Association between enteral essential fatty acids and plasma phospholipid essential fatty acids related immune response in critically ill adults with COVID-19: A prospective cohort study.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a complicated disease with widely varying outcomes. Up to 20% of unvaccinated, hospitalized patients infected with COVID-19 may die during the initial three weeks. Our research shows that COVID-19 infection results in rapid, remarkable change in the balance between essential fatty acid constituents of plasma phospholipids that are substrates for synthesis of signals that regulate immunity, inflammation, and thrombosis.

Methods: We assessed if enteral feeding of EPA (eicosapentaenoic acid, 20:5n-3) and DHA (docosahexaenoic acid; 22:6n-3) normalizes remodeling of plasma phospholipid essential fatty acid content caused by COVID-19 viral infection and modifies immune response. Blood samples were taken on day 1 of hospital admission. From the patient record, patients were categorized into two groups based on enteral formula fed by day 5 after admission: enteral feeds that contained EPA + DHA or not. These two groups were compared at 1 week and 3 weeks postadmission for plasma phospholipid fatty acids, cytokines, and chemokines.

Results: Feeding EPA + DHA increases plasma content of these fatty acids in specific species of plasma phosphatidylcholine. Change in essential fatty acid status was associated with downregulation of the inflammatory signal macrophage inflammatory protein-1β and increase in interleukin-17, monocyte chemoattractant protein (MCP)-4, macrophage-derived chemokine and thymus- and activation-regulated chemokine signals. Plasma arachidonic acid content correlated with chemoattractant protein MCP-4 during early stages of infection.

Conclusion: We conclude that feeding COVID-19 infected intensive care unit patients enteral formulas containing EPA and DHA may alter response to infection; however, the potential benefit to clinical outcome is not clear.