Effect of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition on inflammatory and immune function in postoperative patients with gastrointestinal malignancy: A meta-analysis of randomized control trials in China

BACKGROUND: : There are no consensus regarding the efficacy of omega-3polyunsaturated fatty acids (PUFAs) on inflammatory and immune function in postoperative patients with gastrointestinal malignancy. METHODS: The literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. RESULTS: Sixteen RCTs involving 1008 patients (506 in the omega-3 group, 502 in the control group) were enrolled into the analysis. The results of meta-analysis: the cell immunity: The proportions of CD3(+), CD4(+), CD4(+)/CD8(+) in the omega-3 group were significantly higher than those in the control group (CD3(+): WMD = 4.48; 95% CI, 3.34–5.62; P < .00001; I(2) = 0%; CD4(+): WMD = 5.55; 95% CI, 4.75–6.34; P < .00001; I(2) = 0%; CD4(+)/CD8(+): WMD = .28; 95% CI, 0.13–0.44; P = .0004; I(2) = 81%). In the humoral immunity: The levels of IgA, IgM and IgG in the omega-3 group were significantly higher than those in the control group (IgA: WMD = 0.31; 95% CI, 0.25–0.37; P < .00001; I(2) = 0%; IgM: WMD = 0.12; 95% CI, 0.06–1.81; P < .00001; I(2) = 0%; IgG: WMD = 1.19; 95% CI, 0.80–1.58; P < .00001; I(2) = 0%). The count of lymphocyte in the omega-3 group was significantly higher than that in the control group (WMD = 0.22; 95% CI, 0.12–0.33; P < .0001; I(2) = 40%). In the postoperative inflammatory cytokine: The levels of interleukin-6, tumor necrosis factor (TNF)-α and C-reactive protein in the omega-3 group were significantly lower than those in the control group (IL-6: WMD = −3.09; 95% CI, −3.91 to 2.27; P < .00001; I(2) = 45%; TNF-α: WMD = −1.65; 95% CI, −2.05 to 1.25; P < .00001; I(2) = 28%; CRP: WMD = −4.28; 95% CI, −5.26 to 3.30; P < .00001; I(2) = 37%). The rate of postoperative infective complications in the omega-3 group was significantly lower than that in the control group (OR = 0.36; 95% CI, 0.20–0.66; P = .0008; I(2) = 0%). CONCLUSION: This meta-kanalysis confirmed that early intervention with Omega -3 fatty acid emulsion in gastrointestinal cancer can not only improve the postoperative indicators of immune function, reduce inflammatory reaction, and improve the postoperative curative effect but also improve the immune suppression induced by conventional PN or tumor. Therefore, postoperative patients with gastrointestinal cancer should add omega-3 unsaturated fatty acids in their PN formula. Further high-quality RCTs are needed to verify its efficacy.