Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants on antioxidant status in patients with acute respiratory distress syndrome

• Published in: JPEN. Journal of parenteral and enteral nutrition 2003-03, Vol.27 (2), p.98-104
• Main Authors: Nelson, JL, DeMichele, SJ, Pacht, ER, Wennberg, AK
• Format: Article
• Language: English
• Subjects: Adult; alpha-Tocopherol - blood; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antioxidants - administration & dosage; Antioxidants - metabolism; beta Carotene - blood; Biological and medical sciences; Double-Blind Method; Eicosapentaenoic Acid - administration & dosage; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Enteral Nutrition; gamma-Linolenic Acid - administration & dosage; Humans; Intensive care medicine; Lipid Peroxidation - drug effects; Medical sciences; Oxidation-Reduction; Oxidative Stress; Respiratory Distress Syndrome, Adult - blood; Respiratory Distress Syndrome, Adult - metabolism; Respiratory Distress Syndrome, Adult - therapy
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/014860710302700298

BACKGROUND: We previously showed that enteral feeding of a diet containing eicosapentaenoic acid, gamma-linolenic acid, and elevated antioxidants improved clinical outcomes compared with a control diet in acute respiratory distress syndrome (ARDS) patients. It has been suggested that oxidative stress may overwhelm endogenous antioxidant levels and allow free radicals to further damage lung tissue. Therefore, we determined whether these ARDS patients were under oxidative stress and whether the experimental diet could improve antioxidant status. METHODS: Ninety-eight ARDS patients received either the experimental or control diet (minimum of 75% of basal energy expenditure x 1.3) for at least 4 to 7 days. Total radical antioxidant potential (TRAP), lipid peroxide levels (LPO), and plasma antioxidant concentrations were determined at baseline and study days 4 and 7. Sixty-two normal individuals were assessed for reference values. RESULTS: At baseline, ARDS patients had significantly lower plasma beta-carotene, retinol, and alpha-tocopherol, lower TRAP, and higher LPO values compared with normals. After 4 days of feeding, beta-carotene and alpha-tocopherol levels were normalized and significantly increased in the experimental group compared with controls. TRAP and LPO were not significantly different between groups and study day 4 and 7 values were not different from baseline values. Retinol levels increased equally in both groups. CONCLUSIONS: Before treatment, ARDS patients were found to be in a state of oxidative stress and had reduced levels of antioxidants. Although enteral nutrition with the experimental diet for at least 4 to 7 days did not reduce oxidative stress as measured, it did restore plasma levels of beta-carotene and alpha-tocopherol to normal or higher levels and appeared to protect ARDS patients from further lipid peroxidation. Before treatment, AS patients were found to be in a state of oxidative stress. Enteral nutrition with a diet containing eicosapentaenoic acid, γ-linolenic acid, and elevated antioxidants for at least 4 to 7 days restored plasma levels of β-carotene and α-tocopherol, but had no effect on TRAP or LPO.