Omega‐3–Enriched Lipid Emulsion for Liver Salvage in Parenteral Nutrition–Induced Cholestasis in the Adult Patient

Jurewitsch, Brian; Gardiner, Geoffrey W.; Naccarato, Mark; Jeejeebhoy, Khursheed N.

doi:10.1177/0148607110382023

Cited by 43 publications

(22 citation statements)

References 24 publications

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“…Although the cost of omega-3 supplementation varies by dose, frequency, route of administration, and choice of formula, the leading parenteral formula used in this meta-analysis (Omegaven) has been reported to cost up to 3 times more than another lipid emulsion in conventional use [48]. According to its manufacturer, Omegaven in North America is currently obtained only by applying to special access programs.…”

Section: Discussionmentioning

confidence: 99%

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Sharma

McIntyre

et al. 2017

Ann. Intensive Care

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BackgroundNutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear.MethodsWe searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome.ResultsA total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results.ConclusionOmega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0282-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Sharma

McIntyre

et al. 2017

Ann. Intensive Care

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“…In most instances, clinical improvement occurred approximately one month after initiation of treatment with subsequent resolution of biochemical cholestasis within 2–3 months [121,122,123,124,125,126]. While IFALD in adults is rare, several case reports have demonstrated similar reversal of cholestasis and histologic improvement upon transition from SO to FO IVLE [126,127,128]. To date, there has not been any randomized controlled trials conducted that compare equal doses of SO IVLE with FO IVLE in the treatment of pre-existing IFALD.…”

Section: Introductionmentioning

confidence: 99%

The Use of Fish Oil Lipid Emulsion in the Treatment of Intestinal Failure Associated Liver Disease (IFALD)

Chang

Puder²,

Gura³

2012

Nutrients

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Since 2004, fish oil based lipid emulsions have been used in the treatment of intestinal failure associated liver disease, with a noticeable impact on decreasing the incidence of morbidity and mortality of this often fatal condition. With this new therapy, however, different approaches have emerged as well as concerns about potential risks with using fish oil as a monotherapy. This review will discuss the experience to date with this lipid emulsion along with the rational for its use, controversies and concerns.

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“…Similar outcomes have been reported in adults with IFALD treated with FOLE. Although fatty acid profiles were not reported in these studies, no patient was reported to have clinical signs of EFAD [47,48]. The daily requirements to prevent EFAD in adults are lower than for children.…”

Section: Human Studiesmentioning

confidence: 99%

Redefining essential fatty acids in the era of novel intravenous lipid emulsions

et al. 2018

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The essentiality of fatty acids was determined by the Burrs in the 1920s. Subsequently, it is commonly accepted that provision of linoleic (LA) and alpha-linolenic acids (ALA) prevents and reverses essential fatty acid deficiency (EFAD). Development of alternative injectable lipid emulsions (ILE) low in LA and ALA has raised concern about their ability to prevent EFAD. This review provides biochemical evidence coupled with observations from animal and human studies that aim to characterize which fatty acids are truly essential to prevent EFAD. Retroconversion pathways and mobilization from body stores suggest that arachidonic and docosahexaenoic acids (ARA and DHA – the main derivatives of LA and ALA, respectively) also prevent EFAD. Our group first proposed the essentiality of ARA and DHA by feeding mice exclusively these fatty acids and proving that they prevent EFAD. Survival for 5 generations on this diet provides additional evidence that growth and reproductive capabilities are maintained. Moreover, the use of fish oil-based ILE, which contain minimal LA and ALA and abundant DHA and ARA, for treatment of intestinal failure-associated liver disease, does not result in EFAD. These findings challenge the essentiality of LA and ALA in the presence of ARA and DHA. Evidence discussed in this review supports the idea that ARA and DHA can independently fulfill dietary essential fatty acid requirements. The imminent introduction of new ILE rich in ARA and DHA in the United States highlights the importance of understanding their essentiality, especially when provision of ALA and LA is below the established daily minimum requirement.

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Omega‐3–Enriched Lipid Emulsion for Liver Salvage in Parenteral Nutrition–Induced Cholestasis in the Adult Patient

Cited by 43 publications

References 24 publications

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

The Use of Fish Oil Lipid Emulsion in the Treatment of Intestinal Failure Associated Liver Disease (IFALD)

Redefining essential fatty acids in the era of novel intravenous lipid emulsions

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