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Summary Background & aims The importance of route of administration of omega-3 (n-3) polyunsaturated fatty acids (PUFA) (oral vs intravenous (iv)) is not clear. We determined the relative concentrations of fatty acids in plasma phosphatidylcholine (PC), red blood cells (RBC), white blood cells (WBC) and several tissues after short-term oral or iv administration of soybean oil (SO) or fish oil (FO). Methods Wistar rats ( n = 6/group) received saline, FO, or SO by gavage or saline, FO based-lipid emulsion (FLE), or SO based-lipid emulsion (SLE) iv. The oils were provided at 0.2 g/kg/day for three consecutive days. The animals were sacrificed 24 h after the last administration, blood was collected for plasma, WBC and RBC separation and tissues removed. Fatty acids were analysed by gas chromatography. Results FO resulted in higher eicosapentaenoic acid (EPA) in plasma PC and liver than the control. FLE resulted in higher EPA, docosahexaenoic acid (DHA) and total n-3 PUFA in plasma PC, WBC and liver than both the control and SLE groups. EPA, DHA and total n-3 PUFA were higher in the heart with FLE compared with SLE. Individual and total n-3 PUFA were higher in plasma PC, WBC, liver and heart with FLE than with FO given by gavage. Conclusion Short-term iv administration of n-3 PUFA appears to be more effective at increasing EPA and DHA status in plasma, WBC, liver and heart than oral administration. This might be important for rapid treatment with n-3 PUFA.

Background: enteral supply of ?-3 polyunsaturated fatty acids has been used in an attempt to modulate inflammation and improve outcome in critically ill patients. However, enteral administration may be slow to change membrane composition and therefore may not be the best route to supply these fatty acids in patients with acute conditions. This study evaluated the effects of short-term intravenous (IV) administration of fish oil–based lipid emulsion (FLE) as pharmaconutrition on cytokine levels in critically ill elderly patients. Methods: enterally fed patients (n = 40; aged 60–80 years) were recruited in the first 48 hours of intensive care unit (ICU) admission. Fifteen patients received IV FLE (0.2 g/kg body weight) over 6 hours for 3 consecutive days, and 25 patients did not receive IV lipid (control). Samples were collected before and 24 hours and 72 hours after the third FLE infusion. Nutrient intakes, clinical parameters, and serum cytokine concentrations were measured. Results: compared with the control, FLE resulted in higher energy intake, lower serum tumor necrosis factor–? and interleukin (IL)–8 concentrations, and higher serum IL-10. These differences occurred around 7–9 days of ICU stay at the time of the patient’s extubation. ICU stay, mortality, and markers of coagulation and liver function did not differ between groups. Conclusions: short-term IV FLE modulates some inflammatory markers in critically ill elderly patients receiving enteral nutrition (EN), suggesting an anti-inflammatory effect. This may be a benefit and suggests a role for FLE administration as a supplement in elderly ICU patients receiving standard EN

Summary Background & aims N-3 fatty acids (FA) may have benefits in ICU patients. The aims were to identify whether FA status is altered in critical illness and to evaluate the effect of supplemental intravenous n-3 FA on plasma FA status and clinical outcome in ICU patients receiving enteral nutrition. Methods Enterally fed patients ( n = 49; 60–80 years) were recruited in the first 48 h of ICU admission. Fifteen patients received n-3 FA emulsion (0.2 g/kg) over 6 h for 3 consecutive days, and 34 patients did not (control). Samples were collected before supplementation, and 24 and 72 h after the third infusion. Nineteen healthy elderly subjects were also studied; they gave a single blood sample. FA were measured in plasma phosphatidylcholine (PC). Results Critically ill patients had altered plasma PC FA compared with healthy elderly subjects. Surviving ICU patients had higher levels of docosahexaenoic acid and total n-3 FA and a lower ratio of n-6:n-3 FA in plasma PC than non-survivors. Infusion of n-3 FA increased eicosapentaenoic, docosahexaenoic and total n-3 FA, and decreased arachidonic and total n-6 FA and n-6:n-3 FA and arachidonic:eicosapentaenoic acid ratios. Gas exchange was enhanced 72 h after the third n-3 FA infusion ( p = 0.001). Conclusions Critically ill patients may have altered plasma FA profiles. A higher total n-3 FA and docosahexaenoic acid content in plasma PC is associated with survival and improved gas exchange.

Objective We evaluated the practice of nutritional therapy (NT) by NT multiprofessional teams (NTMTs) in hospitals of the Sao Paulo metropolitan region to verify its adequacy in meeting the legislation that regulates NT in Brazil. Methods This was an open prospective study using active research through an inquiry with a multiple-choice, directed, and descriptive questionnaire, which was evaluated using EPI Info 6.04. Data were presented as median and 25th and 75th percentiles and compared according to the considered outcome. P Results Of 119 evaluated hospitals in the Sao Paulo metropolitan region, 84 were located in the city itself and 35 in the surrounding cities. There were 52 hospitals with NTMTs: 35 in the city of Sao Paulo and 13 in the other cities. No significant statistical differences were found when comparing the hospitals according to size (small, average, large, and specialized) and to the presence of a NTMT. We observed that the philanthropic institutions presented a significantly higher frequency of NTMTs presence. The private, academic, and public hospitals did not present significant differences with regard to the presence of NTMTs. Conclusion The number of NTMTs in the hospitals of the Sao Paulo metropolitan area is below the requirement established by law; the existence of a NTMT is more frequent in medium and large hospitals; the purchase of the necessary supplies and equipment for the NT practice is more adequate in hospitals with non-public reimbursement; the NTMTs in non-public hospitals were found to be more competent than those in public hospitals in implementing enteral and parenteral nutrition; private hospitals offer better conditions for professional growth for a NTMT staff compared with public hospitals.