Fish Oil Treatment of Hyperlipidemia in Children and Adolescents Receiving Renal Replacement Therapy

Abstract

The effect of 8 weeks of daily oral fish oil supplementation in a dose of 3 to 8 g/d on serum lipid levels was studied in 16 patients, 7 to 8 years of age, who had end-stage renal disease and were receiving renal replacement therapy. Fasting serum cholesterol (CHOL), triglyceride (TG) levels, and lipoprotein profiles were measured before therapy, 8 weeks after fish oil supplementation, and 4 weeks after its cessation. During 8 weeks of treatment the mean serum CHOL level did not change. The mean serum TG level, however, decreased significantly (P < .01) from 236 ± 31 mg/dL to 171 ± 21 mg/dL (27.5%). Four weeks after treatment was stopped, the mean serum TG level returned to a value not significantly different from the pretreatment level (208 ± 30 mg/dL). In a subgroup of 11 excessively hyperlipidemic patients, with serum CHOL and TG levels ≥50% of the 90th percentile for age and sex, the mean serum TG level decreased even more (30.8%), from 286 ± 35 mg/dL to 198 ± 24 mg/dL (P < .01), and the mean CHOL/high-density lipoprotein CHOL ratio decreased from 8.4 ± 1.2 to 7.4 ± 1.3 (P < .05). Blood pressure and platelet counts remained stable during the entire study period. Side effects of the treatment were minimal. These results show that dietary fish oil supplementation reduces serum TG levels in young patients receiving renal replacement therapy and improves their "atherogenic" serum lipoprotein profile.

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“…Although Clarke et al 15 reported an increased incidence of epistaxis in adolescents treated with fish oils, more recent studies have not documented a clinically relevant effect on bleeding. 16-18,33-35 Consistent with these studies, no spontaneous bleeding episodes, bleeding complications, or other serious adverse events occurred in our study population. The most common side effects related to DHA supplementation are gastrointestinal in nature, including belching (“fishy burp”), nausea, and loose stools.…”

“…Goren et al orally supplemented children ages 7 to 18 with up to 8 g/day of a fish oil supplement containing EPA and DHA, with no bleeding episodes or changes in platelet counts, and only minimal gastrointestinal side effects reported (abdominal cramping and diarrhea). 16 Sorgi et al 17 reported use of high-dose EPA/DHA supplements in children ages 8 to 16 with 5.4 g DHA/day and 10.8 g of EPA/day without any reported increased bleeding episodes, and only 1 subject reporting loose stools. The EFSA panel considers that supplemental intakes of EPA and DHA combined of up to about 5 g/day for up to 2 years and up to about 7 g/day for up to 6 months do not increase the risk of spontaneous bleeding episodes or bleeding complications, even in subjects at high risk of bleeding (eg, taking acetylsalicylic acid or anti-coagulants).…”