Parenteral fish oil and liver function tests in hospitalized adult patients receiving parenteral nutrition: A propensity score-matched analysis

Llop-Talaverón, J.; Badia-Tahull, M.B.; Leiva‐Badosa, Elisabet; Ramon-Torrel, J.M.

doi:10.1016/j.clnu.2016.06.027

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…To our knowledge this is the first randomised controlled study using SMOFlipid® in septic ICU participants, although it has been studied previously in post-surgery participants [24e31]. In these studies SMOFlipid® was found to decrease the concentrations of inflammatory cytokines and eicosanoids [25,31], decrease liver enzymes [24,26,28], increase plasma a-tocopherol [24,25] and reduce length of hospital stay [25]. Other FO containing LEs have also been studied in post-surgical patients and were associated with decreased production of inflammatory eicosanoids and cytokines [32e34], improved immune function, reduced liver enzymes [33,35] and improved clinical outcomes [34e39].…”

Section: Discussionmentioning

confidence: 99%

Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact)

et al. 2019

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Background and aims: Data in critically ill patients on the effect of intravenous lipid emulsions (LEs), containing omega-3 polyunsaturated fatty acids (PUFAs), in parenteral nutrition (PN) are scarce and conflicting. This study compared the effects of a four-oil LE (30% soybean oil, 30% medium-chain triglycerides, 25% olive oil and 15% fish oil (FO)) (SMOFlipid®) to those of a 100% soybean oil-based LE in critically ill adult intensive care unit (ICU) patients. Methods: In this double-blind, randomised study, patients (n ¼ 75) predicted to need PN for more than 5 days were randomised to receive either a four-oil LE (Study Group (SG)) or a 100% soybean oil LE (Control Group (CG)). Isocaloric, isonitrogenous PN was administered continuously for 5 days. FO was provided at a dose of 0.09e0.22 g/kg body weight. Measurements included biochemical parameters and sequential organ failure assessment (SOFA) score daily and plasma total phospholipid fatty acids (FAs) and cytokine levels on days 1, 3, 6. Days on mechanical ventilation, length of stay and mortality were also recorded. ANOVA was used to compare response variables between the two groups over the time and Pearson correlation was used to measure relationships between continuous variables. Results: 68 patients completed the study (n ¼ 35 SG, n ¼ 33 CG), with male predominance (66% SG, 56% CG). Average age was 60.8 ± 13.9 years (SG) versus 55.7 ± 14.8 (CG) (p ¼ 0.143). The majority were surgical admissions (85% SG versus 91% CG) followed by medical. Plasma phospholipid oleic acid (p ¼ 0.022) and alpha-linolenic acid (p<0.0005) increased in both groups. In the SG, plasma phospholipid EPA and DHA increased (both p<0.001), whereas the omega-6:omega-3 PUFA (n-6:n-3 PUFA) ratio decreased (p < 0.001). Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin decreased in both treatment groups. Considering only the change from day 1 to day 6 there was a bigger decrease in AST, ALT and bilirubin levels in the SG. Concentrations of TNF-a decreased from day 1 to day 6 in the SG, whereas they increased in the CG, but the change was not statistically significant (p ¼ 0.112). A significant negative correlation was found between EPA provision on day 3 and the SOFA score (r ¼ À0.4047, p ¼ 0.018). Days on mechanical ventilation (1.24 ± 0.83 days in SG versus 0.88 ± 1.63 days in CG, p ¼ 0.385) and ICU LOS (9.5 ± 7.09 days in SG versus 10.7 ± 7.6 days in CG, p ¼ 0.490) were not different between groups. Conclusion: PN containing a four-oil LE increased plasma EPA and DHA, decreased n-6:n-3 PUFA ratio, and was safe and well tolerated. The negative relationship between day 3 EPA and SOFA score seems promising, but EPA intake and effects may have been diluted by enteral nutrition which was started in more than half of patients on day 4. There was no significant difference in terms of other biochemical

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Section: Discussionmentioning

confidence: 99%

Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact)

et al. 2019

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“…Lipid composition of TPN could also play a significant role in liver enzyme alteration associated with PN, and n-3 PUFA ILEs have been shown to minimize this disturbance in hospitalized adult patients by reducing liver complications [21,22]. The administration of high doses of intravenous lipids, that are high in n-6 PUFAs and phytosterols (like the ones based on soybean oils), can contribute to the development of parenteral nutrition-associated liver disease [23].…”

Section: Lipid Control and Liver Enzymesmentioning

confidence: 99%

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

et al. 2020

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There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.

