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Cited by 552Clinical Nutrition and GastroenterologyRespiratory Support and MechanismsFatty Acid Research and Health

Enteral Omega-3 Fatty Acid, γ-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury

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Rice, Todd W.·2011·JAMA
DOI 10.1001/jama.2011.1435PMC PMC3770348
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Abstract

CONTEXT: The omega-3 (n-3) fatty acids docosahexaenoic acid and eicosapentaenoic acid, along with γ-linolenic acid and antioxidants, may modulate systemic inflammatory response and improve oxygenation and outcomes in patients with acute lung injury. OBJECTIVE: To determine if dietary supplementation of these substances to patients with acute lung injury would increase ventilator-free days to study day 28. DESIGN, SETTING, AND PARTICIPANTS: The OMEGA study, a randomized, double-blind, placebo-controlled, multicenter trial conducted from January 2, 2008, through February 21, 2009. Participants were 272 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. All participants had complete follow-up. INTERVENTIONS: Twice-daily enteral supplementation of n-3 fatty acids, γ-linolenic acid, and antioxidants compared with an isocaloric control. Enteral nutrition, directed by a protocol, was delivered separately from the study supplement. MAIN OUTCOME MEASURE: Ventilator-free days to study day 28. RESULTS: The study was stopped early for futility after 143 and 129 patients were enrolled in the n-3 and control groups. Despite an 8-fold increase in plasma eicosapentaenoic acid levels, patients receiving the n-3 supplement had fewer ventilator-free days (14.0 vs 17.2; P = .02) (difference, -3.2 [95% CI, -5.8 to -0.7]) and intensive care unit-free days (14.0 vs 16.7; P = .04). Patients in the n-3 group also had fewer nonpulmonary organ failure-free days (12.3 vs 15.5; P = .02). Sixty-day hospital mortality was 26.6% in the n-3 group vs 16.3% in the control group (P = .054), and adjusted 60-day mortality was 25.1% and 17.6% in the n-3 and control groups, respectively (P = .11). Use of the n-3 supplement resulted in more days with diarrhea (29% vs 21%; P = .001). CONCLUSIONS: Twice-daily enteral supplementation of n-3 fatty acids, γ-linolenic acid, and antioxidants did not improve the primary end point of ventilator-free days or other clinical outcomes in patients with acute lung injury and may be harmful. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00609180.

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  • Enteral formulae enriched in borage oil and/or omega-3 fatty acids have been administered in patients suffering from ARDS, acute lung injury and sepsis with positive effects regarding length of stay, length of ventilation and even mortality.

    “Enteral formulae enriched in borage oil and/or omega-3 FA have been administered in patients suffering from ARDS, acute lung injury (ALI) and sepsis with positive effects regarding length of stay, length of ventilation and even mortality (239,240,245,248).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [240]

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Authors
Rice, T. W.
Affiliations
Vanderbilt University (US)
Corresponding author
Rice, Todd W.
ORCID
Rice, Todd W.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2011-10-12
Volume
306
Issue
14
Pages
1574
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2011.1435
PMC
PMC3770348
OpenAlex
W2121517569
Cited by
552
References
4
Citations by year
2026: 25 · 2025: 12 · 2024: 15 · 2023: 15 · 2022: 25 · 2021: 39 · 2020: 38 · 2019: 33 · 2018: 39 · 2017: 41 · 2016: 40 · 2015: 61 · 2014: 64 · 2013: 52 · 2012: 48
FWCI
49.34
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (n01hr56166-20-0-1, n01hr56170-19-0-1, n01hr56175-19-0-1, n01hr56173-20-0-1, n01hr56171-16-0-1, n01hr56169-19-0-1, n01hr56174-20-0-1, n01hr56168-19-0-1, n01hr56167-20-0-1, n01hr56179-17-0-1, n01hr56176-20-0-1, n01hr56172-23-0-1, n01hr56165-19-0-1)
  • U.S. Public Health Service (HHSN 268200536179C, HHSN268200536165C, HHSN268200536176C)
  • National Heart, Lung, and Blood Institute (N01 HR056166, N01 HR056167, N01 HR056165, N01 HR056169, N01 HR056172, N01 HR056171, N01 HR056168, N01 HR056175, N01 HR056170, N01 HR056173, N01 HR056176, N01 HR056179, N01 HR056174)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
acute lung injury, omega-3 fatty acids, docosahexaenoic acid, eicosapentaenoic acid, gamma-linolenic acid, antioxidants, enteral nutrition, dietary supplementation, ventilator-free days, mechanical ventilation, organ failure, mortality, acute respiratory distress syndrome, systemic inflammatory response, futility, diarrhea
MeSH terms
Adult, Aged, Antioxidants, Docosahexaenoic Acids, Double-Blind Method, Drug Therapy, Combination, Enteral Nutrition, Female, Humans, Inflammation, Intensive Care Units, Male, Middle Aged, Pneumonia, Eicosapentaenoic Acid, Ventilator Weaning, Biomarkers, Survival Analysis, Treatment Outcome, gamma-Linolenic Acid, Sepsis, Dietary Supplements, Acute Lung Injury

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