Omega-3 fatty acids in parenteral nutrition – A systematic review with network meta-analysis on clinical outcomes

Pradelli, Lorenzo; Mayer, Konstantin; Kłęk, Stanisław; Rosenthal, Martin D.; Povero, Massimiliano; Heller, Axel R.; Muscaritoli, Maurizio

doi:10.1016/j.clnu.2023.02.008

Cited by 15 publications

(13 citation statements)

References 70 publications

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“…Studies have also shown that O3FAs do not significantly reduce the LOS level of patients with postoperative colon cancer receiving a PN therapy ( Lee et al, 2023 ). However, a recent network meta-analysis indicated that LOS was shortened with parenteral O3FA supplementation ( Pradelli et al, 2023 ), which was consistent with our meta-analysis results.…”

Section: Discussionsupporting

confidence: 92%

Efficacy and safety of Omega-3 polyunsaturated fatty acids in adjuvant treatments for colorectal cancer: A meta-analysis of randomized controlled trials

et al. 2023

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Background: Colorectal cancer (CRC) ranks third globally. There are many adverse reactions to treatments such as surgeries and post-surgical chemotherapy, which affect patients’ prognosis and reduce their life quality. Omega-3 polyunsaturated fatty acids (O3FAs) have become an essential part of immune nutrition due to their anti-inflammatory properties, which improve body immunity and have attracted widespread attention. A systematic review focused on the efficacy and safety of O3FAs for patients undergoing surgeries in combination with chemotherapy or a surgery alone is lacking.Objectives: To evaluate the efficacy of O3FAs in the adjuvant treatment of CRC, a meta-analysis was conducted on patients with CRC who underwent surgeries in combination with chemotherapy or a surgery alone.Methods: As of March 2023, publications have been obtained using search terms from digital databases such as PubMed, Web of Science, Embase and Cochrane Library. Only randomized clinical trials (RCTs) evaluating the efficacy and safety of O3FAs following adjuvant treatments for CRC were included in the meta-analysis. Key outcomes were tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1beta (IL-1β), albumin, body mass index (BMI), weight, the rate of infectious and non-infectious complications, the length of hospital stay (LOS), CRC mortality and life quality.Results: After screening 1,080 studies, 19 RCTs (n = 1,556) with O3FAs in CRC were included, in all of which at least one efficacy or safety outcome was examined. Compared to the control group, the level of TNF-α (MD = −0.79, 95% CI: 1.51 to −0.07, p = 0.03) and IL-6 was reduced due to O3FA-enriched nutrition during the perioperative period (MD = −4.70, 95% CI: 6.59 to −2.80, p < 0.00001). It also reduces LOS (MD = 9.36, 95% CI: 2.16 to 16.57, p = 0.01). No significant differences were found in CRP, IL-1β, albumin, BMI, weight, the rate of infectious and non-infectious complications, CRC mortality or life quality. The inflammatory status of patients with CRC undergoing adjuvant therapies decreased after a total parenteral nutrition (TPN) O3FA supplementation (TNF-α, MD = −1.26, 95% CI: 2.25 to −0.27, p = 0.01, I2 = 4%, n = 183 participants). The rate of infectious and non-infectious complications was reduced among patients with CRC undergoing adjuvant therapies after a parenteral nutrition (PN) O3FA supplementation (RR = 3.73, 95% CI: 1.52 to 9.17, p = 0.004, I2 = 0%, n = 76 participants).Conclusion: Our observations suggest that supplementation with O3FAs has little or no effect on patients with CRC undergoing adjuvant therapies and that a prolonged inflammatory state may be modified. To validate these findings, well-designed, large-scale, randomized and controlled studies on homogeneous patient populations are expected.

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Section: Discussionsupporting

confidence: 92%

Efficacy and safety of Omega-3 polyunsaturated fatty acids in adjuvant treatments for colorectal cancer: A meta-analysis of randomized controlled trials

et al. 2023

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“…Undoubtedly, there is a need for further large-scale multicenter studies to determine which formulation will provide the greatest benefit to critically ill patients [46 ▪ ]. However, key recent meta-analyses and other newer clinical studies continue to demonstrate benefits and cost-savings associated with the use of FO-ILEs, OO-ILEs, and 4-OLEs over SO-ILEs [4 ▪▪ ,10 ▪▪ ,33,34,36 ▪▪ ]. Unfortunately, a majority of US centers continue to utilize SO-ILE for PN patients (personal communication, P.E.…”

