Short-Term Efficacy of Omega-3 Polyunsaturated Fatty Acid-Supplemented Parenteral Nutrition in Postoperative Gastrointestinal Malignancy: A Meta Analysis of Randomized Control Trials_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIULi-gang ¹ ,  LIUWu-hua ¹ , YAOPeng-fei ¹ , FANGXing-zhong ¹ , LIXiao-feng ² , WANGYan ¹

1. Department of General Surgery, The First People, s Hospital of Lanzhou, Lanzhou 730050, Gansu Province, China;
2. Department of Nosocomial Infection, The First People, s Hospital of Lanzhou, Lanzhou 730050, Gansu Province, China;

Corresponding?author：

LIUWu-hua, Email: lwh-lz@163.com

Keywords：

Gastrointestinal malignancy; Omega-3 polyunsaturated fatty acid; Parenteral nutrition; Meta analysis

DOI：

10.7507/1007-9424.20150349

Video：

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Objective To systematically evaluate short-term efficacy of omega-3(ω-3) polyunsaturated fatty acidsupplemented parenteral nutrition in postoperative gastrointestinal malignancy. Methods The literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes ofω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. All the relevant studies were screened and the data were extracted before January 2015. The quality of included literatures was assessed by the risk of bias table provided on Cochrane Library. Statistical analysis was performed by Revman 5.3 software. Results Sixteen RCTs involving 1019 patients (511 in the study group, 508 in the control group) were enrolled into the analysis. The results of meta analysis:①In the cell immunity:The proportions of CD3, CD4, CD4/CD8 in the study group were significantly higher than those in the control group[CD3:WMD=6.09, 95% CI (2.40, 9.77), P=0.001; CD4:WMD=5.25, 95% CI (3.30, 7.20), P < 0.00001; CD4/CD8:WMD=0.40, 95% CI (0.22, 0.58), P < 0.0001].②In the humoral immunity:The levels of IgA and IgG in the study group were significantly higher than those in the control group[IgA:WMD=0.56, 95% CI (0.36, 0.77), P < 0.00001; IgG:WMD=2.88, 95% CI (0.63, 5.13), P=0.01].③The count of lymphocyte in the study group was significantly higher than that in the control group[WMD=0.27, 95% CI (0.10, 0.43), P=0.002].④In the cytokines:The levels of interleukin-6 and tumor necrosis factor (TNF)-αin the study group were significantly lower than those in the control group[interleukin-6:WMD=-16.75, 95% CI (-25.00, -8.50), P < 0.0001; TNF-α:WMD=-6.25, 95% CI (-10.55, -1.95), P=0.004].⑤The rate of postoperative infective complications in the study group was significantly lower than that in the control group[OR=0.36, 95% CI (0.20, 0.66), P=0.0008]. Conclusion For postoperative patients with gastrointestinal malignancy, ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition could improve immune function, decrease postoperative inflammatory reaction, and reduce rate of infective complications.

Citation： LIULi-gang, LIUWu-hua, YAOPeng-fei, FANGXing-zhong, LIXiao-feng, WANGYan. Short-Term Efficacy of Omega-3 Polyunsaturated Fatty Acid-Supplemented Parenteral Nutrition in Postoperative Gastrointestinal Malignancy: A Meta Analysis of Randomized Control Trials. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(11): 1338-1346. doi: 10.7507/1007-9424.20150349 Copy

