Impact of Intravenous Lipid Emulsions Containing Fish Oil on Clinical Outcomes in Critically Ill Surgical Patients: A Literature Review

Abstract

A fish oil (FO)–containing intravenous lipid emulsion (ILE; FO ILE) has been approved for use in the United States; however, similar formulations have been used throughout Europe and China in intensive care units since the 1990s. This literature review evaluates the evidence regarding the effectiveness of FO ILE on clinical outcomes in the critically ill surgical patient population. The review of available evidence demonstrates that ILEs containing FO lower triglyceride concentrations, inflammatory markers, and liver function enzymes, and improve morbidity and mortality outcomes in critically ill surgical patients.

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study

“…Fish oil contains ω-3 PUFAs (docosahexaenoic acid [DHA] and eicosapentaenoic acid [EPA]) that incorporate into cell membranes influencing various transcription factors modifying the expression of genes involved in many biological processes which include metabolism, immune function, and inflammation [3]. ILEs based on fish oil have been shown to have anti-inflammatory and immunomodulatory effects [5].…”

“…In patients with PN it is not uncommon to experience increases in serum triglyceride concentrations and hypertriglyceridemia correlated with hepatic steatosis, which can contribute to liver damage. In this regard, ILEs based on fish oil may be protective against rapid increases in serum triglycerides, compared with other formulas such as those based on MCT/LCT, although the evidence is not conclusive [5,20]. In our study we did not observe any differences in the percentage of patients that developed hypertriglyceridemia (levels above 400 mg/dL) which was, in any case, low in both groups (5% in the n-3 PUFA group and 7.4% in the other group); nonetheless, we observed significant reductions of levels of serum triglycerides in the n-3 PUFA group.…”

“…Several studies have also shown a significant decrease in hospital stay, especially in ICU surgical patients [3,5,7,9,27] and in infectious complications [2,28,29] when using ILEs based on fish oil compared mainly with ILEs based on pure soybean oil or MCT/LCT emulsions. A reduction of infectious complications is seen with the doses that are usually applied in clinical practice [3] and is supported by the observations that using these fish oil containing ILEs can decrease the blood concentrations or ex-vivo production of proinflammatory eicosanoids and cytokines [3,5]. In our sample we administered similar doses to those used in other studies [3], but we did not find any differences in these parameters and also C reactive protein levels decreased similarly in both groups.…”

“…Lipid emulsions containing fish oil are rich in n-3 polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which exhibit anti-inflammatory, immunomodulatory, and antioxidative properties in preclinical models. In recent years the evidence to support the use of intravenous lipid emulsions (ILEs) enriched with fish oil has grown increasingly [2][3][4], showing that they could lower triglyceride concentrations, inflammatory markers, and liver function enzymes, and improve morbidity (risk of infection and sepsis and length of stay) and even mortality outcomes in hospitalized patients especially in post-surgical and oncology patients [5][6][7][8], when compared with ILEs based on soybean oil.…”

Clinical Nutrition of Critically Ill Patients in the Context of the Latest ESPEN Guidelines

“…In addition, the positive modulation of the inflammatory process also involves the incorporation of EPA and DHA into cell membranes, which causes a decrease in the concentration of arachidonic acid in phospholipid membranes and, as a consequence, the reduction in the production of pro-inflammatory eicosanoids [69,70]. The authors of the latest review concerning the impact of intravenous lipid emulsions containing fish oil on clinical outcomes in critically ill surgical patients demonstrated that those lipid emulsions positively affect the functioning of the body by lowering triglyceride concentrations, inflammatory markers, and liver function enzymes, improving patients morbidity and mortality [71].…”