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The role of n-3 fatty acids in acute pancreatitis
Published online by Cambridge University Press: 09 December 2024
Abstract
Prior observational studies have reported the potential protective effect of n-3 fatty acids on the prognosis of acute pancreatitis (AP). However, the causal impact of n-3 fatty acids on AP is unclear. We aimed to investigate further the association of n-3 fatty acids with AP. We performed a meta-analysis and Mendelian randomisation (MR) to explore the association between n-3 fatty acids and the prognosis of AP from clinical observation and genetics perspectives, respectively. Nine randomised controlled trials were included in this study. The result meta-analysis showed that complementary therapy of n-3 fatty acids significantly decreased mortality (Relative Risk (RR): 0·30; 95 % CI 0·14, 0·65, P < 0·05) and infectious complications in AP (RR: 0·45; 95 % CI 0·27, 0·77, P < 0·05). Compared with the control groups, the hospital stays (MD: −1·02; 95 % CI −1·85, −0·20, P < 0·05) in AP patients with n-3 fatty acids treatment were statistically reduced. However, the ICU stay (MD: −0·49; 95 % CI −1·29, −0·31, P > 0·05) between control groups and AP patients with n-3 fatty acids treatment was insignificant. Utilising genetic susceptibility analysis in the MR approach, the MR showed n-3 fatty acids have a significant causal effect on the AP risk (OR, 0·887; 95 % CI 0·797, 0·986, P = 0·027, fixed-effect; OR, 0·887; 95 % CI 0·792, 0·993, P = 0·037, random-effect). n-3 fatty acids complementary therapy may improve the prognosis of AP. Furthermore, genetically predicted serum levels of n-3 fatty acids can significantly lower AP risk.
Keywords
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- Research Article
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- © The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society
Footnotes
Binbin Tang and Wenyang Zhang are first authors.
References
Mayerle, J, Sendler, M, Hegyi, E, et al. (2019) Genetics, cell biology, and pathophysiology of pancreatitis. Gastroenterology 156, 1951–1968.e1.CrossRefGoogle Scholar
Boxhoorn, L, Voermans, RP, Bouwense, SA, et al. (2020) Acute pancreatitis. Lancet 396, 726–734. Erratum in: Lancet. 2021; 398(10312): 1686. PMID: 32891214.Google Scholar
Xiao, AY, Tan, ML, Wu, LM, et al. (2016) Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol 1, 45–55.Google ScholarPubMed
Besselink, MG, van Santvoort, HC, Boermeester, MA, et al. (2009) Timing and impact of infections in acute pancreatitis. Br J Surg 96, 267–273.CrossRefGoogle ScholarPubMed
Banks, PA, Bollen, TL, Dervenis, C, et al. (2013) Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 62, 102–111.CrossRefGoogle ScholarPubMed
van Santvoort, HC, Besselink, MG, Bakker, OJ, et al. (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362, 1491–1502.CrossRefGoogle ScholarPubMed
Rhee, C, Dantes, R, Epstein, L, et al. (2017) Incidence and trends of sepsis in US hospitals using clinical v. claims data, 2009–2014. JAMA 318, 1241–1249.CrossRefGoogle Scholar
Calder, PC (2010) Rationale and use of n-3 fatty acids in artificial nutrition. Proc Nutr Soc 69, 565–573. Erratum in: Proc Nutr Soc. 2011; 70(2): 282.Google Scholar
Lasztity, N, Hamvas, J, Biró, L, et al. (2005) Effect of enterally administered n-3 polyunsaturated fatty acids in acute pancreatitis--a prospective randomized clinical trial. Clin Nutr 24, 198–205.CrossRefGoogle ScholarPubMed
