PMC:7589163 / 51973-56285 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7589163","sourcedb":"PMC","sourceid":"7589163","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7589163","text":"6.4. Omega-3 Fatty Acids Supplementation against Viral Infection\nAs mentioned above, the omega-3 fatty acids play a crucial role in the resolution of inflammation induced by infections, including in the respiratory tract [196]. Table 7 summarizes the main studies in which were investigated the link between the omega-3 fatty acids supplementation and respiratory infections/illness, and the potential role in improving the acute lung injury and acute respiratory distress syndrome (ARDS) [213,214,215,216,217,218,219,220,221,222,223].\nSome studies investigated the effects of the omega-3 fatty acids supplementation on infant morbidity, particularly caused by respiratory tract infections, wheezing, and asthma. Imhoff et al. showed that DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration [213]. Pastor et al. in a multicenter, prospective, open-label observational study, which included 1342 infants, showed a higher incidence of bronchiolitis in control versus groups who received omega-3-supplemented formula [214]. In contrast, in another study aimed to valuate the effect of neonatal DHA supplementation, the hospitalisation for lower respiratory tract problems in the first 18 months for preterm infants was not reduced [215]. A randomized controlled, trial which included 736 pregnant women and a total of 695 children, showed that the risk of persistent wheeze or asthma was reduced by approximately 7% in the first 5 years of life among children of women who received daily supplementation with omega−3 PUFA (EPA/DHA) during the third trimester of pregnancy. It is notable that this effect was most prominent among children of women with low EPA and DHA blood levels at randomization. Furthermore, supplementation was also associated with a reduced risk of infections of the lower respiratory tract [216].\nSome studies have demonstrated the effect of omega-3 supplementation also on children’s morbidity, particularly reducing the episodes of upper respiratory tract infections [217,218]. Malan et al. in a randomized, double-blind, placebo-controlled trial, which included 321 South African children with iron-deficiency, showed that iron supplementation was associated with an increased morbidity, mostly respiratory, but when given in combination with DHA/EPA, this increase in morbidity was prevented. Authors suggested that this effect could be explained by the DHA- and EPA-mediated protection against iron-induced oxidative stress and the improved resolution of inflammation [219].\nIt has been shown that severe COVID-19 could manifest as a hyperinflammatory syndrome (secondary haemophagocitic lymphohistiocytosis), which is characterized by an important hypercytokinaemia (cytokine storm) with multiorgan failure and ARDS in approximately 50% of patients [220]. Several studies have been conducted to determinate if omega-3 fatty acids DHA and EPA could modulate systemic inflammatory response and affect plasma cytokine production. Thienprasert et al., in a randomized controlled trial, demonstrated that consumption of omega-3 PUFAs was associated with fewer episodes and shorter duration of illness (mainly upper respiratory tract) and with a significantly lower concentration of TGF-beta1 concentration compared with the placebo group [221]. Two randomized controlled trials, aimed to determinate if omega-3 fatty acids could modulate the systemic inflammatory response, improving the outcomes in patients with acute lung injury, have shown that in the intervention groups there was not a reduction of the biomarkers of systemic inflammation and pulmonary outcomes did not improve [222,223]. In a recent systematic review, Dushianthan et al. have reported a significant improvement in blood oxygenation and in the duration of ventilator days and ICU length of stay in patients with ARDS who received nutrition containing antioxidants and rich in EPA and DHA, although there was a low quality of evidence [224].\nThese findings supported also by results of animal studies [225,226,227], may suggest a potential role for EPA and DHA in reducing the lung injury supporting the resolution of inflammation, probably via the production of SPMs [207]. 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