Improvement of parenteral nutrition-associated cholestasis in an adult using fish oil-based parenteral nutrition

Abstract

Parenteral nutrition-associated cholestasis (PNAC) is a severe complication of parenteral nutrition. Standard feed preparations contain soybean and olive oil that are rich in ω-6 polyunsaturated fats, and which studies suggest can be hepatotoxic. Preparations containing fish oil, rich in ω-3 polyunsaturated fats, may be hepatoprotective and have been used in the critical care setting as immunotherapy. A case demonstrating dramatic improvement in liver function and overall clinical condition in an adult with PNAC and intestinal failure within 8 weeks of changing to a fish oil-based parenteral feed is reported. As far as is known, this is the first report of an adult patient whose parenteral nutrition-associated liver disease resolved after a parenteral nutrition lipid emulsion was changed to the fish oil-containing emulsion, SMOFlipid.

Risk factors of parenteral nutrition‐associated cholestasis in very‐low‐birthweight infants

“…Lisa H Moyes et al reported that PNassociated liver disease in an adult patient resolved after ClinOleic 20% was changed to the SMOF lipid emulsion. 38 Currently, the use of alternative sources of parenteral lipids is an active area of research in the treatment and prevention of cholestasis in preterm infants. We are also currently conducting randomized controlled trial studies to determine the effects of fish oil.…”

Intravenous Lipid Emulsions in the Prevention and Treatment of Liver Disease in Intestinal Failure

“…Moyes et al in 2012 reported the devlopment of jaundice in a 43-year old man who had received 6 months of a mixture of refined olive oil (80%) and soybean oil (20%) with the liver biopsy showing severe acute cholestasis, minimal steatosis without inflammation and portal fibrosis all consistent with PNALD [ 73 ]. Subsequently the patient developed portal hypertension which resulted in a gastric variceal bleed.…”

“…Subsequently the patient developed portal hypertension which resulted in a gastric variceal bleed. A change to SMOFlipid 20% was implemented which provided the patient with a mixture of soybean (30%), medium-chain triglycerides (30%), olive oil (25%) and fish oils (15%) [ 73 ]. Over 16 months of treatment with SMOFlipid20% the patient developed biochemical improvement, resolution of portal hypertension and a decrease in liver stiffness assessed by serial fibroscan [ 73 ].…”

“…A change to SMOFlipid 20% was implemented which provided the patient with a mixture of soybean (30%), medium-chain triglycerides (30%), olive oil (25%) and fish oils (15%) [ 73 ]. Over 16 months of treatment with SMOFlipid20% the patient developed biochemical improvement, resolution of portal hypertension and a decrease in liver stiffness assessed by serial fibroscan [ 73 ]. The authors attributed the improvement to the ω-3 fatty acids in fish oil that result in prevention of hepatic injury by inhibition of de novo lipogenesis and stimulation of fatty acid β-oxidation, thus reversing hepatic steatosis [ 73 ].…”