What are the effects of anti-inflammatory and anti-oxidative stress therapies?

From the Guidelines

The use of anti-inflammatory and anti-oxidative stress therapies, such as omega-3 fatty acids, is strongly recommended for critical care patients due to their potential to improve patient outcomes by regulating inflammation and oxidative stress. When considering the effects of anti-inflammatory and anti-oxidative stress therapies, it is essential to focus on the most recent and highest quality evidence available. According to a 2024 study published in Critical Care 1, the inclusion of fish oil in intravenous lipid emulsions (ILEs) is associated with meaningful clinical benefits without signals of harm, based on a strong biological rationale and current clinical evidence.

Key Recommendations

• The use of omega-3 polyunsaturated fatty acids (PUFAs) as part of parenteral nutrition (PN) is supported due to their potential anti-inflammatory effects.
• Decisions concerning ILE choice should be made based on current evidence, addressing clinical requirements for guidance.
• A future of individualized ICU care is envisioned, yielding better clinical outcomes, which will require the greater use of intelligent study designs incorporating the use of biomarkers of omega-3 derivatives, inflammatory-resolving processes, and/or muscle protein breakdown.

Rationale

The regulation of inflammation and oxidative stress can improve patient outcomes in critical illness, and omega-3 PUFAs have been used as part of PN owing to their potential anti-inflammatory effects. The international lipids in PN Summit participants agreed that the inclusion of fish oil in ILEs is associated with meaningful clinical benefits without signals of harm, based on a strong biological rationale and current clinical evidence 1.

Clinical Implications

The use of anti-inflammatory and anti-oxidative stress therapies, such as omega-3 fatty acids, has the potential to improve patient outcomes in critical care settings. By incorporating these therapies into treatment plans, healthcare providers can help regulate inflammation and oxidative stress, ultimately leading to better clinical outcomes. As stated in the 2024 study published in Critical Care, the inclusion of fish oil in ILEs is a recommended approach for critical care patients 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli. The effects of anti-inflammatory therapies, such as corticosteroids, include reducing inflammation in various organ systems. However, there is no direct information on anti-oxidative stress therapies in the provided drug labels 2 2.

From the Research

Effects of Anti-Inflammatory and Anti-Oxidative Stress Therapies

• The effects of anti-inflammatory and anti-oxidative stress therapies have been studied in various research papers 3, 4, 5, 6, 7.
• These therapies have been found to have beneficial effects on human health, including reducing the risk of chronic non-communicable diseases such as cardiovascular diseases (CVDs) 3.
• Omega-3 polyunsaturated fatty acids (PUFAs), in particular, have been shown to have anti-inflammatory and anti-oxidative effects, and may be beneficial in reducing the incidence of CVDs 3, 4.
• Co-supplementation with omega-3 fatty acids and vitamin E has been found to decrease hs-CRP concentrations and increase total antioxidant capacity (TAC) and nitric oxide levels (NO) 4.
• Other dietary constituents with anti-inflammatory and antioxidant capacity include vitamin C, vitamin E, phytochemicals such as carotenoids and polyphenols, and dietary fiber 6.
• Flavonoids, found in foods such as cocoa and olive oil, have also been shown to have antioxidant and anti-inflammatory effects, and may be beneficial in reducing oxidative stress and inflammation in adults at risk of CVD 7.

Mechanisms of Action

• The mechanisms of action of these therapies involve regulating the antioxidant signaling pathway and modulating inflammatory processes 3.
• Omega-3 PUFAs, for example, have been shown to influence hepatic lipid metabolism and physiological responses of other organs, including the heart 3.
• Vitamin D has been found to interact with cell entry receptors (angiotensin converting enzyme 2), ACE2, and may perturb viral cellular infection 6.
• Dietary fiber, fermented by the gut microbiota into short-chain fatty acids, has been shown to produce anti-inflammatory effects 6.

Benefits and Applications

• The benefits of these therapies include reducing the risk of CVDs, improving muscle and cognitive performance, and regulating platelet homeostasis and lowering the risk of thrombosis 3, 4.
• These therapies may also be beneficial in reducing oxidative stress and inflammation in adults at risk of CVD, and may have applications in the prevention and treatment of COVID-19 6, 7.