Effect of Collagen Hydrolysate and Fish Oil on High-Sensitivity C-Reactive Protein and Glucose Homeostasis in Patients with severe Burn; a Randomized Clinical Trial
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
Introduction: Collagen and omega-3 fatty acids (FAs) are suggested to have anti-inflammatory, anti-oxidant, and insulin-sensitizing properties. The aim of this study was to investigate the effect of collagen hydrolysate and omega-3 FAs on inflammation and insulin resistance in patients with major burns.
Methods: In this double-blind randomized clinical trial, 66 patients with 20-45% burns were assigned to either of the three groups of collagen (40 gr/d), collagen (40 gr/d) plus fish oil (10 ml/d), or control. High-sensitivity C-reactive protein (hs-CRP), fasting blood glucose (FBG) and insulin concentrations, and homeostatic model assessment for insulin resistance (HOMA-IR) were assessed at baseline, as well as end of weeks two and three.
Results: Based on post-hoc analyses, hs-CRP levels were significantly lower in the collagen (p=0.026) and collagen+omega-3 (p=0.044) groups compared to the control group, at week three. However, pre- to post- (week three) changes of hs-CRP were significantly higher only in the collagen+omega-3 group compared to the control group (173.2 vs. 103.7 mg/l, p=0.024). After three weeks of the intervention, insulin (11.3 and 11.9 vs. 22.8 µIU/ml) and HOMA-IR (2.9 and 2.8 vs. 7.9) values seemed to be clinically, but not statistically, lower in both intervention groups compared to the control group. Pre- to post- (week three) values of FBG decreased significantly in the collagen (p=0.002) and collagen+omega-3 (p=0.036) groups. Insulin (p=0.008) and HOMA-IR (p=0.001) decreased significantly only in the collagen+omega-3 group at week three compared to the baseline.
Conclusions: Supplementation with collagen hydrolysate and omega-3 FAs can improve hs-CRP concentration and probably insulin resistance in patients with severe burns. Omega-3 FAs had additional effects on modulating inflammation. Larger clinical trials are needed to confirm the current findings especially in terms of glucose homeostasis.
- Insulin resistance
- Omega-3 fatty acids
How to Cite
Atiyeh BS, Gunn SWA, Dibo SA. Metabolic implications of severe burn injuries and their management: a systematic review of the literature. World J Surg. 2008; 32 (8):1857-69.
Aghajani MH, Haddadi M, Saadat S. Epidemiological pattern of injuries in Iran; a nationwide review of seven million emergency department admissions. Emergency. 2017; 5 (1):
Rezaee R, Alimohamadzadeh K, Hossini S-M. Epiemiologic features and hospitalization cost of burn injuries in Iran based on national burn registry; a cross-sectional study. Archives of academic emergency medicine. 2019; 7 (1):
Stanojcic M, Abdullahi A, Rehou S, Parousis A, Jeschke MG. Pathophysiological Response to Burn Injury in Adults. Ann Surg. 2018; 267 (3):576-84.
Williams FN, Jeschke MG, Chinkes DL, Suman OE, Branski LK, Herndon DN. Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugs. J Am Coll Surg. 2009; 208 (4):489-502.
Beiraghi-Toosi A, Askarian R, Haghighi FS, Safarian M, Kalantari F, Hashemy SI. Burn-induced oxidative stress and serum glutathione depletion; a cross sectional study. Emergency. 2018; 6 (1):
Jeschke MG, Finnerty CC, Herndon DN, et al. Severe injury is associated with insulin resistance, endoplasmic reticulum stress response, and unfolded protein response. Ann Surg. 2012; 255 (2):370.
Rehou S, Mason S, Burnett M, Jeschke MG. Burned adults develop profound glucose intolerance. Crit Care Med. 2016; 44 (6):1059.
Carter EA, Tompkins RG, Babich JW, Correia J, Bailey EM, Fischman AJ. Thermal injury in rats alters glucose utilization by skin, wound, and small intestine, but not by skeletal muscle. Metabolism. 1996; 45 (9):1161-67.
Wilmore DW, Aulick LH, Mason AD, Pruitt BA, Jr. Influence of the burn wound on local and systemic responses to injury. Ann Surg. 1977; 186 (4):444-58.
Pidcoke HF, Wade CE, Wolf SE. Insulin and the burned patient. Crit Care Med. 2007; 35 (9):S524-S30.
van de Goot F, Krijnen PA, Begieneman MP, Ulrich MM, Middelkoop E, Niessen HW. Acute inflammation is persistent locally in burn wounds: a pivotal role for complement and C-reactive protein. Journal of burn care & research. 2009; 30 (2):274-80.
Herndon DN, Tompkins RG. Support of the metabolic response to burn injury. Lancet. 2004; 363 (9424):1895-902.
Chan MM, Chan GM. Nutritional therapy for burns in children and adults. Nutrition. 2009; 25 (3):261-9.
Bagheri Miyab K, Alipoor E, Vaghardoost R, et al. The effect of a hydrolyzed collagen-based supplement on wound healing in patients with burn: A randomized double-blind pilot clinical trial. Burns. 2020; 46 (1):156-63.
