Parenteral n–3 PUFA supplementation aids in recovery of CD patients after bowel resection

Parenteral supplementation with n‒3 polyunsaturated fatty acids (PUFAs) helps in the recovery of patients with Crohn’s disease (CD) following bowel resection, reports a study. This intervention is also safe, as shown by the fewer complications and reduced inflammatory cytokines.

“[P]ostoperative parenteral n–3 PUFAs supplementation may improve recovery for patients with CD following bowel resection and may function via an anti-inflammatory role,” said the researchers, led by Xiaolong Ge, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

Ge and colleagues conducted this prospective randomized, unblinded controlled trial to examine the effects of postoperative parenteral n‒3 PUFA supplementation in CD patients who underwent bowel resection between May 2019 and February 2022.

The research team then compared postoperative complications, complete blood count, serum biochemical values, and cytokine concentrations in those with and without parenteral n‒3 PUFA supplementation for 5 days after the procedure.

Of the 268 eligible participants, 134 were randomized to the treatment group (a mix of long-chain, medium-chain, and n‒3 PUFAs at 1.2 g/kg/d) and 134 to the control group (long-chain and medium-chain fats at 1.0 g/kg/d). Twenty-six patients failed to complete the allocated treatment, while eight were lost to follow-up. [Am J Clin Nutr 2024;119:1027-1035]

Both the intention-to-treat (ITT) and the per-protocol (PP) analyses revealed significant decreases in overall complication rates (ITT: 22.4 percent vs 49.3 percent; p<0.001; PP: 21.8 percent vs 38.2 percent; p=0.006) and postoperative stay (ITT: 8.8 vs 11.2 d; p=0.001) and 8.7 vs 11.5 d; p<0.001) in patients with parenteral n‒3 PUFA supplementation compared with those in the control group.

On postoperative day 5, the treatment group also showed markedly lower mean concentrations of interleukin (IL)-6 (17.11 vs 30.50 pg/mL; p=0.014), IL-1β (2.01 vs 2.24 pg/mL; p=0.019), tumour necrosis factor-α (TNF-α; 2.09 vs 2.29 pg/mL; p=0.029), and C-reactive protein (CRP) concentrations (51.3 vs 64.4 mg/L; p=0.05) than the control group.

“Our results … revealed that n–3 PUFAs significantly reduced IL-1β, IL-6, TNF-α, and CRP concentrations after surgery,” Ge said.

“Growing evidence also suggests that anastomotic leakage is associated with intestinal homeostasis. Therefore, n–3 PUFAs might reduce anastomotic leakage by regulating the host-microbe interaction,” he added. [J Gastrointest Surg 2021;25:2728-2731]

The n‒3 PUFAs also influence the integrity, stability, and mobility of the cell membrane by controlling the sterol regulatory element binding protein, protein acylation, and calcium release, which then leads to a decrease in inflammation, according to an earlier study. [Mol Nutr Food Res 2015;59:1791-1802]

Deep sea fish oil is the main source of n‒3 PUFAs, which include EPA, DHA, and docosapentaenoic acid. These acids help promote tissue regeneration. [Cochrane Database Syst Rev 2014;2014CD006320]

“Researchers have already reported the relationship between n–3 PUFAs and postoperative outcomes; however, the results are still regarded as inconsistent,” Ge said. “Some studies found that n–3 PUFAs could reduce infection rates and length of stay in major abdominal surgery. [J Parenter Enteral Nutr 2022;46:878-886; Clin Nutr 2014;33:226-239; World J Gastroenterol 2008;14:2434-2439]

In the current study, Ge and colleagues found that postoperative parenteral n‒3 PUFAs supplementation in CD patients reduced the rate of complications, particularly ileus and anastomotic leakage, as well as their length of hospital stay.