Xiong, J, Zhu, S, Zhou, Y, et al. (2009) Regulation of n-3 fish oil emulsion on the SIRS during the initial stage of severe acute pancreatitis. J Huazhong Univ Sci Technolog Med Sci 29, 35–38.CrossRefGoogle Scholar
Al-Leswas, D, Eltweri, AM, Chung, WY, et al. (2020) Intravenous n-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: a randomised double blind controlled trial. Clin Nutr 39, 2711–2719.CrossRefGoogle ScholarPubMed
Wang, X, Li, W, Li, N, et al. (2008)
n-3 fatty acids-supplemented parenteral nutrition decreases hyperinflammatory response and attenuates systemic disease sequelae in severe acute pancreatitis: a randomized and controlled study. JPEN J Parenter Enteral Nutr 32, 236–241.Google Scholar
Wang, X, Li, W, Zhang, F, et al. (2009) Fish oil-supplemented parenteral nutrition in severe acute pancreatitis patients and effects on immune function and infectious risk: a randomized controlled trial. Inflammation 32, 304–309.CrossRefGoogle ScholarPubMed
Pearce, CB, Sadek, SA, Walters, AM, et al. (2006) A double-blind, randomised, controlled trial to study the effects of an enteral feed supplemented with glutamine, arginine, and n-3 fatty acid in predicted acute severe pancreatitis. JOP 7, 361–371.Google Scholar
Xu, QH, Cai, GL, Lü, XC, et al. (2012) The effects of ω-3 fish oil lipid emulsion on inflammation-immune response and organ function in patients with severe acute pancreatitis. Zhonghua Nei Ke Za Zhi 51, 962–965.Google ScholarPubMed
Smith, GD & Ebrahim, S (2003) ‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease? Int J Epidemiol 32, 1–22.CrossRefGoogle ScholarPubMed
Mao, X, Mao, S, Sun, H, et al. (2023) Causal associations between modifiable risk factors and pancreatitis: a comprehensive Mendelian randomization study. Front Immunol 14, 1091780.CrossRefGoogle ScholarPubMed
Mao, X, Huang, C, Wang, Y, et al. (2023) Association between dietary habits and pancreatitis among individuals of European ancestry: a two-sample Mendelian randomization study. Nutrients 15, 1153.CrossRefGoogle ScholarPubMed
Ling, R, Liang, J, Mo, S, et al. (2023) Physical activity, sedentary behavior and pancreatitis risk: Mendelian randomization study. PLoS One 18, e0287810.CrossRefGoogle ScholarPubMed
Tu, Y-K & Greenwood, DC (2012) Modern Methods for Epidemiology. Dordrecht: Springer.CrossRefGoogle Scholar
Moher, D, Liberati, A, Tetzlaff, J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6, e1000097.CrossRefGoogle ScholarPubMed
Mi, J, Jiang, L, Liu, Z, et al. (2022) Identification of blood metabolites linked to the risk of cholelithiasis: a comprehensive Mendelian randomization study. Hepatol Int 16, 1484–1493.CrossRefGoogle Scholar
Chen, L, Peters, JE, Prins, B, et al. (2022) Systematic Mendelian randomization using the human plasma proteome to discover potential therapeutic targets for stroke. Nat Commun 13, 6143.CrossRefGoogle ScholarPubMed
Cohen, JF, Chalumeau, M, Cohen, R, et al. (2015) Cochran’s Q test was useful to assess heterogeneity in likelihood ratios in studies of diagnostic accuracy. J Clin Epidemiol 68, 299–306.CrossRefGoogle ScholarPubMed
Hartwig, FP, Davey Smith, G & Bowden, J (2017) Robust inference in summary data Mendelian randomization via the zero modal pleiotropy assumption. Int J Epidemiol 46, 1985–1998.CrossRefGoogle ScholarPubMed
Bowden, J, Davey Smith, G & Burgess, S (2015) Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol 44, 512–525.CrossRefGoogle ScholarPubMed
Hemani, G, Zheng, J, Elsworth, B, et al. (2018) The MR-Base platform supports systematic causal inference across the human phenome. Elife 7, e34408.CrossRefGoogle ScholarPubMed
