Supplementation of Arachidonic Acid Plus Docosahexaenoic Acid in Cirrhotic Patients Awaiting Liver Transplantation: A Preliminary Study

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 31; no. 6; pp. 511 - 516
• Main Authors: Pazirandeh, Sassan, Ling, Pei-Ra, Ollero, Mario, Gordon, Fredric, Burns, David L., Bistrian, Bruce R.
• Format: Journal Article
• Language: English
• Published: Silver Spring, MD SAGE Publications 01.11.2007; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: alpha-Linolenic Acid - administration & dosage; alpha-Linolenic Acid - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arachidonic Acid - administration & dosage; Arachidonic Acid - adverse effects; Arachidonic Acid - blood; Arachidonic Acid - deficiency; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; C-Reactive Protein - metabolism; Dietary Supplements; Docosahexaenoic Acids - administration & dosage; Docosahexaenoic Acids - adverse effects; Docosahexaenoic Acids - blood; Double-Blind Method; Eicosapentaenoic Acid - administration & dosage; Eicosapentaenoic Acid - adverse effects; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Etanercept; Fatty Acids - analysis; Female; Humans; Immunoglobulin G - metabolism; Intensive care medicine; Interleukin-6 - blood; Liver Cirrhosis - blood; Liver Cirrhosis - drug therapy; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Phospholipids - analysis; Receptors, Tumor Necrosis Factor - metabolism; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Triglycerides - analysis; Tumor Necrosis Factor-alpha - blood; Human; Cirrhosis; Nutrition; Digestive system; Liver; Digestive diseases; Hepatic disease; Supplementation; Arachidonic acid; Enteral administration; Parenteral administration; Feeding
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607107031006511

Background: In patients with cirrhotic liver diseases, supplementation of linoleic acid and α-linolenic acid often does not alter the levels of arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), suggesting the necessity to directly provide these nutrients. Methods: In a double-blind, placebo-controlled fashion, 9 cirrhotic patients listed for liver transplantation at Lahey Clinic Center were given daily supplementation with either 10 gel caps containing 500 mg of AA and 1000 mg of DHA (AA/DHA) or 250 mg of linolenic acid (LA) and 125 mg of oleic acid (OA; OA/LA) for 6 weeks. α-Tocopherol at 200 IU was provided daily. No other dietary prescription was made. Plasma fatty acid profiles were determined in triglyceride and phospholipids fractions. Plasma levels of C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin 6 (IL-6), and soluble TNF receptor II (sTNFRII) were also measured. Results: Four patients receiving OA/LA and 5 patients receiving AA/DHA completed the study without evidence of any adverse effects or intolerance. The supplementation of LA, AA, and DHA effectively raised their levels in either one or both plasma lipid fractions in this limited number of subjects. DHA plus AA also lowered 22:4ω-6, 22:5ω-6, and 22:5ω-3, suggesting that DHA reduced the elongation and desaturation of AA and EPA. Conclusions: It is feasible to improve the liver disease–associated deficiency of AA or DHA with modest intakes of AA and DHA. Whether this maneuver will affect the systemic inflammatory responsiveness and ultimately clinical outcome will require a large-scale and well-controlled intervention. Supplementation with small amounts of arachidonic acid and docosahexaenoic acid in patients with advanced liver disease is well tolerated and increases their respective levels in serum phospholipids.