The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease

Abstract

Parenteral nutrition associated liver disease (PNALD) is the major source of morbidity and mortality in children with short bowel syndrome (SBS). There is emerging evidence that omega-6 fatty acids (omega6FA) within the parenteral solution play a major role in PNALD and their effects may be reversed or ameliorated by substitution with omega-3 fatty acids (omega3FA). This paper reviews the mechanisms whereby omega3FAs may influence PNALD by improving bile flow, inhibiting steatosis, and having immunomodulatory effects. The early clinical experience with omega3FAs in SBS and PNALD is briefly reviewed and the implications of such, and future directions are considered.

Parenteral fish oil as monotherapy for patients with parenteral nutrition-associated liver disease

“…The authors themselves, however, substituted Intralipid Ò with Omegaven Ò in short bowel syndrome patients with advanced liver disease and concluded that Omegaven Ò has the ability to restore liver function without complications or mortality [1]. Furthermore, they ''rescued'' eight of 12 patients with Omegaven Ò alone [1,6]. In a prospective case series of 18 consecutive patients, which was published in the journal Pediatrics the month prior to the authors' manuscript submission, we have demonstrated that patients on Omegaven Ò experienced from adequate to improved growth and did not have signs of coagulopathy or EFAD 30 days after initiation of therapy [3].…”

“…The authors themselves, however, substituted Intralipid Ò with Omegaven Ò in short bowel syndrome patients with advanced liver disease and concluded that Omegaven Ò has the ability to restore liver function without complications or mortality [1]. Furthermore, they ''rescued'' eight of 12 patients with Omegaven Ò alone [1,6].…”

“…We read the paper by Diamond et al [1] which provided a brief overview of the use of fish oil in patients with short bowel syndrome and parenteral nutrition-associated liver disease (PNALD). In their article, the authors discourage the use of the fish oil-based Omegaven Ò (Fresenius Kabi, Bad Homburg, Germany) as the sole lipid source in patients on parenteral nutrition, which in our opinion is unwarranted.…”

Production of omega-3 polyunsaturated fatty acid concentrates: A review

“…Zulfakar, Edwards, and Heard (2007) have reviewed the works that have examined the potential use of n−3 PUFA in psoriasis. Several recent reviews have studied the influence of omega-3 PUFA on bowel diseases (Razack & Seidner, 2007;Diamond, Sterescu, Pencharz, & Wales, 2008;Turner, Zlotkin, Shah, & Griffiths, 2008). The application of omega-3 fatty acids in the treatment and prevention of mental illnesses (Horrobin, Manku, Hillman, Iain, & Glen, 1991;Stillwell & Wassall, 2003;McNamara, 2006;Clayton, Hanstock, Garg, & Hazell, 2007;Mazza, Pomponi, Janiri, Bria, & Mazza, 2007;Ross, Seguin, & Sieswerda, 2007;Song & Zhao, 2007) and on the prevention of several types of cancer (MacLean et al, 2006;Chen et al, 2007;Calviello, Serini, & Piccioni, 2007) has also been widely reviewed.…”

Feeding Very-Low-Birth-Weight Infants: Our Aspirations versus the Reality in Practice

“…Third-generation lipid emulsions contain soybean oil for the supply of essential fatty acids, medium-chain triglycerides for rapid provision of energy, olive oil to reduce the n–6:n–3 ratio and to supply vitamin E, and fish oil for its anti-inflammatory effects. Beneficial effects of these mixtures on liver function and serum triglycerides have been described in various studies, including children [39,40]. Whether they will also increase the tolerance to parenteral substrates in preterm neonates is being investigated in several ongoing trials.…”