The Effect of Omega-3 Enriched Parenteral Lipid Emulsion on Leukotriens B5 in Cancer Patients Undergoing GIT Surgery; A Comparative Study between SMOFlipid and Intralipid

Background: Malnutrition in cancer patients who are candidates for major surgery is considered a problem because it represents a risk factor for postoperative morbidity and mortality. Administration of standard parenteral diets supple-mented with omega-3(ω-3) fatty acids (immunonutrition) modulates immune and inflammatory responses and gut function in elective surgical patients, immunonutrition is associated with a reduction in infectious complication rates and a shorter length of hospital stay. Patients and Methods: The present study included 40 patients divided to two groups, group A: Including 20 patients receiving the traditional intralipid emulsion, and group B: Including 20 patients receiving the new omega-3 SMOFlipid 20% lipid emulsion. The Subjective Global Assessment method of nutrition (class B and C) is used as screening test to select patients in the study which takes into consideration body weight, dietary intake, GIT symptoms. In all patients parenteral nutrition support was started at day 1 to provide 25-30 kcal/kg/d and 1-1.5g protein/kg/d, at least for 7 days post operative. 30-40% of non protein caloric intake was provided from lipid emulsions. All patients received perioperative fluids, electrolytes, trace elements, micronutrients, prophylactic antibiotics, and deep venous thrombosis and stress ulcer prophylaxis as clinically prescribed. Parameters measured in the study were leukotriens B5 (LTB5) as anti-inflammatory mediator which were quantified using ELISA technique. Other parameter measured were weights, serum Na, K, Ca, Mg and kidney functions (urea creatinine). Results: Leukotriens B5 were non significant between the two groups in the first day postoperatively (p=0.22), but are statistically significant at day 7 postoperatively (p=0.001) in group B supplemented by SMOFlipid. Conclusion: This study demonstrates the beneficial im-munomodulation effect of Omega 3 enriched parenteral nutrition represented by elevation of LTB5 after 7 days of nutrition with SMOFlipid compared with intralipid.