1.	?Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery:a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2010, 34(4):387-394.
2.	張維康, 龍躍平, 陳俊華.ω-3魚油脂肪乳對胃腸道惡性腫瘤患者術后恢復的作用.臨床外科雜志, 2007, 15(9):606-608.
3.	Liang B, Wang S, Ye YL, et al. Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World J Gastroenterol, 2008, 14(15):2434-2439.
4.	魏玉哲, 宋洪江, 王佳, 等.ω-3多不飽和脂肪酸在老年胃癌病人術后腸外營養中的應用.腸外與腸內營養, 2009, 16(6):328-331.
5.	劉鑫, 辛福澤, 張彥波, 等.ω-3魚油脂肪乳對胃腸道腫瘤病人術后免疫功能和炎性反應的影響.腸外與腸內營養, 2009, 16(5):280-282, 285.
6.	陸承, 王文躍, 彭維朝, 等.魚油脂肪乳對胃腸道惡性腫瘤病人術后營養狀況和體液免疫的影響.腸外與腸內營養, 2009, 16(6):324-327.
7.	Jiang ZM, Wilmore DW, Wang XR, et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg, 2010, 97(6):804-809.
8.	夏俊, 熊奇如, 錢葉本, 等.ω-3魚油脂肪乳在胃癌患者術后腸外營養中的應用.安徽醫科大學學報, 2011, 46(10):1105-1106.
9.	薛平慧, 劉君, 林松.ω-3魚油脂肪乳對大腸癌患者術后機體免疫的影響.華南國防醫學雜志, 2011, 25(2):138-139.
10.	鄭偉, 王宇.ω-3魚油脂肪乳在結直腸惡性腫瘤病人術后腸外營養中的作用.腸外與腸內營養, 2011, 18(3):129-131, 135.
11.	Zhu MW, Da-Nian T, Hou J, et al. Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery. Chin Med J, 2012, 125(2):178-181.
12.	郭健, 周峰, 余震, 等.ω-3多不飽和脂肪酸對胃癌患者術后免疫功能及術后疲勞綜合征的影響.中華臨床營養雜志, 2012, 20(6):382-383.
13.	黃建強, 鄭權, 趙建輝, 等.魚油脂肪乳對胃腸道腫瘤患者術后細胞免疫及炎癥反應的影響研究.重慶醫學, 2013, 42(35):4289-4291.
14.	Long H, Yang H, Lin Y, et al. Fish oil-supplemented parenteral nutrition in patients following esophageal cancer surgery:effect on inflammation and immune function. Nutr Cancer, 2013, 65(1):71-75.
15.	Wei Z, Wang W, Chen J, et al. A prospective, randomized, controlled study ofω-3 fish oil fat emulsion-based parenteral nutrition for patients following surgical resection of gastric tumors. Nutr J, 2014, 13:25.
16.	黃劍, 方強.ω-3魚油脂肪乳對食管惡性腫瘤患者術后免疫功能和炎性反應的影響.浙江醫學, 2014, 36(2):148-150.
17.	胡國強, 陳威.含ω-3魚油脂肪乳的腸外營養液對胃腸道腫瘤病人術后免疫與炎性因子的影響.腸外與腸內營養, 2015, 22(1):16-19.
18.	Zaloga GP. Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts:assessment of outcomes. Lancet, 2006, 367(9516):1101-1111.
19.	Gramlich L, Kichian K, Pinilla J, et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition, 2004, 20(10):843-848.
20.	Peter JV, Moran JL, Phillips-Hughes J. A meta analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med, 2005, 33(1):213-261.
21.	Mayer K, Seeger W. Fish oil in critical illness. Curr Opin Clin Nutr Metab Care, 2008, 11(2):121-127.
22.	Fan YY, McMurray DN, Ly LH, et al. Dietary (n-3) polyunsaturated fatty acids remodel mouse T-cell lipid rafts. J Nutr, 2003, 133(6):1913-1920.
23.	Zeyda M, Szekeres AB, S?emann MD, et al. Suppression of T cell signaling by polyunsaturated fatty acids:selectivity in inhibition of mitogen-activated protein kinase and nuclear factor activation. J Immunol, 2003, 170(12):6033-6039.
24.	Nohé B, Ruoff H, Johannes T, et al. A fish oil emulsion used for parenteral nutrition attenuates monocyte-endothelial interactions under flow. Shock, 2002, 18(3):217-222.

