The Role of an Intravenous Fat Emulsion Composed of Fish Oil in a Parenteral Nutrition‐Dependent Patient With Hypertriglyceridemia

Gura, Kathleen M.; Strijbosch, Robbert; Arnold, Sarah; McPherson, Christopher; Puder, Mark

doi:10.1177/0115426507022006664

Cited by 27 publications

(22 citation statements)

References 58 publications

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“…We have also shown that fish oil-based lipid emulsion can be effective as a sole fat source in cases of hypertriglyceridemia or when standard soybean-based emulsions are contraindicated (9, 10). It should be noted that although both emulsions are primarily constituted of a single fatty acid type (omega-6 or omega-3), they are not a pure fatty acid subtype formulation and both possess some amount of the other (primarily omega-6 + some omega-3, primarily omega-3 + some omega-6).…”

mentioning

confidence: 88%

Impact of Fish Oil-Based Lipid Emulsion on Serum Triglyceride, Bilirubin, and Albumin Levels in Children With Parenteral Nutrition-Associated Liver Disease

et al. 2009

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Parenteral nutrition is known to cause liver injury in babies. The aim of this study is to investigate the effects of different lipid emulsions on parenteral nutrition-associated cholestasis in infants. In addition, there may be a relationship between the lipid emulsion and triglyceride levels. Furthermore, triglyceride levels may correlate with direct bilirubin and albumin, as markers of liver impairment and nutritional status. Patients with parenteral nutrition-associated cholestasis who were treated with a fish oil-based lipid emulsion (n=18) were prospectively followed for triglyceride, direct bilirubin, and albumin levels and compared to patients who were maintained on a soy-based lipid emulsion (n=59). Triglyceride levels decreased in the fish oil cohort from a mean of 140 mg/dL at week 0 to 40 mg/dL at week 20, but remained unchanged at approximately 140 mg/dl in the soybean cohort. Triglyceride levels of patients treated with fish oil declined over time, while those receiving soybean oil did not. Also, changes in triglyceride levels over time were directly correlated with direct bilirubin and inversely related to albumin levels. These findings may indicate an added benefit of reduced triglyceride levels for patients treated with fish oil and this effect coincides with markers for improved liver function and nutritional status.

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confidence: 88%

Impact of Fish Oil-Based Lipid Emulsion on Serum Triglyceride, Bilirubin, and Albumin Levels in Children With Parenteral Nutrition-Associated Liver Disease

et al. 2009

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“…The aforementioned studies using fish oil as the sole source of fat in a subset of pediatric patients dependent on PN showed that their EFAD reversed, liver function improved, and growth was maintained (47). However, there is still skepticism regarding the ability of a fish oil-based diet, when used as monotherapy, to prevent EFAD and maintain adequate growth rate (48-50).…”

Section: Fish Oil Prevents Essential Fatty Acid Deficiencymentioning

confidence: 99%

The essentiality of arachidonic acid and docosahexaenoic acid

Meisel

Meijer

et al. 2009

Prostaglandins, Leukotrienes and Essential Fatty Acids

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Objective The purpose of this review is to correlate the clinical finding that patients receiving parenteral nutrition with a fish oil-based lipid emulsion do not develop essential fatty acid deficiency (EFAD) with an experimental murine model, thus showing that arachidonic acid (AA) and docosahexaenoic acid (DHA) are likely to be the essential fatty acids. Background Conventional belief is that linoleic acid (LA, omega-6) and alpha-linolenic acid (ALA, omega-3) are the essential fatty acids (EFAs). We have shown that a fish oil-based lipid emulsion containing AA (omega-6) and docosahexaenoic acid (DHA, omega-3) and insignificant quantities of LA and ALA is efficacious in the treatment of parenteral nutrition-associated liver disease (PNALD), a major cause of liver-related morbidity and mortality. The prospect of using a fish oil-based lipid emulsion as monotherapy has raised concerns of EFAD development, hindering its adoption into clinical practice. Design Data from patients in our institution who received PN with a fish oil-based lipid emulsion was reviewed for clinical and biochemical evidence of EFAD, defined as an elevated triene-tetraene ratio (Mead acid/AA >0.2). We also investigated the minimum amount of fish oil required to prevent EFAD in a murine model and determined whether DHA and AA alone can prevent EFAD. Results No patients receiving PN with a fish oil-based lipid emulsion in our institution have developed biochemical or clinical evidence of EFAD such as an elevated triene-tetraene ratio, growth retardation or dermatitis. This observation parallels our previously published animal studies, which demonstrated prevention of EFAD when thirteen percent of total calories were from fish oil. Moreover, current work in our laboratory shows that AA and DHA provision alone is sufficient to prevent biochemical and physiologic evidence of EFAD in a murine model. Conclusions When dosed appropriately, fish oil-based lipid emulsions contain sufficient EFAs to prevent EFAD. Furthermore, AA and DHA alone may be the true EFAs.

