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Aktuelle Ernährungsmedizin 2001; 26(1): 19-25
DOI: 10.1055/s-2001-11574
ORIGINALBEITRAG
Originalbeitrag
© Georg Thieme Verlag Stuttgart · New York

Nutritive Sepsismodulation - Was können wir von „Fettemulsionen der dritten Generation” erwarten?[1]

H. Grimm1 , K. Mayer2
  • 1Klinik für Allgemein- und Thoraxchirurgie der Justus-Liebig-Universität, Gießen
  • 2Medizinische Klinik II der Justus-Liebig-Universität, Gießen
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung

Immunonutrition verfolgt neben der Ernährung des Patienten auch eine symptomorientierte pharmakologische Intervention. Fischölhaltige Fettemulsionen der dritten Generation versprechen hyperinflammatorische Reaktionen des Organismus, wie z. B. die hyperdyname Phase der Sepsis, abzuschwächen. N-3-Fettsäuren beeinflussen das inflammatorische Reaktionspotenzial der Zelle von der Signaltransduktion bis zur Proteinexpression. Sie inhibieren in verschiedenen Interaktionsschritten die Induktion inflammatorischer Gene, die Zytokinfreisetzung und die Expression von Adhäsionsmolekülen. Durch Variation des Lipidmediatorspektrums werden Thrombozytenaggregation und granulozytäre Mobilisation reduziert, die mit Entzündungsprozessen korreliert sind. N-3-Fettsäuren schränken auch das lymphozytäre Reaktionspotenzial ein. In Kombination mit LCT, MCT und Olivenöl verfügen fischölhaltige Lipidemulsionen über einen balancierten Anteil an gesättigten und ungesättigten Fettsäuren mit einem ausgewogenen n-3/n-6-Verhältnis und einer guten ketogenen Potenz. Als artifizielle Lipidaggregate binden sie außerdem Endotoxin, den Vermittler der grammnegativen Sepsis.

Nutritional Sepsis Modulation - What Can be Expected From Third Generation Lipid Emulsions?

Immunonutrition combining nutrition and pharmacological intervention is gaining increasing importance in different clinical situations. Fish oil-based lipid emulsions of the third generation might prove to be advantageous in hyperinflammatory reactions such as the hyperdynamic phase of sepsis. N-3 fatty acids influence the inflammatory reaction potential of cells from signal transduction to protein expression. They inhibit inflammatory gene induction, cytokine release and adhesion molecule expression employing different interactive pathways. Due to the modified lipid mediator pattern inflammation-associated platelet aggregation and granulocyte mobilisation are markedly reduced. N-3 fatty acids also restrain lymphocyte functions. In combination with LCT, MCT and olive oil fish oil-based lipid emulsions contain a harmonic proportion of saturated and unsaturated fatty acids showing a balanced n-3/n-6 ratio and a good ketogenic potency. As artificial lipid aggregates they bind to endotoxin, the mediator of Gram-negative sepsis.

1 Nach einem Vortrag bei der 19. Gemeinsamen Jahrestagung der AKE/DGEM, 18. - 20. 5. 2000, in Wien.

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1 Nach einem Vortrag bei der 19. Gemeinsamen Jahrestagung der AKE/DGEM, 18. - 20. 5. 2000, in Wien.

Prof. Dr. Helmut Grimm

Klinik für Allgemein- und Thoraxchirurgie der Justus-Liebig-Universität Gießen

Rudolf-Buchheim-Straße 735385 Gießen

Email: helmut.grimm@chiru.med.uni-giessen.de

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