A randomized controlled trial of EPA/DHA supplemented enteral nutrition in patients undergoing laparoscopic colorectal surgery
Creators: name: White, Daniel Stuart
Publisher: name: University of Surrey
Year: 2023

description: <b>Introduction</b><br>
description: <br>
description: Laparoscopic colorectal surgery and enhanced recovery programs have been
description: shown to improve patient outcomes and shorten length of stay following
description: surgery. There is growing evidence that perioperative supplementation with
description: immune-enhancing nutrition [IMN] containing Eicosapentaenoic acid [EPA]and
description: Docosahexaenoic acid [DHA] long chain, marine derived, omega-3 fatty acids can
description: further shorten length of stay, primarily by reducing infectious complications.
description: Their primary actions to achieve this include altering the lipid membrane
description: composition of peripheral blood mononuclear cells, and subsequently changing
description: the balance of inflammatory eicosanoids produced, which drive the innate
description: immune response. The aim of this study is to examine the effects of EPA and DHA
description: on the innate immune response, primarily measuring phagocytosis of pathogenic
description: bacteria.<br>
description: <br>
description: <b>Methods</b><br>
description: <br>
description: A randomized controlled trial was conducted 2017-2019 (NCT03598413). All
description: patients underwent laparoscopic colorectal surgery for confirmed malignancy.
description: Patients were randomised 1:1 to receive a nutritional supplement containing
description: 2.84g/day EPA and DHA or no supplementation. These were given for 7 days
description: pre- and 7 days post-operatively. Blood was taken pre-operatively, before
description: supplementation [Baseline], after 7 days of nutrition (on the day of surgery), and
description: day one post-operatively. The primary outcome was neutrophil and monocyte
description: phagocytosis of Staphylococcus aureus, Escherichia coli, and Mycobacterium
description: tuberculosis. Analysis of phagocytosis was via flow cytometry. Changes in the
description: fatty acid membrane composition of red [RBC] and white blood cells [WBC] were
description: analysed using Gas Chromatography Mass Spectroscopy.<br>
description: <br>
description: <b>Results</b><br>
description: <br>
description: A total of 40 patients were recruited to the study with no dropouts, nor any lost
description: to follow up. Incorporation of EPA into RBC’s lipid membranes was significant
description: after 7 days of supplementation [Control (mean ± SD as % total phospholipids)
description: (1.28 ± 0.38 to 1.08 ± 0.42) vs. IMN (1.08 ± 0.49 to 2.94 ± 2.66) p=&lt;0.05]. It was
description: also significant in PBMC’s [Control (mean ± SD as % total phospholipids) (0.53 ±
description: 0.14 to 0.52 ± 0.14) vs. IMN (0.55 ± 0.19 to 0.79 ± 0.35) p=0.01]. There were no
description: differences in the primary outcome of phagocytosis between groups, for any
description: pathogen. There were significant correlations between phagocytosis and
description: membrane composition of Neutrophils with DHA [E.coli (Spearmans r=0.398,
description: p=0.012) S.aureus (Spearmans r=0.542 p=0.0004)] and with Monocytes for
description: Tuberculosis (Spearmans r= 0.363, p=0.021). Generally, increasing percentages
description: of EPA and DHA in PBMC correlated with an increased phagocytosis of all three
description: tested bacteria. In contrast however, increased levels of DHA in PBMC led to a
description: reduced phagocytosis of E.coli by both monocytes (Spearmans r= -0.463,
description: p=0.003) and neutrophils (Spearmans r = -0.330, p=0.04). Secondary outcomes
description: did not differ between groups.<br>
description: <br>
description: <b>Conclusion</b><br>
description: <br>
description: There were no benefits observed in the supplemented group for the primary
description: outcome. There were significant changes with supplementation in lipid
description: membrane composition of both RBCs and PBMCs. Increased DHA in PBMC
description: enhanced the abilities of both monocytes and neutrophils to phagocytose
description: pathogenic bacteria. It is possible that the clinical effects may only be
description: appreciable when combination immunonutrition is used, or a targeted approach
description: to the clinically malnourished is adopted.<br>