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“…In a large retrospective study including more than 1,500 patients receiving PN, a higher FO dose was associated with a greater decrease in gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) in a multivariate adjusted model (22). Additionally, in a propensity score-matched study, a higher percentage of FO administered by PN was associated with lower LET elevation during PN (23).…”

Section: Potential Benefits Prevention Of Alterations In Liver Enzymementioning

confidence: 99%

Effects unrelated to anti-inflammation of lipid emulsions containing fish oil in parenteral nutrition for adult patients

Joaquín¹,

Florit-Sureda²

2017

Nutr Hosp

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Mateu-de-Antonio J, Florit-Sureda M. Effects unrelated to anti-infl ammation of lipid emulsions containing fi sh oil in parenteral nutrition for adult patients. Nutr Hosp 2017;34:193-203 ResumenSe han publicado varias revisiones y metaanálisis sobre la modulación de las respuestas infl amatorias e inmunológicas por la administración de ácidos grasos poliinsaturados (AGPI) omega-3. Sin embargo, los AGPI omega-3 ejercen otras acciones no directamente relacionadas con estas respuestas. El objetivo de este trabajo es revisar los efectos de las emulsiones lipídicas intravenosas (ELIV) que contienen aceite de pescado (AP) en la nutrición parenteral (NP) de pacientes adultos. Estas emulsiones pueden tener un papel importante en la prevención de las alteraciones del perfi l hepático o de la enfermedad hepática asociada a la NP (EHANP) en comparación con las ELIV sin AP. Los estudios que usaron dosis ≥ 0,150 mg/kg/día presentaron resultados más positivos que aquellos con dosis menores. Una vez se ha presentado la EHANP, el uso de una ELIV compuesta exclusivamente de AP, a dosis de 0,25-1 g de AP/kg/día durante varias semanas, podría atenuar o incluso revertir la alteración hepática y la colestasis cuando la administración de la NP es crónica. Las ELIV con AP parecen tener un aclaramiento plasmático más rápido, lo que podría suponer una ventaja en ciertos pacientes. Algunos estudios también sugieren que estas emulsiones podrían mejorar la función respiratoria. En general, estas ELIV que contienen AP son muy seguras, no aumentan el estrés oxidativo e incluso incrementan el nivel de alfa-tocoferol plasmático. Asimismo, no alteran la sensibilidad a la insulina o el control glicémico y tampoco se ha demostrado que afecten clínicamente a la agregación plaquetaria o a la hemostasia. En conclusión, el uso de ELIV con AP en la NP podría suponer algunas ventajas frente a la ELIV sin AP, además de la modulación de la respuesta infl amatoria sistémica. AbstractSeveral reviews and meta-analyses on modulated infl ammatory and immunologic responses after the administration of omega-3 polyunsaturated fatty acids (PUFAs) in different diseases and conditions have been published. However, omega-3 PUFAs exert several other actions which are not directly related to immunologic or infl ammatory responses. The aim of this paper was to review the effects which are not directly related to immunologic and infl ammatory responses of intravenous lipid emulsions (IVLEs) containing fi sh oil (FO) in parenteral nutrition (PN) for adult patients. IVLEs containing FO could have a role in the prevention of alterations in liver enzyme tests (LETs) or PN-associated liver disease (PNALD). Studies using FO doses of ≥ 0.150 mg/kg/day or IVLEs with high FO concentration reported more positive results than those with lower doses. Once PNALD was developed, the use of IVLEs exclusively composed of FO at doses of 0.25-1 g of FO/kg/day for several weeks could attenuate or even eradicate cholestasis and liver alteration. IVLEs containing FO seemed to have faster...

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Parenteral fish oil and liver function tests in hospitalized adult patients receiving parenteral nutrition: A propensity score-matched analysis

Cited by 13 publications

References 28 publications

Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact)

Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact)

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

Effects unrelated to anti-inflammation of lipid emulsions containing fish oil in parenteral nutrition for adult patients

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