Parenteral Fish Oil Monotherapy in the Management of Patients With Parenteral Nutrition–Associated Liver Disease

Abstract

Fish oil-derived emulsions have been demonstrated to reverse preexisting PNALD and to prevent and treat essential fatty acid deficiency. Its ability to prevent PNALD is currently under investigation. Although the mechanism has yet to be fully understood, the advantages of fish oil-based lipid emulsions over soybean oil-based lipid emulsions seen to date suggest that fish oil-based emulsions would be better suited for use in long-term parenteral nutrition.

Parenteral nutrition–associated cholestasis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review

“…Information on how to obtain Omegaven for clinical use can be obtained from http://www.oley.org/.../How_Physicians_ Can_Obtain_Omegaven.pdf. There are a number of open compassionate use clinical trials in the National Institutes of Health clinical trial database (Table 2), and more than 60 institutions in the United States have used Omegaven under a compassionate use protocol in patients with PNALD [44]. A prospective clinical trial comparing Omegaven to a standard soybean oil lipid emulsion was recently suspended because of a mandate from the Food and Drug Administration (NCT00512629).…”

Lipids for parenteral nutrition in neonates

“…It is usually recommended to infuse Omegan with soybean oil-based lipid emulsions which are rich in n-6 fatty acids rich in linoleic acid. A prospective cohort study by de Meijer et al [32] looked at EFA and growth status of 10 preterm and near term neonates who were exclusively given 100% fish oil-based lipid emulsion (Omegaven) for the treatment of parenteral nutritioninduced cholestasis. EFA deficiency was defined as a triene : tetraene ratio greater than 0.2.…”

Fish Oil–Based Lipid Emulsions in the Treatment of Parenteral Nutrition-Associated Liver Disease: An Ongoing Positive Experience

“…Both animal and human research during the past decade has implicated phytosterols and v-6 (n-6) fatty acids as the most likely components in the current lipid formulations as primary reasons for PNALD (8)(9)(10)(11)(12). In contrast, fish oil-based lipid emulsions (FOLEs) have been shown to be associated with full resolution of PNALD (13)(14)(15)(16)(17)(18). The beneficial effects of FOLE have been attributed to the abundance of v-3 fatty acids, which, in contrast to v-6 fatty acids, have been shown to possess considerable anti-inflammatory properties (11,(19)(20)(21)(22).…”