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June 2010

Parenteral Fish Oil Monotherapy in the Management of Patients With Parenteral Nutrition–Associated Liver Disease

Author Affiliations

Author Affiliations: Vascular Biology Program (Drs de Meijer, Meisel, Le, and Puder) and Departments of Surgery (Drs de Meijer, Meisel, Le, and Puder) and Pharmacy (Dr Gura), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.

Arch Surg. 2010;145(6):547-551. doi:10.1001/archsurg.2010.80

Objectives  To update knowledge on the management of parenteral nutrition–associated liver disease (PNALD) and to review the clinical data on the use of parenteral fish oil for reversal of PNALD.

Data Sources  A literature review was conducted by searching the MEDLINE database (May 1, 2009) using the keywords parenteral nutrition–associated liver disease, fish oil, omega-3, Omegaven, and lipid emulsion.

Study Selection  All articles reporting clinical cases with the use of parenteral fish oil for management of PNALD.

Data Extraction  Three reviewers independently analyzed the epidemiological, clinical, and treatment data of the articles.

Data Synthesis  Six case reports (10 patients) and 2 cohort studies (12 and 18 patients) were analyzed.

Conclusions  Fish oil–derived emulsions have been demonstrated to reverse preexisting PNALD and to prevent and treat essential fatty acid deficiency. Its ability to prevent PNALD is currently under investigation. Although the mechanism has yet to be fully understood, the advantages of fish oil–based lipid emulsions over soybean oil–based lipid emulsions seen to date suggest that fish oil–based emulsions would be better suited for use in long-term parenteral nutrition.