The Use of Fish Oil Lipid Emulsion in the Treatment of Intestinal Failure Associated Liver Disease (IFALD)

Abstract

Since 2004, fish oil based lipid emulsions have been used in the treatment of intestinal failure associated liver disease, with a noticeable impact on decreasing the incidence of morbidity and mortality of this often fatal condition. With this new therapy, however, different approaches have emerged as well as concerns about potential risks with using fish oil as a monotherapy. This review will discuss the experience to date with this lipid emulsion along with the rational for its use, controversies and concerns.

Influence of Soybean Oil or Non-Soybean Oil Based Lipid Emulsions on Parenteral Nutrition Associated Liver Disease in Late Preterm and Term Infants

“…However, in a recent prospective cohort study involving surgical infants who received prolonged TPN (at least two weeks), there was a significant reduction in the incidence of PNALD with restricted lipid dosing (1g/kg/day), compared to those who received normal lipid dosing (2-3g/kg/day) [7]. It is known that there is a greater risk of PNALD when infants are on TPN for a longer duration [8,9]. Given that in our Group B sample size is smaller and there is a skew in the gender distribution of the 'Soy' group, the significance of the increase in PNALD prevalence rates between infants in Group A and B may be underestimated, or confounded by other nutritional components like amino acids in the TPN formulations [9].…”

“…The inflammation, secretion of gut hormones and extent of bowel loss associated with short bowel syndrome, as well as the prematurity of the infants in other studies may be a possible confounding factor in other studies that show a benefit of substituting SLE with FLE. Furthermore, there are also concerns whether FLE contain sufficient essential fatty acids to prevent nutritional deficiency because FLE only provide the downstream mediators [8]. Therefore, the benefits of using FLE need to be further elucidated.…”

Immune activation by medium-chain triglyceride-containing lipid emulsions is not modulated by n-3 lipids or toll-like receptor 4

“…For instance, the amount of the anti-oxidant a-tocopherol differs among the different emulsions and is sensitive to storage conditions. The highest amount of a-tocopherol is found in FO, and a-tocopherol is added to LCT/MCT/FO/OO and LCT/MCT/FO (Chang et al, 2012). To determine whether differences in anti-oxidants in the emulsions explain differences in lipid effects, we assessed the total oxidant capacity of all tested lipids.…”

Emergence of Mixed‐Oil Fat Emulsions for Use in Parenteral Nutrition

“…Lack of EN can also lead to reduced gallbladder contraction and biliary sludge, as well as increased intestinal stasis and bacterial overgrowth, which may also contribute to the development of IFALD. In addition, SO IFE tends to contain a high amount of phytosterols, which tend to correlate with the severity of IFALD 36 – 39 . Enteral phytosterols can play a beneficial role by inhibiting absorption of cholesterol; however, parenteral administration can lead to increased circulating levels as they are not as readily converted to bile acids and disposed of by the body 40 …”

“…They can act through a number of mechanisms, including enhancement of phagocytic and clearance function of macrophages and reduction in cytokine production, as well as a decrease in neutrophil infiltration, to produce benefits in models ranging from lung injury and wound healing to ischemic reperfusion 83 , 84 . In addition to these benefits of reducing inflammation, EPA through the activation of peroxisome proliferator receptor α (PPAR‐α) can upregulate β‐oxidation, thereby preventing hepatic lipid accumulation 39 …”