Parenteral Fish Oil as Monotherapy Prevents Essential Fatty Acid Deficiency in Parenteral Nutrition–dependent Patients

Abstract

Objective The use of fish oil-based emulsions as the sole source of fat for patients receiving parenteral nutrition (PN) has raised concerns for the development of essential fatty acid deficiency (EFAD), hindering its adoption into clinical practice. The purpose of this study was to examine fatty acid profiles of patients receiving no enteral calories, while completely dependent on PN and an intravenous fish oil-based lipid emulsion, for onset of EFAD and maintenance of growth. Methods Prospectively collected data from ten patients was reviewed for evidence of EFAD, defined as a triene:tetraene ratio greater than 0.2. Gestational age-adjusted Z-scores for length, growth and head circumference at baseline were compared to the corresponding Z-scores at time of censoring. All patients received PN with a fish oil-based lipid emulsion at 1 g.kg−1.day−1 as the sole source of fat calories for at least 1 month. The fish oil monotherapy was used under a compassionate use protocol. Results Median gestational age at time of birth was 35 weeks, and median age at the start of treatment was 3.5 months. After a median time of 3.8 months on exclusive PN and fish oil-based lipid emulsion, none of the patients developed biochemical or clinical evidence of EFAD. Z-scores were not statistically different, indicating no growth impairment. Median direct bilirubin levels improved in 9 patients from 6.8 mg/dL to 0.9 mg/dL (P=0.009). Conclusions When dosed appropriately, fish oil-based lipid emulsions contain sufficient amounts of essential fatty acids to prevent EFAD and sustain growth in patients completely dependent on PN.

Prevention and reversal of intestinal failure–associated liver disease in premature infants with short bowel syndrome using intravenous fish oil in combination with omega-6/9 lipid emulsions

“…Our observations in these 5 premature neonates with SBS support previous clinical reports on the use of fish oil-based lipid emulsions to prevent IFALD [17][18][19][20][21][22]. However, it is difficult to compare our observations to those reported by others because the doses of fish oil differ between the centers.…”

“…This proportion is within the optimal range for anti-inflammatory effects and is similar to that found in breast milk [41]. We chose to combine Omegaven with ClinOleic to avoid n-6 FA deficiency, although a recent report did not find signs of such deficiencies when using Omegaven as the sole lipid source [22]. Another rationale for combining Omegaven with ClinOleic is to provide the premature infant with adequate amounts of energy for rapid growth.…”

“…[3,[8][9][10][11]. Several reports concerning animal models [12][13][14][15][16] and, more recently, a few clinical studies [17][18][19][20][21][22] have observed prevention and reversal of IFALD when replacing a conventional soy-based lipid emulsion containing omega-6 (n-6) fatty acids (FAs) (Intralipid; Fresenius Kabi, Bad Homburg, Germany) with a fish oil-based lipid emulsion rich in n-3 FAs (Omegaven; Fresenius Kabi).…”

Effects of Parenteral Nutrition Formulas on Plasma Lipid Profile in Children with Bone Marrow Transplantation

“…Therefore, given the homogeneity of the two groups prior to and after transplantation, we can assume that the variations found in the lipid profile may be due to the lipid emulsions used in PN. This differentiates our study from previous studies based on heterogeneous samples in terms of age and type of pathology [14,15]. …”

Comparison of 5 intravenous lipid emulsions and their effects on hepatic steatosis in a murine model

“…In addition, the first case report using parenteral fish oil as monotherapy was to treat preexisting EFAD in a PN dependent patient allergic to soy [40]. Since that time, results from our center indicate that PN-dependent patients did not develop EFAD while on Omegaven monotherapy [41].…”