Zhang Z, Zhao M, Wang J, Ding Y, Dai X, Li Y. Oral administration of skin gelatin isolated from Chum salmon (Oncorhynchus keta) enhances wound healing in diabetic rats. Mar Drugs. 2011; 9 (5):696-711.
Zhuang Y, Hou H, Zhao X, Zhang Z, Li B. Effects of collagen and collagen hydrolysate from jellyfish (Rhopilema esculentum) on mice skin photoaging induced by UV irradiation. J Food Sci. 2009; 74 (6):H183-8.
Woo M, Seol BG, Kang K-H, Choi YH, Cho EJ, Noh JS. Effects of collagen peptides from skate (Raja kenojei) skin on improvements of the insulin signaling pathway via attenuation of oxidative stress and inflammation. Food & function. 2020; 11 (3):2017-25.
Xiong X, Liang J, Xu Y, Liu J, Liu Y. The wound healing effects of the Tilapia collagen peptide mixture TY001 in streptozotocin diabetic mice. J Sci Food Agric. 2020; 100 (7):2848-58.
Zhu C, Zhang W, Mu B, et al. Effects of marine collagen peptides on glucose metabolism and insulin resistance in type 2 diabetic rats. Journal of food science and technology. 2017; 54 (8):2260-69.
Mahmoud WH, Mostafa W, Abdel-Khalek AH, Shalaby H. Effect of immune-enhancing diets on the outcomes of patients after major burns. Ann Burns Fire Disasters. 2014; 27 (4):192-6.
Tihista S, Echavarria E. Effect of omega 3 polyunsaturated fatty acids derived from fish oil in major burn patients: A prospective randomized controlled pilot trial. Clin Nutr. 2018; 37 (1):107-12.
Chuntrasakul C, Siltham S, Sarasombath S, et al. Comparison of a immunonutrition formula enriched arginine, glutamine and omega-3 fatty acid, with a currently high-enriched enteral nutrition for trauma patients. JMed Assoc Thai. 2003; 86 (6):552-61.
Wibbenmeyer LA, Mitchell MA, Newel IM, et al. Effect of a fish oil and arginine-fortified diet in thermally injured patients. J Burn Care Res. 2006; 27 (5):694-702.
Babajafari S, Akhlaghi M, Mazloomi SM, et al. The effect of isolated soy protein adjunctive with flaxseed oil on markers of inflammation, oxidative stress, acute phase proteins, and wound healing of burn patients; a randomized clinical trial. Burns. 2018; 44 (1):140-49.
Lepretti M, Martucciello S, Burgos Aceves MA. Omega-3 Fatty Acids and Insulin Resistance: Focus on the Regulation of Mitochondria and Endoplasmic Reticulum Stress. 2018; 10 (3):
Jeschke MG, Gauglitz GG, Finnerty CC, Kraft R, Mlcak RP, Herndon DN. Survivors versus non-survivors postburn: differences in inflammatory and hypermetabolic trajectories. Ann Surg. 2014; 259 (4):814.
Thomas S, Wolf SE, Chinkes DL, Herndon DN. Recovery from the hepatic acute phase response in the severely burned and the effects of long-term growth hormone treatment. Burns. 2004; 30 (7):675-79.
Jeschke MG, Chinkes DL, Finnerty CC, et al. Pathophysiologic response to severe burn injury. Ann Surg. 2008; 248 (3):387-401.
Zhu C-F, Li G-Z, Peng H-B, Zhang F, Chen Y, Li Y. Treatment with marine collagen peptides modulates glucose and lipid metabolism in Chinese patients with type 2 diabetes mellitus. Applied Physiology, Nutrition, and Metabolism. 2010; 35 (6):797-804.
Astre G, Deleruyelle S, Dortignac A, Bonnet C, Valet P, Dray C. Diet-induced obesity and associated disorders are prevented by natural bioactive type 1 fish collagen peptides (Naticol®) treatment. J Physiol Biochem. 2018; 74 (4):647-54.
Gottschlich MM, Jenkins M, Warden GD, et al. Differential effects of three enteral dietary regimens on selected outcome variables in burn patients. Journal of Parenteral and Enteral Nutrition. 1990; 14 (3):225-36.
Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010; 2 (3):355-74.
Molfino A, Amabile MI, Monti M, Muscaritoli M. Omega-3 polyunsaturated fatty acids in critical illness: anti-inflammatory, proresolving, or both? Oxidative Medicine and Cellular Longevity. 2017; 2017
Martindale RG, Warren MM, McClave SA. Does the use of specialized proresolving molecules in critical care offer a more focused approach to controlling inflammation than that of fish oils? Current Opinion in Clinical Nutrition & Metabolic Care. 2016; 19 (2):151-54.
González-Périz A, Horrillo R, Ferre N, et al. Obesity‐induced insulin resistance and hepatic steatosis are alleviated by ω‐3 fatty acids: a role for resolvins and protectins. The FASEB journal. 2009; 23 (6):1946-57.
White PJ, Arita M, Taguchi R, Kang JX, Marette A. Transgenic restoration of long-chain n-3 fatty acids in insulin target tissues improves resolution capacity and alleviates obesity-linked inflammation and insulin resistance in high-fat–fed mice. Diabetes. 2010; 59 (12):3066-73.
- Abstract Viewed: 386 times
- pdf Downloaded: 59 times