Improved antioxidant and fatty acid status of patients with cystic fibrosis after antioxidant supplementation is linked to improved lung function. Dietary supplementation with multiple micronutrients: no beneficial effects in pediatric cystic fibrosis patients. The clinical benefits of long-term supplementation with omega-3 fatty acids in cystic fibrosis patients - A pilot study. Oral absorption of omega-3 fatty acids in patients with cystic fibrosis who have pancreatic insufficiency and in healthy control subjects. Supplementation With Fatty Acids Influences the Airway Nitric Oxide and Inflammatory Markers in Patients With Cystic Fibrosis Fatty acid supplements improve respiratory, inflammatory and nutritional parameters in adults with cystic fibrosis. Fatty acids composition of plasma phospholipids and triglycerides in children with cystic fibrosis. The effect of dietary supplementation with an olive and soybean oils mixture. The absorption and effect of dietary supplementation with omega-3 fatty acids on serum leukotriene B4 in patients with cystic fibrosis. A randomized placebo-controlled study on high-dose oral algal docosahexaenoic acid supplementation in children with cystic fibrosis. Effect of an organized lipid matrix on lipid absorption and clinical outcomes in patients with cystic fibrosis. Short-term nutritional supplementation during management of pulmonary exacerbations in cystic fibrosis: a controlled study, including effects of protein turnover. Effects of an Antioxidant‐enriched Multivitamin in Cystic Fibrosis. A Randomized, Controlled, Multicenter Clinical Trial Nutritional supplement therapy improves oxidative stress, immune response, pulmonary function, and quality of life in allergic asthma patients: an open-label pilot study. Bioavailability and safety of a high dose of docosahexaenoic acid triacylglycerol of algal origin in cystic fibrosis patients: a randomized, controlled study. [Antioxidant micronutrients and chronic degenerative pathology: the role of complementary nutritional doses]. Biological effects of a dietary omega-3 polyunsaturated fatty acids supplementation in cystic fibrosis patients: a randomized, crossover placebo-controlled trial. Oral DHA supplementation in DeltaF508 homozygous cystic fibrosis patients.
BACKGROUND Oxidative stress , as measured by 8-iso-prostagl and in F(2)(alpha ) ( 8-iso-PGF(2)(alpha ) ) , and depleted antioxidant defenses were shown in stable cystic fibrosis ( CF ) patients . The plasma fatty acid status of CF patients was linked to oxidative stress after respiratory exacerbations . OBJECTIVE We examined changes in plasma 8-iso-PGF(2)(alpha ) , antioxidant defenses , plasma fatty acid status , and clinical markers result ing from short-term antioxidant supplementation . DESIGN Forty-six CF patients were r and omly assigned to either group A [ low dose of supplement ( 10 mg vitamin E and 500 micro g vitamin A ) ] or group B [ high dose of supplement ( 200 mg vitamin E , 300 mg vitamin C , 25 mg beta-carotene , 90 micro g Se , and 500 micro g vitamin A ) ] . Plasma concentrations of 8-iso-PGF(2)(alpha ) , vitamins E and C , beta-carotene , zinc , selenium , and copper ; plasma fatty acid composition ; erythrocyte glutathione peroxidase ( EC 1.11.1.9 ) and superoxide dismutase ( EC 1.15.1.1 ) activities ; lung function ; and dietary intake were measured before and after 8 wk of supplementation . RESULTS Antioxidant defenses in group B improved , whereas those in group A did not : in groups B and A , the mean ( + /- SEM ) changes ( Delta ) in vitamin E were 10.6 + /- 1.5 and -1.9 + /- 0.9 micro mol/L , respectively ( P < 0.001 ) , (Delta)beta-carotene were 0.1 + /- 0.04 and -0.01 + /- 0.02 micro mol/L , respectively ( P = 0.007 ) , (Delta)selenium were 0.51 + /- 0.10 and -0.09 + /- 0.04 micro mol/L , respectively ( P < 0.001 ) , and (Delta)glutathione peroxidase activity were 1.3 + /- 0.3 and -0.3 + /- 0.6 U/g hemoglobin , respectively ( P = 0.016 ) . There were no significant differences between the groups in Delta8-iso-PGF(2)(alpha ) , (Delta)vitamin C , (Delta)fatty acid composition , (Delta)superoxide dismutase activity , (Delta)lung function , or (Delta)white cell count . Within group B , (Delta)beta-carotene correlated with (Delta)percentage of forced vital capacity ( r = 0.586 , P = 0.005 ) , (Delta)selenium correlated with (Delta)percentage of forced expiratory volume in 1 s ( r = 0.440 , P = 0.046 ) , and (Delta)plasma fatty acid concentrations correlated with (Delta)percentage of forced expiratory volume