Written by Tatjana Djakovic, Staff Writer. A three-month supplementation with different fatty acid combinations demonstrated that increased dietary DHA decreased inflammatory markers and markers of infection while increased dietary arachidonic acid (AA) decreased FENO and nNO in the participating subjects with cystic fibrosis.
Cystic fibrosis (CF) is a multi-organ genetic disorder that is characterized by decreased lung function, frequent infections and digestive issues 1. Impaired fatty acid metabolism, chronic inflammation and infections in the airways, lead to frequent hospitalizations and diminished lung function.
Patients with CF have an impaired balance of fatty acid metabolism 2 with increased levels of n-6 arachidonic acid (AA) associated with increased inflammation 3, and decreased levels of n-3 docosahexaenoic acid (DHA) associated with decreased inflammation 2, the reason for which is not known but is associated with the genetic defect causing CF.
Nitric oxide (NO) has been shown to have antimicrobial properties that inhibit bacterial adhesion to epithelial cells and is of benefit to those with P aeruginosa 4. An association between lipid imbalances in patients with CF and levels of nitric acid were recently discovered 5 suggesting that these lipid imbalances may affect levels of NO in CF patients. Therefore, treatments that increase NO production could potentially have a therapeutic effect on airway infections in patients with CF.
The objective of this study was to examine the influences of supplementing CF patients with different blends of n-3 or n-6 PUFAs. The primary outcome was the effect of the fatty acids on exhaled NO (FENO) and low nasal NO (nNO): the secondary outcome was their effect on several inflammatory markers.
In this randomized, double blind placebo-controlled study 6, 43 Swedish CF patients (ages 7 to 41), and with severe mutations, supplemented with 3 different fatty acid blends in a dose of 50 mg per kg of body) per day for 3 months. Group A’s blend was high in n-3 DHA; Group B (placebo) was high in saturated fatty acids; and Group C was high in AA.
FENO, nNO, serum phospholipid concentrations of FA, and biomarkers of inflammation were measured before and after 3 months of supplementation. Each patient maintained an extensive food frequency questionnaire (FFG) and had regular monthly follow ups. After 3 months the following clinical and biochemical results were observed:
- Thirty five students completed the study in clinically stable condition. Significant weight gain occurred in groups A (DHA) and Group B (saturated fats), and when compared to baseline, the mean value of weight gain was significant (P=0.001 and P=0.004 respectively).
- The serum phospholipid FA pattern changed significantly in all 3 groups.
- No change occurred in FENO and nNO relative to the increase of n-3 fatty acids; however, an increase of n-6 (arachidonic acid) in Group C was associated with a decrease of exhaled nitric oxide (nNO) by 23% (from 42.7 ppb at baseline to 32.7 ppb at 3 months (P=0.003).
- In group A, n-3 (DHA) decreased the inflammatory markers as well as markers indicative of infections (IL-8 decreased by 47% from 17.5 pg/mL to 9.3 pg/mL (P=0.0017) and erythrocyte sedimentation rate decreased by 14% from 7 mm/hour to 6 mm/hour (P= 0.05).
- There was no change in lung function in any of the three groups.
This study is important in that it shows how different mixtures of dietary fatty acids influenced serum fatty acids in CF patients and NO levels in their airways which, in turn, may influence the inflammation and infections seen in CF patients. This study found that, while n-3 fatty acids helped decrease inflammation, lipid abnormalities, so characteristic of CF, influence the inflammatory response in the airways of those with CF and that increased AA concentrations decrease FENO and nNO. Therefore an optimal blend of fatty acids might potentially “influence both airway NO with possible microbial effect and the systemic lipid abnormality.”
The study also showed that there was no change in lung function or antibiotic use which could have been due to the relatively short time of the study. For a future study, it will be beneficial to show how different fatty acid blends affects CF patients for a longer period and with a greater number of patients.
Source: Keen, Christina, Anna-Carin Olin, Susanne Eriksson, Anna Ekman, Anders Lindblad, Samar Basu, Christopher Beermann, and Birgitta Strandvik. “Supplementation with fatty acids influences the airway nitric oxide and inflammatory markers in patients with cystic fibrosis.” Journal of pediatric gastroenterology and nutrition 50, no. 5 (2010): 537-544.
© 2010 by Lippincott Williams & Wilkins
Posted July 31, 2017.
References:
- Farrell PM, White TB. Introduction to “Cystic Fibrosis Foundation Consensus Guidelines for Diagnosis of Cystic Fibrosis”. The Journal of pediatrics. 2017;181:S1-S3.
- Carlstedt-Duke J, Brönnegård M, Strandvik B. Pathological regulation of arachidonic acid release in cystic fibrosis: the putative basic defect. Proceedings of the National Academy of Sciences. 1986;83(23):9202-9206.
- Yaqoob P. Fatty acids as gatekeepers of immune cell regulation. Trends in immunology. 2003;24(12):639-645.
- Solymar L, Aronsson P, Bake B, Bjure J. Nitrogen single breath test, flow-volume curves and spirometry in healthy children, 7-18 years of age. European journal of respiratory diseases. 1980;61(5):275-286.
- Keen C, Olin A-C, Edentoft A, Gronowitz E, Strandvik B. Airway nitric oxide in patients with cystic fibrosis is associated with pancreatic function, Pseudomonas infection, and polyunsaturated fatty acids. Chest. 2007;131(6):1857-1864.
- Keen C, Olin A-C, Eriksson S, et al. Supplementation with fatty acids influences the airway nitric oxide and inflammatory markers in patients with cystic fibrosis. Journal of pediatric gastroenterology and nutrition. 2010;50(5):537-544.