Section: Discussionmentioning

confidence: 99%

“…ILE's as a component of PN, are key to deliver essential fatty acids and energy [13 ▪ ,14 ▪ ]. However, the optimal form of ILE in PN is controversial and has undergone further study recently [4 ▪▪ ,10 ▪▪ ]. The addition of ILE's to PN has been found to modulate cell signaling and immune function [15].…”

Section: Effect Of Parental Nutrition-lipid Intravenous Lipid Emulsio...mentioning

confidence: 99%

“…Fatty acids (FAs) or triglycerides that make up PN-ILEs are classified by degrees of saturation, carbon length, and location of double bonds. Each of these classifications have effects on biochemical functioning and may influence clinical outcomes in critically ill patients [10 ▪▪ ]. Medium-chain fatty acids (MCFAs), long-chain fatty acids (LCFAs), and polyunsaturated fatty acids (PUFAs) are the major components currently used in ILE formulations.…”

mentioning

confidence: 99%

“…However, recent evidence from multiple level 1 randomized controlled trials has shown that PN is no longer associated with increased risk of infection in ICU patients versus EN [6–9]. Further, there is increasing evidence that implicates the make-up of specific intravenous lipid emulsion (ILE) formulations in a range of the traditionally-believed adverse effects of PN [4 ▪▪ ,10 ▪▪ ,11]. ILE's function in PN as artificial chylomicrons, allowing nutrition to bypass normal routes of absorption, bile emulsification, and pancreatic degradation [11].…”

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confidence: 99%

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Lipid emulsions in parenteral nutrition: does it matter?

Haines

Grisel²,

Gorenshtein³

et al. 2023

Current Opinion in Critical Care

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Purpose of review Recently, clinicians have shown interest in switching patients to nonsoybean-based intravenous lipid emulsion (ILE) formulas for parental nutrition (PN) due to adverse outcomes related to high Omega-6 content in soybean oil (SO) ILE's. This review summarizes recent literature on improved clinical outcomes with new Omega-6 lipid-sparing ILE's in PN management. Recent findings Although there is a paucity of large-scale studies directly comparing Omega-6 lipid sparing ILE's with SO-based lipid emulsion use in PN in ICU patients, there is strong translational and meta-analysis evidence to suggest that lipid formulations containing fish oil (FO) and/or olive oil (OO) have favorable effects on immune function and improve clinical outcomes in ICU populations. Summary More research is needed to directly compare omega-6-sparing PN formulas with FO and/or OO versus traditional SO ILE's. However, current evidence is promising for improved outcomes using newer ILE's including reduced infections, shorter lengths of stay, and reduced costs.

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Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review

Lopez‐Delgado,

Patel,

Stoppe

et al. 2024

Nut in Clin Prac

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Patients with hematological malignancies (HMs) are more frequently admitted now than in the past to the intensive care unit (ICU) due to more aggressive approaches in primary therapy of HMs and the need for critical care support. Pathophysiological alterations derived from HMs and the different hematological therapies, such as chemotherapy, negatively affect gastrointestinal (GI) function, metabolism, and nutrition status. Further, malnutrition strongly influences outcomes and tolerance of the different hematological therapies. In consequence, these critically ill patients frequently present with malnutrition and pathophysiological alterations that create challenges for the delivery of medical nutrition therapy (MNT) in the ICU. Frequent screening, gauging tolerance, and monitoring nutrition status are mandatory to provide individualized MNT and achieve nutrition objectives. The present review discusses how HM impact GI function and nutrition status, the importance of MNT in patients with HM, and specific considerations for guidance in providing adequate MNT to these patients when admitted to the ICU.

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Omega-3 fatty acids in parenteral nutrition – A systematic review with network meta-analysis on clinical outcomes

Cited by 15 publications

References 70 publications

Efficacy and safety of Omega-3 polyunsaturated fatty acids in adjuvant treatments for colorectal cancer: A meta-analysis of randomized controlled trials

Efficacy and safety of Omega-3 polyunsaturated fatty acids in adjuvant treatments for colorectal cancer: A meta-analysis of randomized controlled trials

Lipid emulsions in parenteral nutrition: does it matter?

Considerations for medical nutrition therapy management of the critically ill patient with hematological malignancies: A narrative review

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