in 1 s ( r = 0.583 , P = 0.006 ) and Delta8-iso-PGF(2)(alpha ) ( r = 0.538 , P = 0.010 ) . CONCLUSIONS Whereas increased beta-carotene , selenium , and fatty acid concentrations are linked to improved lung function , increased plasma fatty acid concentrations are linked to oxidative stress . If oxidative stress is deemed to be important to the clinical outcome of CF patients , means of reducing oxidative stress while maintaining a high-fat , high-energy diet must be investigated BACKGROUND Cystic fibrosis ( CF ) patients are subjected to increased oxidative stress due to chronic pulmonary inflammation and recurrent infections . Additionally , these patients have diminished skeletal muscle performance and exercise capacity . We hypothesize that a mixture of multiple micronutrients could have beneficial effects on pulmonary function and muscle performance . METHODS A double-blind , r and omized , placebo controlled , cross-over trial with a mixture of multiple micronutrients ( ML1 ) was performed in 22 CF patients ( 12.9+/-2.5 yrs ) with predominantly mild lung disease .  Anthropometric measures , pulmonary function , exercise performance by bicycle ergometry , muscular strength and vitamins A and E were determined . RESULTS Analysis was performed using the paired Student t-test comparing the change in each parameter during ML1 and placebo . Plasma vitamin E and A levels increased during ML1 when compared to placebo . However , no significant difference between the effect of the ML1 or placebo was observed neither for FEV1 , FVC , anthropometry , nor for the parameters for muscle performance . CONCLUSIONS The micronutrient mixture was not superior to placebo with respect to changes in pulmonary function or muscle performance in pediatric CF patients , despite a significant increase in plasma vitamin E concentrations Effectiveness of omega-3 supplementation in cystic fibrosis ( CF ) remains controversial . This study sought to evaluate clinical status , exercise tolerance , inflammatory parameters , and erythrocyte fatty acid profile after 1 year of oral omega-3 supplementation in CF patients . Fifteen ΔF508-homozygous patients undergoing chronic azithromycin  were r and omized to receive omega-3 fish oil supplementation at a dose of 60mg/Kg/day or placebo . In comparison with the previous year , in the supplemented group , the number of pulmonary exacerbations decreased at 12 months ( 1.7 vs. 3.0 , p<0.01 ) , as did the duration of antibiotic therapy ( 26.5 days vs. 60.0 days , p<0.025 ) . Supplementation significantly increased the levels of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) as early as <3 months of administration , with concomitant decreases in arachidonic acid ( AA ) levels . This pilot study suggests that long-term omega-3 supplementation offers several clinical benefits as to the number of exacerbations and duration of antibiotic therapy in CF patients Dietary supplementation with fish oils high in the omega-3 fatty acids , eicosapentaenoic acid and docosahexaenoic acid , may have an antiinflammatory effect . We determined whether patients with cystic fibrosis ( CF ) could incorporate omega-3 fatty acids into their plasma and cell membrane phospholipids without adverse effects . In this double-blind study , 12 patients with pancreatic insufficiency who have CF ( mean age , 12.2 + /- 5.4 ( SD ) years ) and 13 subjects without CF ( mean age , 13.4 + /- 6.3 ( SD ) years ) were r and omly assigned to ingest 8 gm daily of either encapsulated fish oil ( 3.2 gm of eicosapentaenoic acid and 2.2 gm of docosahexaenoic acid daily ) or olive oil ethyl esters for 6 weeks . Two of seven and two of five patients with CF who received fish and olive oils , respectively , and one of eight and none of five subjects without CF discontinued taking the capsules before 6 weeks because of eructation or diarrhea . Significant incorporation of omega-3 fatty acids into plasma and erythrocyte membrane phospholipids was observed in subjects with and those without CF r and omly assigned to the fish oil treatment . For example , in subjects r and omly assigned to receive fish oil , the eicosapentaenoic acid/arachidonic acid ratio in plasma increased 9.8-fold , from 0.04 + /- 0.02 ( mean + /- SEM ) to 0.39 + /- 0.11 ( p = 0.02 ) , in the patients with CF ( n = 7 ) and 23.0-fold , from 0.04 + /- 0.01 to 0.92 + /- 0.17 ( p = 0.001 ) , in the subjects without CF ( n = 8) who received fish oil ( p = 0.02 , patients with CF vs subjects without CF at 6 weeks ) . No clinical ly or statistically