Yavorska, OO & Burgess, S (2017) Mendelian Randomization: an R package for performing Mendelian randomization analyses using summarized data. Int J Epidemiol 46, 1734–1739.CrossRefGoogle Scholar
Kamat, MA, Blackshaw, JA, Young, R, et al. (2019) PhenoScanner V2: an expanded tool for searching human genotype-phenotype associations. Bioinf 35, 4851–4853.Google ScholarPubMed
Simopoulos, AP (2016) An increase in the n-6/n-3 fatty acid ratio increases the risk for obesity. Nutrients 8, 128.CrossRefGoogle Scholar
Hahn, J, Cook, NR, Alexander, EK, et al. (2022) Vitamin D and marine n-3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ 376, e066452.CrossRefGoogle ScholarPubMed
Djoussé, L, Cook, NR, Kim, E, et al. (2020) Supplementation with vitamin D and n-3 fatty acids and incidence of heart failure hospitalization: VITAL-heart failure. Circulation 141, 784–786.CrossRefGoogle ScholarPubMed
Patchen, BK, Balte, P, Bartz, TM, et al. (2023) Investigating associations of n-3 fatty acids, lung function decline, and airway obstruction. Am J Respir Crit Care Med 208, 846–857.CrossRefGoogle ScholarPubMed
Jafari, T, Feizi, A, Askari, G, et al. (2015) Parenteral immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis. Clin Nutr 34, 35–43.Google ScholarPubMed
Zhou, J, Xue, Y, Liu, Y, et al. (2021) The effect of immunonutrition in patients with acute pancreatitis: a systematic review and meta-analysis. J Hum Nutr Diet 34, 429–439.CrossRefGoogle ScholarPubMed
Lei, QC, Wang, XY, Xia, XF, et al. (2015) The role of n-3 fatty acids in acute pancreatitis: a meta-analysis of randomized controlled trials. Nutrients 7, 2261–2273.CrossRefGoogle ScholarPubMed
Wolbrink, DRJ, Grundsell, JR, Witteman, B, et al. (2020) Are n-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis. Clin Nutr 39, 2686–2694.CrossRefGoogle ScholarPubMed
Tao, X, Yang, Y, Xu, S, et al. (2023) Efficacy of immune nutrients in severe acute pancreatitis: a network meta-analysis. Medicine (Baltimore) 102, e35615.CrossRefGoogle ScholarPubMed
Calder, PC, Albers, R, Antoine, JM, et al. (2009) Inflammatory disease processes and interactions with nutrition. Br J Nutr 101, S1–45.Google ScholarPubMed
Panigrahy, D, Gilligan, MM, Serhan, CN, et al. (2021) Resolution of inflammation: an organizing principle in biology and medicine. Pharmacol Ther 227, 107879.CrossRefGoogle Scholar
Barnig, C, Bezema, T, Calder, PC, et al. (2019) Activation of resolution pathways to prevent and fight chronic inflammation: lessons from asthma and inflammatory bowel disease. Front Immunol 10, 1699.CrossRefGoogle ScholarPubMed
Calder, PC (2020)
n-3 PUFA and inflammation: from membrane to nucleus and from bench to bedside. Proc Nutr Soc 1–13.Google ScholarPubMed
Calder, PC (2017) n-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans 45, 1105–1115.CrossRefGoogle Scholar
Giacobbe, J, Benoiton, B, Zunszain, P, et al. (2020) The anti-inflammatory role of n-3 polyunsaturated fatty acids metabolites in pre-clinical models of psychiatric, neurodegenerative, and neurological disorders. Front Psychiatry 11, 122.CrossRefGoogle ScholarPubMed
Djuricic, ID, Mazic, SD, Kotur-Stevuljevic, JM, et al. (2014) Long-chain n-3 polyunsaturated fatty acid dietary recommendations are moderately efficient in optimizing their status in healthy middle-aged subjects with low fish consumption: a cross-over study. Nutr Res 34, 210–218.CrossRefGoogle ScholarPubMed