1. ?Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery:a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2010, 34(4):387-394.
2. 張維康, 龍躍平, 陳俊華.ω-3魚油脂肪乳對胃腸道惡性腫瘤患者術后恢復的作用.臨床外科雜志, 2007, 15(9):606-608.
3. Liang B, Wang S, Ye YL, et al. Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World J Gastroenterol, 2008, 14(15):2434-2439.
4. 魏玉哲, 宋洪江, 王佳, 等.ω-3多不飽和脂肪酸在老年胃癌病人術后腸外營養中的應用.腸外與腸內營養, 2009, 16(6):328-331.
5. 劉鑫, 辛福澤, 張彥波, 等.ω-3魚油脂肪乳對胃腸道腫瘤病人術后免疫功能和炎性反應的影響.腸外與腸內營養, 2009, 16(5):280-282, 285.
6. 陸承, 王文躍, 彭維朝, 等.魚油脂肪乳對胃腸道惡性腫瘤病人術后營養狀況和體液免疫的影響.腸外與腸內營養, 2009, 16(6):324-327.
7. Jiang ZM, Wilmore DW, Wang XR, et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg, 2010, 97(6):804-809.
8. 夏俊, 熊奇如, 錢葉本, 等.ω-3魚油脂肪乳在胃癌患者術后腸外營養中的應用.安徽醫科大學學報, 2011, 46(10):1105-1106.
9. 薛平慧, 劉君, 林松.ω-3魚油脂肪乳對大腸癌患者術后機體免疫的影響.華南國防醫學雜志, 2011, 25(2):138-139.
10. 鄭偉, 王宇.ω-3魚油脂肪乳在結直腸惡性腫瘤病人術后腸外營養中的作用.腸外與腸內營養, 2011, 18(3):129-131, 135.
11. Zhu MW, Da-Nian T, Hou J, et al. Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery. Chin Med J, 2012, 125(2):178-181.
12. 郭健, 周峰, 余震, 等.ω-3多不飽和脂肪酸對胃癌患者術后免疫功能及術后疲勞綜合征的影響.中華臨床營養雜志, 2012, 20(6):382-383.
13. 黃建強, 鄭權, 趙建輝, 等.魚油脂肪乳對胃腸道腫瘤患者術后細胞免疫及炎癥反應的影響研究.重慶醫學, 2013, 42(35):4289-4291.
14. Long H, Yang H, Lin Y, et al. Fish oil-supplemented parenteral nutrition in patients following esophageal cancer surgery:effect on inflammation and immune function. Nutr Cancer, 2013, 65(1):71-75.
15. Wei Z, Wang W, Chen J, et al. A prospective, randomized, controlled study ofω-3 fish oil fat emulsion-based parenteral nutrition for patients following surgical resection of gastric tumors. Nutr J, 2014, 13:25.
16. 黃劍, 方強.ω-3魚油脂肪乳對食管惡性腫瘤患者術后免疫功能和炎性反應的影響.浙江醫學, 2014, 36(2):148-150.
17. 胡國強, 陳威.含ω-3魚油脂肪乳的腸外營養液對胃腸道腫瘤病人術后免疫與炎性因子的影響.腸外與腸內營養, 2015, 22(1):16-19.
18. Zaloga GP. Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts:assessment of outcomes. Lancet, 2006, 367(9516):1101-1111.
19. Gramlich L, Kichian K, Pinilla J, et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition, 2004, 20(10):843-848.
20. Peter JV, Moran JL, Phillips-Hughes J. A meta analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med, 2005, 33(1):213-261.
21. Mayer K, Seeger W. Fish oil in critical illness. Curr Opin Clin Nutr Metab Care, 2008, 11(2):121-127.
22. Fan YY, McMurray DN, Ly LH, et al. Dietary (n-3) polyunsaturated fatty acids remodel mouse T-cell lipid rafts. J Nutr, 2003, 133(6):1913-1920.
23. Zeyda M, Szekeres AB, S?emann MD, et al. Suppression of T cell signaling by polyunsaturated fatty acids:selectivity in inhibition of mitogen-activated protein kinase and nuclear factor activation. J Immunol, 2003, 170(12):6033-6039.
24. Nohé B, Ruoff H, Johannes T, et al. A fish oil emulsion used for parenteral nutrition attenuates monocyte-endothelial interactions under flow. Shock, 2002, 18(3):217-222.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Short-Term Efficacy of Omega-3 Polyunsaturated Fatty Acid-Supplemented Parenteral Nutrition in Postoperative Gastrointestinal Malignancy: A Meta Analysis of Randomized Control Trials

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