significant changes from baseline were observed in platelet aggregation or levels of vitamin E or A in subjects who received fish oil . Future studies are indicated to determine whether omega-3 fatty acid enrichment provides a clinical ly beneficial antiinflammatory effect in patients with CF Objectives : To obtain a balance in the fatty acid ( FA ) metabolism is important for the inflammatory response and of special importance in cystic fibrosis ( CF ) , which is characterized by impaired FA metabolism , chronic inflammation , and infection in the airways . Nitric oxide ( NO ) has antimicrobial properties and low nasal ( nNO ) and exhaled NO ( FENO ) , commonly reported in CF that may affect bacterial status . The present study investigates the effect of different FA blends on nNO and FENO and immunological markers in patients with CF . Patients and Methods : Forty-three patients with CF and “ severe ” mutations were consecutively enrolled in a r and omized double-blind placebo-controlled study with 3 FA blends containing mainly n-3 or n-6 FA or saturated FA acting as placebo .  FENO , nNO , serum phospholipid concentrations of FA , and biomarkers of inflammation were measured before and after 3 months of supplementation . Results : Thirty-five patients in clinical ly stable condition completed the study . The serum phospholipid FA pattern changed significantly in all 3 groups . An increase of the n-6 FA , arachidonic acid , was associated with a decrease of FENO and nNO . The inflammatory biomarkers , erythrocyte sedimentation rate , and interleukin-8 decreased after supplementation with n-3 FA and erythrocyte sedimentation rate increased after supplementation with n-6 FA . Conclusions : This small pilot study indicated that the composition of dietary n-3 and n-6 FA influenced the inflammatory markers in CF . FENO and nNO were influenced by changes in the arachidonic acid concentration , supporting previous studies suggesting that both the lipid abnormality and the colonization with Pseudomonas influenced NO in the airways INTRODUCTION AND AIMS Chronic inflammation plays a major role in lung deterioration in cystic fibrosis ( CF ) patients and anti-inflammatory strategies have beneficial effects . To study the changes seen after a one-year course of low-dose dietary supplements with a mixture of fatty acids in adult patients with CF in chronic inflammation , pulmonary status ( lung function , respiratory exacerbations and antibiotic consumption ) , quality of life and anthropometric parameters . PATIENTS AND METHOD Seventeen adult subjects with CF received 324 mg of eicosapentaenoic , 216 mg of docosahexaenoic , 480 mg of linoleic and 258 mg of gammalinolenic acid daily . We assessed inflammation markers , spirometry parameters , number and severity of respiratory exacerbations , antibiotic consumption , quality of life ( St George 's QoL ) , anthropometric parameters and serum phospholipid fatty acid composition . RESULTS At the end of the treatment period TNF alpha levels fell significantly and its soluble receptors ( 60 and 80 ) rose significantly . Levels of IgG and IgM anti-oxidized LDL antibodies fell significantly . Spirometry improved significantly . Annual respiratory exacerbations and days of antibiotic treatment fell significantly . The improvement in QoL was not significant . Serum levels of docosahexaenoic , total omega-3 and linoleic acid rose significantly and more favourable profiles were seen in monoenoic acids , arachidonic acid and the arachidonic/docosahexaenoic ratio . The fat-free mass and h and grip dynamometry improved significantly . CONCLUSIONS Low-dose supplements of n-3 and gammalinolenic fatty acids over a long period ( one year ) appears to improve pulmonary status ( lung function , respiratory exacerbations and antibiotic consumption ) , inflammatory and anthropometric parameters in adults with CF Cystic fibrosis ( CF ) is characterized by abnormal levels of essential fatty acids ( EFA ) in plasma phospholipids . The reduced availability of EFA has been reported to alter patterns of circulating and tissue esterified acids and may determine profound changes in membrane fluidity and cell signaling mechanisms . In the current study , the results of a new strategy aim ed at the realization of a practical , low cost integrator , for daily use in the dietary management of FC subjects , are reported . We investigated the plasma phospholipids and triglycerides fatty acids composition of CF patients subjected to a dietary supplement constituted