Djuricic, I & Calder, PC (2021) Beneficial outcomes of n-6 and n-3 polyunsaturated fatty acids on human health: an update for 2021. Nutrients 13, 2421.Google Scholar
Weatherill, AR, Lee, JY, Zhao, L, et al. (2005) Saturated and polyunsaturated fatty acids reciprocally modulate dendritic cell functions mediated through TLR4. J Immunol 174, 5390–5397.CrossRefGoogle ScholarPubMed
Lee, JY, Sohn, KH, Rhee, SH, et al. (2001) Saturated fatty acids, but not unsaturated fatty acids, induce the expression of cyclooxygenase-2 mediated through Toll-like receptor 4. J Biol Chem 276, 16683–16689.CrossRefGoogle ScholarPubMed
Ariturk, LA, Cilingir, S, Kolgazi, M, et al. (2024) Docosahexaenoic acid (DHA) alleviates inflammation and damage induced by experimental colitis. Eur J Nutr 63, 2801–2813.CrossRefGoogle ScholarPubMed
Calder, PC (2010)
n-3 fatty acids and inflammatory processes. Nutrients 2, 355–374.CrossRefGoogle ScholarPubMed
Lee, JM & Johnson, JA (2004) An important role of Nrf2-ARE pathway in the cellular defense mechanism. J Biochem Mol Biol 37, 139–143.Google ScholarPubMed
Brustad, N, Bønnelykke, K & Chawes, B (2023) Dietary prevention strategies for childhood asthma. Pediatr Allergy Immunol 34, e13984.CrossRefGoogle ScholarPubMed
Chen, H, Wang, S, Zhao, Y, et al. (2018) Correlation analysis of n-3 fatty acids and mortality of sepsis and sepsis-induced ARDS in adults: data from previous randomized controlled trials. Nutr J 17, 57.CrossRefGoogle ScholarPubMed
Fekete, M, Szarvas, Z, Fazekas-Pongor, V, et al. (2022) Effects of n-3 supplementation on quality of life, nutritional status, inflammatory parameters, lipid profile, exercise tolerance and inhaled medications in chronic obstructive pulmonary disease. Ann Palliat Med 11, 2819–2829.CrossRefGoogle Scholar
Wang, YJ, Dou, P & Pan, YS (2024) Associations between eicosapentaenoic acid and docosahexaenoic acid consumption and inflammatory bowel disease in adults: the National Health and Nutrition Examination Survey (NHANES) 2009–2010. Asia Pac J Clin Nutr 33, 562–568.Google Scholar
Dichi, I, Frenhane, P, Dichi, JB, et al. (2000) Comparison of n-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition 16, 87–90.CrossRefGoogle ScholarPubMed
Yue, HY, Zeng, J, Wang, Y, et al. (2023) Efficacy of n-3 fatty acids for hospitalized COVID-19 patients: a systematic review and meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr 32, 308–320.Google ScholarPubMed
Yang, AL & McNabb-Baltar, J (2020) Hypertriglyceridemia and acute pancreatitis. Pancreatology 20, 795–800.CrossRefGoogle ScholarPubMed
Mohan, BP (2020) Diagnosis of idiopathic acute pancreatitis: the simpler, the better? Endoscopy 52, 965–966.Google ScholarPubMed
Wang, T, Zhang, X, Zhou, N, et al. (2023) Association between n-3 fatty acid intake and dyslipidemia: a continuous dose-response meta-analysis of randomized controlled trials. J Am Heart Assoc 12, e029512.CrossRefGoogle ScholarPubMed
Nadeem, M, Imran, M, Taj, I, et al. (2017)
n-3 fatty acids, phenolic compounds and antioxidant characteristics of chia oil supplemented margarine. Lipids Health Dis 16, 102.CrossRefGoogle ScholarPubMed
Ibrahim, D, Arisha, AH, Khater, SI, et al. (2022) Impact of n-3 fatty acids nano-formulation on growth, antioxidant potential, fillet quality, immunity, autophagy-related genes and Aeromonas hydrophila resistance in Nile Tilapia (Oreochromis niloticus). Antioxidants (Basel) 11, 1523.CrossRefGoogle ScholarPubMed
Tang et al. supplementary material
Tang et al. supplementary material
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