ABSTRACT
BACKGROUND/OBJECTIVES: Randomised controlled trials (RCTs) evaluating the effect of fish oil supplementation on postoperative atrial fibrillation (POAF) following cardiac surgery have produced mixed results. In this study, we examined relationships between levels of red blood cell (RBC) n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) and the incidence of POAF. SUBJECTS/METHODS: We used combined data (n=355) from RCTs conducted in Australia and Iceland. The primary end point was defined as POAF lasting >10 min in the first 6 days following surgery. The odds ratios (ORs) for POAF were compared between quintiles of preoperative RBC n-3 LC-PUFA levels by multivariable logistic regression. RESULTS: Subjects with RBC docosahexaenoic acid (DHA) in the fourth quintile, comprising a RBC DHA range of 7.0-7.9%, had the lowest incidence of POAF. Subjects in the lowest and highest quintiles had significantly higher risk of developing POAF compared with those in the fourth quintile (OR=2.36: 95% CI; 1.07-5.24 and OR=2.45: 95% CI; 1.16-5.17, respectively). There was no association between RBC eicosapentaenoic acid levels and POAF incidence. CONCLUSIONS: The results suggest a 'U-shaped' relationship between RBC DHA levels and POAF incidence. The possibility of increased risk of POAF at high levels of DHA suggests an upper limit for n-3 LC-PUFAs in certain conditions.
Subject(s)
Atrial Fibrillation/blood , Atrial Fibrillation/epidemiology , Cardiac Surgical Procedures , Docosahexaenoic Acids/adverse effects , Docosahexaenoic Acids/blood , Adolescent , Adult , Australia/epidemiology , Dietary Supplements , Docosahexaenoic Acids/administration & dosage , Eicosapentaenoic Acid/administration & dosage , Eicosapentaenoic Acid/adverse effects , Eicosapentaenoic Acid/blood , Female , Fish Oils/administration & dosage , Humans , Iceland/epidemiology , Incidence , Logistic Models , Male , Multivariate Analysis , Odds Ratio , Postoperative Care , Randomized Controlled Trials as Topic , Young AdultABSTRACT
BACKGROUND: Open heart surgery is associated with a systemic inflammatory response. The n-3 long-chain polyunsaturated fatty acids (LC-PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the n-6 LC-PUFA arachidonic acid (AA) may contribute to modulation of the inflammatory response. OBJECTIVE: We investigated whether the preoperative levels of EPA, DHA and AA in plasma phospholipids (PL) and red blood cell (RBC) membrane lipids in patients (n=168) undergoing open heart surgery were associated with changes in the plasma concentration of selected inflammatory mediators in the immediate postoperative period. RESULTS AND CONCLUSIONS: The postoperative concentration of TNF-ß was lower (P<0.05) and those of hs-CRP, IL-6, IL-8, IL-18 and IL-10 higher (P<0.05) than the respective preoperative concentrations. We observed that the preoperative levels of EPA and AA in plasma PL and RBC membrane lipids were associated with changes in the concentration of pro-inflammatory and anti-inflammatory mediators, suggesting a complex role in the postoperative inflammatory process.
Subject(s)
Arachidonic Acid/blood , Cell Membrane/metabolism , Chemokines/blood , Docosahexaenoic Acids/blood , Eicosapentaenoic Acid/blood , Erythrocytes/metabolism , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/prevention & control , Cardiac Surgical Procedures , Double-Blind Method , Fatty Acids, Omega-3/administration & dosage , Female , Heart Diseases/blood , Heart Diseases/immunology , Heart Diseases/surgery , Humans , Male , Middle Aged , Phospholipids/blood , Postoperative Complications/prevention & control , Postoperative Period , Preoperative Period , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
BACKGROUND: Maternal socioeconomic status is known to influence perinatal outcome. Antenatal care is free of charge in Sweden and all pregnant women are followed according to a standardized protocol of surveillance. The city of Malmö in southern Sweden is divided into 124 townships with great differences in socioeconomic standard. The aim of this study was to evaluate perinatal outcome according to the address of residence of the mothers within the city of Malmö. METHODS: Perinatal outcome of 7056 pregnancies was related to three socioeconomic characteristics of the 124 townships in Malmö: percentage of immigrants, percentage of inhabitants on social welfare and the median income. RESULTS: Maternal age was lower, number of abortions and parity were higher in low income areas. Perinatal complications were also more frequent, including low birthweight, small-for-gestational age newborns, maternal anemia, infections, and low 1- and 5-minute Apgar scores. Premature rupture of membranes was associated with low income areas. Symphysiolysis and pre-eclampsia were more frequent in the high income areas. CONCLUSION: Although maternity care is provided free of charge, perinatal complications were more frequent in areas of lower socioeconomic status. In order to improve perinatal outcome, antenatal surveillance should be intensified in low class socioeconomic areas.