of a mixture of 50 % extra virgin olive oil and 50 % soybean oil  and studied the clinical effects of this supplementation . The study included fourteen young subjects , aged between 6 and 15 years , affected by cystic fibrosis , with pancreatic insufficiency and heterozygotes or homozygotes for the delta F508 mutation . The subjects were matched by age and r and omly assigned to either an oil mixture supplemented ( OM ) group ( n = 7 ) , or to a control ( C ) group ( n = 7 ) . In contrast to the control group , the patients with supplemented diet achieved significant increases of the relative amount of C18:1 in the triglycerides as well as a significant decrease in saturated fatty acids ( C 16:0 , C 17:0 , C 18:0 , C 22:0 ) . Moreover , the ratio between LA acid and AA significantly increased in the triglycerides of the OM group . In the phospholipids of the OM group , the relative amount of C 18:1 and of palmitic acid increased significantly whereas the relative amount of the most important polyunsaturated fatty acids ( PUFA ) decreased . These results show that oleic acid can be absorbed and incorporated into the plasma triglycerides of CF patients receiving pancreatic enzymes , whereas poor incorporation of LA occurs . Despite the reduction in the relative amounts of phospholipid PUFA , the supplemented subjects did not reported adverse effects There were no significant differences between groups in the clinical indexes recorded ( height , weight , BMI , Schwachman-Kulczycki score and FEV 1s ) . The results of this study showed that the supplementation with a mixture of extravirgin olive and soybean oil was safe in seven CF patients treated during a 2-months period and no negative clinical effects were evident . However , further clinical trials will be necessary in order to better evaluate the consequence of the observed changes in plasma fatty acids composition in a longer testing period The substitution of omega-3 ( n-3 ) fatty acids for omega-6 ( n-6 ) fatty acids generates eicosanoids with diminished inflammatory effects . As the lungs of patients with cystic fibrosis ( CF ) are in a state of chronic inflammation in which increased amounts of eicosanoids are found , n-3 supplementation may reduce this level of inflammation and result in clinical improvement . The absorption and clinical effects of n-3 vs. n-6 fatty acids in CF were measured in a prospect i ve , r and omized , double-blind , crossover study in which 14 patients with CF ( age : 6 - 16 years , mean 10.5 years ; baseline Shwachman-Brasfield scores : 41 - 88 , mean 76.7 ) received 6 weeks of n-3 ethyl ester concentrate from menhaden oil ( 100 - 131 mg/kg/day , mean 112.8 ) or n-6 fatty acids from safflower oil ( 102 - 132 mg/kg/day , mean 113.3 ) , followed by a washout period of 6 weeks , and then 6 weeks of the other supplement . Analysis by gas chromatography showed that n-3 supplementation result ed in increased eicosapentaenoic acid ( 20:5n-3 ) in platelet phospholipids , from 0.14 to 2.16 % , P < 0.05 and in increased docosahexaenoic acid ( 22:6n-3 ) , from 1.33 to 3.72 % , P < 0.05 . Clinical effects were evaluated at weeks 0 , 6 , 12 , and 18 , and analyzed for differences among the n-3 , n-6 , and washout periods . No adverse effects were reported or observed . No statistically significant differences were found ( ANOVA , P > 0.05 ) in Shwachman-Brasfield scores , sweat test , weight change , or forced expiratory volume and flow ( FEV1 , FEF25 - 75 % , and FVC ) percentiles . Tumor necrosis factor was not measurable in any serum sample . Serum leukotriene B4 ( LTB4 ) levels were significantly reduced by n-3 fatty acids , mean reduction ( -177 pg/mL ) compared to n-6 fatty acids ( + 63 pg/mL ) P < 0.05 . These results show that both n-3 fatty acids are absorbed and incorporated into platelet phospholipids in patients with CF and reduced serum LTB4 . No significant clinical differences or adverse effects were found Low plasma concentrations of docosahexaenoic acid ( DHA ) are reported in unsupplemented cystic fibrosis ( CF ) patients . Forty-one CF patients aged from 6 to 12 years were r and omized to receive high-dose DHA ( 100 mg/kg/day in the first month and 1 g per day thereafter through a 12-month supplementation ) or placebo ( germ oil ) . Primary outcome was percentage change in plasma AA : DHA ratio . Secondary outcomes were changes in the number of pulmonary exacerbations compared to previous year , lung function , BMI , skinfold thicknesses , and body composition assessed by DXA and