leukotriene B-5 as compared to the co ntrol group (p less than or equal to 0.001), This was accompanied by a significant decrease in the generation of proinflammatory leukotriene B-4 (p less than or equal to 0.006) in the study group. In contrast t o interleukin-1 beta, interleukin-6, and interleukin-10 systemic level s of tumor necrosis factor-alpha (p less than or equal to 0.05) were p ostoperatively decreased in the study group. Conclusion: Our data prov ide evidence that a total parenteral nutrition enriched with omega-3 f atty acids modulates the lipid mediator pattern and systemic tumor nec rosis factor-alpha levels.