The 2008 ESPEN Sir David Cuthbertson Lecture: Fatty acids and inflammation - from the membrane to the nucleus and from the laboratory bench to the clinic

Many chronic conditions involve excessive inflammation that is damaging to host tissues. Excessive orinappropriate inflammation and immunosuppression are components of the response to surgery,trauma, injury and infection in some individuals and these can lead, progressively, to sepsis and septicshock. Hyperinflammation is characterised by the production of inflammatory cytokines, eicosanoids andother inflammatory mediators, while the immunosuppression is characterised by impairment of antigenpresentation and of certain T cell responses. N-6 fatty acids may contribute to the hyperinflammed andimmunosuppressed states. N-3 fatty acids from fish oil decrease the production of inflammatory cytokinesand eicosanoids. They act both directly (by replacing arachidonic acid as an eicosanoid precursor)and indirectly (by altering the expression of inflammatory genes through effects on transcription factoractivation). Thus, these fatty acids are potentially useful anti-inflammatory agents and may be of benefitin patients with chronic inflammatory diseases or at risk of hyperinflammation and sepsis. An emergingapplication of n-3 fatty acids is in surgical or critically ill patients where they may be added to parenteralor enteral formulas. Studies to date are suggestive of clinical benefits from these approaches, althoughmore robust data are needed especially in critically ill patients