in serum concentrations of C-reactive protein , cytokines and vitamin ( α-tocopherol and retinol ) . Compared to the control group plasma AA : DHA ratio decreased in the intervention group after 6 months ( median percentage changes : -73 % in the intervention group vs. -10 % in the control group , P=0.001 ) . No differences were detected between groups for secondary outcomes . Despite a decrease of the AA/DHA ratio  , DHA supplementation for one year did not induce any significant biochemical and clinical improvement in CF patients OBJECTIVES To compare the absorption of a lysophosphatidylcholine , monoglyceride , and fatty acid matrix ( organized lipid matrix , OLM ) with that of a triacylglycerol (TG)-based fat meal in patients with cystic fibrosis ( CF ) . STUDY DESIGN Five adolescents with CF and 3 control patients were given fat meals supplemented with retinyl palmitate of either OLM or TG at a 2-week interval . In a clinical trial , 73 patients with CF were r and omly assigned to nutritional supplements containing either OLM or TG for a 1-year double-blind trial followed by a 6-month observation period . RESULTS The peak increases and areas under the curve for TG and retinyl palmitate after the fat meal were 10-fold higher after OLM than after the TG fat load and did not differ from values obtained in control patients . OLM led to better clinical outcomes in terms of energy intake from the diet , weight-for-age Z score , essential fatty acid status , vitamin E , and retinol binding protein . Height-for-age Z score and FEV(1 ) only reached statistical significance at the end of the 6-month observation period . CONCLUSIONS These results suggest that OLM is a readily absorbable source of fat and energy in CF and is an effective nutritional supplement Effects of nutritional supplements on minimizing weight loss and abnormalities of protein turnover during pulmonary exacerbations in cystic fibrosis ( CF ) were studied by controlled trial . Patients received pulmonary therapy and either st and ard diet ( n = 10 ) or adjunctive enteral supplements ( n = 12 ) . Initial protein turnover , measured by [15N]glycine kinetics , showed alterations of protein synthesis ( P Syn ) and catabolism ( P Cat ) , which correlated with the degree of underweight , and negligible net protein deposition ( P Dep ) . With treatment both groups had significant increases in mean body weight and forced expiratory volume in 1 s , expressed as percent predicted value for height ( FEV1 ) by 3 wk , but a significant correlation between initial underweight and subsequent weight gain was observed only in supplemented patients . Mean P Syn and P Dep increased significantly ( p less than 0.001 ) only in the supplemented group . Pulmonary exacerbations in CF have important adverse effects on body-protein metabolism , similar to changes in protein-energy malnutrition and infection . These effects are reversed by short-term nutritional support . Strategic nutritional intervention should thus be considered in management , especially in malnourished patients Rationale : Cystic fibrosis ( CF ) is characterized by dietary antioxidant deficiencies , which may contribute to an oxidant‐antioxidant imbalance and oxidative stress . Objectives : Evaluate the effects of an oral antioxidant‐enriched multivitamin supplement on antioxidant concentrations , markers of inflammation and oxidative stress , and clinical outcomes . Methods : In this investigator‐initiated , multicenter , r and omized , double‐blind , controlled trial , 73 pancreatic‐insufficient subjects with CF 10 years of age and older with an FEV1 between 40 % and 100 % predicted were r and omized to 16 weeks of an antioxidant‐enriched multivitamin or control multivitamin without antioxidant enrichment . Endpoints included systemic antioxidant concentrations , markers of inflammation and oxidative stress , clinical outcomes ( pulmonary exacerbations , anthropometric measures , pulmonary function ) , safety , and tolerability . Measurements and Main Results : Change in sputum myeloperoxidase concentration over 16 weeks , the primary efficacy endpoint , was not significantly different between the treated and control groups . Systemic antioxidant ( & bgr;‐carotene , coenzyme Q10 , & ggr;‐tocopherol , and lutein ) concentrations significantly increased in the antioxidant‐treated group ( P < 0.001 for each ) , whereas circulating calprotectin and myeloperoxidase decreased in the treated group compared with the control group at Week 4 . The treated group had a lower