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“…In contrast with OM3 EE forms that require this digestive step, the free fatty acid forms of omega-3 are not dependent on pancreatic enzyme activity5–12 and are readily absorbed, so have improved bioavailability that is less dependent on meal fat content 13. A novel free fatty acid formulation of omega-3 (OM3 FFA, Epanova™, Omthera Pharmaceuticals Inc, Princeton, NJ, USA) was developed to maximize the bioavailability of the omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic (DHA), in patients with hypertriglyceridemia who are advised to restrict fat intake 3.…”

Section: Introductionmentioning

confidence: 99%

Steady-state bioavailability of prescription omega-3 on a low-fat diet is significantly improved with a free fatty acid formulation compared with an ethyl ester formulation: the ECLIPSE II study

Offman¹,

Marenco²,

Ferber³

et al. 2013

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The systemic bioavailability of free fatty acid (FFA) forms of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) compared with ethyl ester (EE) forms is dependent on the presence of intestinal lipases and is highest during consumption of high-fat meals. Given that patients with cardiovascular disease are advised to reduce dietary fat intake, potentially lowering the bioavailability and therapeutic benefit, the hypothesis that FFA forms provide for higher bioavailability compared with EE forms under low-fat diet conditions was tested where the pharmacokinetics of the FFA form (Epanova™) were compared with those of an ethyl ester form (Lovaza®) following repeat dosing. Fifty-two healthy male and female subjects were equally allocated to one of two open-label, parallel-group cohorts. Following a Therapeutic Lifestyle Changes diet for a minimum of 7 days, blood samples were drawn for endogenous values for EPA and DHA over a 24-hour period. Subjects were then administered 4 × 1 g capsules of either Epanova (OM3 FFA) or Lovaza (OM3 EE) once daily for 14 days, following which serial blood samples were drawn over a 24-hour period to characterize the bioavailability of EPA and DHA from the respective formulations. In addition, changes from baseline in lipid profile were explored. Systemic bioavailability, as measured by area under the curve from time zero to 24 hours (AUC0-τ) and the maximum measured plasma concentrations during the 0–24 hour dosing interval (Cmax,ss) of unadjusted total plasma EPA + DHA were approximately 3-fold and 3.9-fold higher, respectively, for Epanova relative to Lovaza. Following baseline adjustment, the magnitude of difference in bioavailability was approximately 5.8-fold and 6.5-fold higher in AUC0-τ and Cmax, respectively, for Epanova relative to Lovaza. Serum triglycerides were reduced by a significantly greater extent (P = 0.013) for Epanova relative to Lovaza (21% versus 8%). The bioavailability of the FFA forms of EPA and DHA in Epanova are significantly greater than the bioavailability from the EE forms present in Lovaza under low-fat dietary conditions normally recommended for patients with cardiovascular disease. This increased bioavailability may lead to improved triglyceride-lowering in patients with hypertriglyceridemia.

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The Role of an Intravenous Fat Emulsion Composed of Fish Oil in a Parenteral Nutrition‐Dependent Patient With Hypertriglyceridemia

Cited by 27 publications

References 58 publications

Impact of Fish Oil-Based Lipid Emulsion on Serum Triglyceride, Bilirubin, and Albumin Levels in Children With Parenteral Nutrition-Associated Liver Disease

Impact of Fish Oil-Based Lipid Emulsion on Serum Triglyceride, Bilirubin, and Albumin Levels in Children With Parenteral Nutrition-Associated Liver Disease

The essentiality of arachidonic acid and docosahexaenoic acid

Steady-state bioavailability of prescription omega-3 on a low-fat diet is significantly improved with a free fatty acid formulation compared with an ethyl ester formulation: the ECLIPSE II study

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