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Researchers have recently shown that patients with acute respiratory distress syndrome (ARDS) who were fed an enteral diet containing eicosapentaenoic acid (EPA), y-linolenic acid (GLA) and anti-oxidants had significantly less pulmonary inflammation and better clinical outcomes than ARDS patients receiving a standard enteral diet. In this study, the same group from Ohio State University Medical Center investigated the mechanisms underlying these clinical improvements.
A total of 43 patients with ARDS were randomly assigned to be tube fed EPA, GLA and anti-oxidants (Oxepa, Abbott Laboratories, Ohio) or standard (control) diet (n=24) for at least 4?V7 days. An observation that is normally noted in ARDS patients is an increased alveolar-capillary membrane protein permeability, resulting in increased bronchoalveolar lavage fluid (BALF) and increases in the inflammatory mediators, including interleukin-8 (IL-8) and leukotriene B4 (LtB4), within that fluid. These inflammatory agents are thought to complicate the problem by attracting neutrophils to the alveoli.
When the BALF in the study group was compared to that of the controls, it had significantly less IL-8 and trends for less LtB4. Since both of these mediators have important roles in the pathogenesis of ARDS through their neutrophil chemoattractant properties, the researchers believed that the decrease in these mediators was responsible for the other major finding in this study: the trend in the reduction of total alveolar protein and neutrophils.
The researchers concluded that enteral feeding with a diet supplemented with EPA, GLA and anti-oxidants in patients with ARDS can modulate pulmonary inflammation through a decrease in BALF levels of IL-8 and LtB4. They further believed that the associated reduction in BALF neutrophils was a reasonable explanation for the observed clinical improvements in these patients.
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