risk of first pulmonary exacerbation requiring antibiotics than the control group ( adjusted hazard ratio , 0.50 ; P = 0.04 ) . Lung function and growth endpoints did not differ between groups . Adverse events and tolerability were similar between groups . Conclusions : Antioxidant supplementation was safe and well tolerated , result ing in increased systemic antioxidant concentrations and modest reductions in systemic inflammation after 4 weeks . Antioxidant treatment was also associated with a lower risk of first pulmonary exacerbation . Clinical trial registered with www . clinical trials.gov ( NCT01859390 ) OBJECTIVE To examine the effects of nutritional supplement therapy on oxidant-antioxidant status , inflammation and immune system responses , pulmonary function , and health-related quality of life in patients with mild to moderate allergic asthma . METHODS Adult asthma patients ( n=30 ) received daily multiple nutrient supplements for two months . Age- and gender-matched healthy controls ( n=30 ) did not receive any supplements .  Enzymatic and non-enzymatic antioxidant status , malondialdehyde ( MDA ) , high-sensitivity C-reactive protein ( hs-CRP ) , immunoglobulin E ( IgE ) and T-lymphocyte subsets , pulmonary function indices , as well as scores for asthma control and quality of life , were assessed at baseline , at one month of treatment , and at two months of treatment , which was also the end of the study . RESULTS At baseline , asthma patients had significantly higher IgE , MDA , copper ( Cu ) , hs-CRP , and CD19 and CD4/CD8 lymphocyte ratios , and decreased selenium ( Se ) , zinc ( Zn ) , β-carotene , vitamins C and E , and catalase , glutathione peroxidase ( GPx ) and glutathione reductase ( GR ) activities compared to healthy controls ( p < 0.05 ) . During the study period , asthmatics showed non-significantly increased pulmonary function and a trend toward lower IgE levels , markedly reduced MDA , Cu , hs-CRP , and CD19 and CD4/CD8 ratios , and increases in levels of Se , Zn , β-carotene , vitamins C and E , and enzymatic antioxidant activities . Also , their asthma control and health-related quality -of-life scores increased significantly by the end of the study . CONCLUSION Our results indicate that nutritional supplement therapy may improve dysregulated oxidant and antioxidant status , inflammation and immune responses , pulmonary function , and health-related quality of life in patients with mild to moderate allergic asthma OBJECTIVE Several studies have reported omega-3 and omega-6 fatty acid imbalances in patients with cystic fibrosis ( CF ) . Whether these imbalances contribute to or are manifestations of the pathophysiology of CF is unknown . The study objective was to determine bioavailability , tissue accretion , and safety of a large dose of an algal source of docosahexaenoic acid ( DHA ) triacylglycerol and to observe effects on lung function in patients with CF . METHODS Twenty subjects with CF ( 8 to 20 y of age ) were r and omly assigned to receive algal oil providing 50 mg of DHA per kilogram per day ( 1 to 4.2 g of DHA per subject per day ) or placebo for 6 mo . Fatty acids , liver enzymes , and lipid soluble antioxidants were measured in blood at baseline and at 1 , 3 , and 6 mo . Rectal biopsy specimens were collected at baseline and at 3 mo for fatty acid analysis . Lung function , anthropometrics , and adverse experiences were monitored throughout the study . RESULTS Compared with placebo , DHA supplementation increased plasma , erythrocyte , and rectal DHA levels four- to five-fold ( P < 0.001 ) with concomitant decreases in blood arachidonic acid levels and the ratio of arachidonic acid to DHA . Supplementation was well tolerated , with no treatment-related changes in liver enzymes , growth , or antioxidant status . DHA supplementation had no detectable effect on lung function during the course of this study . CONCLUSIONS Algal DHA triacylglycerol oil is readily absorbed , well tolerated , and increases blood and tissue DHA levels in patients with CF . No adverse developments were associated with this large dose of DHA oil . Larger studies of longer duration are needed to determine whether DHA supplementation results in any clinical ly significant benefits in patients with CF Many epidemiologic studies based on an observational approach indicate that a high dietary intake or high blood concentrations of some antioxidant micronutrients are associated with a reduced risk of cardiovascular diseases and cancer at several common sites . Inconsistent results of intervention trials suggest that low risk of pathologies may be related to multiple nutrients consumed , at nutritional doses , and in combination . This hypothesis was the rationale of the SU.VI.MAX . study , a r and omized double-blind , placebo-controlled , primary -prevention trial design ed to test the efficacy of a daily supplementation with antioxidant vitamins and minerals at nutritional doses in reducing the major health problems in industrialized countries , and especially the main causes of premature death ( cancers and cardiovascular diseases ) BACKGROUND AND AIMS Various anti-inflammatory therapies , including dietary omega-3 polyunsaturated fatty acids ( PUFA ) supplementation , have been investigated in cystic fibrosis ( CF ) patients . To further explore this nutritional approach , biological effects of an omega-3 PUFA oral liquid supplementation were measured in 17 CF patients in a double-blind , r and omized , crossover without a washout period and placebo-controlled study . METHODS CF patients ( age : 18+/-9 year ; weight : 43+/-13 kg ) received a liquid dietary supplementation either enriched or not in omega-3 PUFA ( 390 - 1170 mg/day according to patient weight ) during two 6-month periods . RESULTS Increase in eicosapentaenoic acid was observed in neutrophil membrane following omega-3 PUFA dietary supplementation ( from 0.7+/-0.6 to 1.6+/-0.6 micromol% , P<0.01 ) . The leukotriene B(4 ) ( LTB(4))/leukotriene B(5 ) ( LTB(5 ) ) ratio was decreased ( from 72+/-27 to 24+/-7 , P<0.001 ) in CF patients taking omega-3 PUFA supplements . In contrast , omega-3 PUFA supplementation affected neither internalization of IL-8 receptors following IL-8 exposure , nor IL-8-induced neutrophil chemotaxis . CONCLUSION Our results show that omega-3 PUFA are incorporated in neutrophil membranes . The subsequent decrease in LTB(4)/LTB(5 ) ratio suggests that , in such conditions , neutrophils may produce less pro-inflammatory mediators from the acid arachidonic pathway . These data indicate that omega-3 PUFA intake may have anti-inflammatory effect that still need to be assessed by long-term studies following large groups of patients AIM The aim of this study was to evaluate whether the previously observed changes in the fatty acid profile , as a result of DHA supplementation , could be maintained during longer study trials and to observe its effect on the clinical outcome of cystic fibrosis ( CF ) patients . METHOD A year-long double-blind placebo-controlled study was performed in DeltaF508 homozygous CF patients above the age of 6 . Clinical data , including pulmonary function and number of infections , were collected . Blood for the determination of the fatty acid ( FA ) composition of serum phospholipid , vitamin E , liver enzymes , immunoglobulins , erythrocyte sedimentation rate and coagulation was drawn at the beginning and then every 6 months after the start of the study . RESULTS Seventeen patients were included ; one dropped out . The treatment group was supplemented with an algal DHA-rich oil and the control group with sunflower seed oil . There was no difference between the control and treatment groups for W/H% , caloric intake , FEV1 % and FVC% at the start of the study and after 1 year of supplements . The phospholipid FA composition did not change in the control group . The treatment group had a significant increase in DHA and eicosapentaenoic acid ( EPA ) concentration . A concomitant decrease of dihomo-gammalinolenic acid , arachidonic acid , 22:5 n-6 and Mead acid was observed . The laboratory results showed no changes in vitamin E level , liver enzymes , albumin , erythrocyte sedimentation rate and IgG concentration in either the placebo or the intervention group . CONCLUSION Although DHA-rich oil shifted the serum phospholipid FAs to a less pro-inflammatory profile , no conclusive clinical improvement could be observed so far
The benefits of antioxidants or DHA/EPA supplementation for CF , although observed in some studies , are not consistent enough to recommend routine use of these supplements .
Antioxidant micronutrients and essential fatty acids supplementation intake appears to have a protective effect in some diseases such as cardiovascular disease , cancer , and asthma .
The aim of this study was to perform a systematic review to evaluate the effects of these nutrients on nutritional and clinical outcomes of patients with cystic fibrosis ( CF ) .
This is a systematic review of r and omized clinical trials ( RCTs ) in CF .