Use of Parenteral Fish Oil in the Management of IF-Associated Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease affecting up to 25% of the population worldwide. n-3 long-chain polyunsaturated fatty acids (n-3 PUFA) have been associated with improved clinical parameters of NAFLD. Our purpose was to conduct a pilot study to evaluate the effects of n-3 PUFA supplementation in a randomized, double-blind, placebo-controlled clinical study performed on NAFLD individuals diagnosed by ultrasound. Patients received n-3 PUFA (n = 13) or placebo (n = 11) supplementation for six months. Circulating miR-122 expression (determined by quantitative real time-polymerase chain reaction (qRT-PCR), liver fibrosis (FibroScan®), red blood cells (RBC) fatty acids (gas chromatography), and biochemical tests were performed at baseline and after intervention. After the intervention, in the n-3 PUFA group, docosahexaenoic acid (DHA) and omega index increased significantly in RBC (p = 0.022 and p = 0.012, respectively), in addition to a significant reduction in alkaline phosphatase (ALP) (p = 0.002) and liver fibrosis (p = 0.039). However, there was no change in the expression of circulating miR-122 in both groups. Our results showed that omega-3 PUFA were incorporated in erythrocytes after six months of fish oil supplementary intake, and that n-3 PUFA were effective in reducing ALP and liver fibrosis without altering the expression of circulating miR-122 in individuals with NAFLD.

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Reversal of Intestinal Failure–Associated Liver Disease by Increasing Fish Oil Within a Multi‐Oil Intravenous Lipid Emulsion in Adult Short‐Bowel Syndrome Patients

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1823 ◽

2020 ◽

Cited By ~ 2

Author(s):

Hyo Jung Park ◽

Sanghoon Lee ◽

Chi‐Min Park ◽

Keesang Yoo ◽

Jeong‐Meen Seo

Keyword(s):

Liver Disease ◽

Fish Oil ◽

Short Bowel Syndrome ◽

Lipid Emulsion ◽

Intestinal Failure ◽

Short Bowel ◽

Intravenous Lipid Emulsion

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Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit

Journal of Clinical Medicine ◽

10.3390/jcm9113393 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3393

Author(s):

Sanghoon Lee ◽

Se In Sung ◽

Hyo Jung Park ◽

Yun Sil Chang ◽

Won Soon Park ◽

...

Keyword(s):

Liver Disease ◽

Birth Weight ◽

Fish Oil ◽

Neonatal Intensive Care ◽

Lipid Emulsion ◽

Intestinal Failure ◽

Direct Bilirubin ◽

Low Birth Weight Infants ◽

Life Threatening

Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven® (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.

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A Retrospective Analysis of the Effect of Combination of Pure Fish Oil with Third Generation Lipid Emulsion on Liver Function in Children on Long-Term Parenteral Nutrition

Nutrients ◽

10.3390/nu11102495 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2495

Author(s):

Mikołaj Danko ◽

Aleksandra Żyła-Pawlak ◽

Janusz Książyk ◽

Katarzyna Olszewska-Durkacz ◽

Marta Sibilska ◽

...

Keyword(s):

Liver Disease ◽

Liver Function ◽

Parenteral Nutrition ◽

Fish Oil ◽

Retrospective Analysis ◽

Lipid Emulsion ◽

Intestinal Failure ◽

Third Generation ◽

Glutamyl Transferase

Background: Deterioration of liver function, or intestinal failure-associated liver disease, is often observed in long-term parenterally fed children. Fish oil-based intravenous lipids have been reported to play a role in the prevention and treatment of intestinal failure associated liver disease. Methods: This retrospective analysis included 40 pediatric patients, (20 male and 20 female), median age 38 months (range 1.5–200 months) on long-term (≥1 month) parenteral nutrition who received the parenteral mixtures containing a combination of a third-generation lipid emulsion and pure fish oil because of laboratory liver function abnormalities. The total dose of fish oil from both emulsions for each patient exceeded 0.5 g/kg/day. Data from visits in an outpatient clinic were retrospectively analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation test. Results: The median time of therapy was 149 days (range 28–418 days). There was a decrease of median total and direct (conjugated) bilirubin concentration from 22.23 µmol/L (range 3.42–243 µmol/L) to 10.26 µmol/L (range 3.42–180.58 µmol/L; p < 0.005) and 8.55 (range 1.71–212.04 µmol/L) to 6.84 µmol/L (range 1.71–150.48 µmol/L; p < 0.007) respectively. A significant decrease in median alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase was also observed. In 11 patients bilirubin concentrations increased or remained unchanged. When compared to the patients who responded to the combination therapy, the patients who did not respond received parenteral nutrition for a longer time prior to the start of the therapy (51 vs. 30 months; p < 0.05). Conclusions: The mixture of an intravenous lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil with the addition of pure fish oil emulsion may be helpful in the treatment of liver complications in children on long-term parenteral nutrition.

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Intravenous fish oil lipid emulsion promotes a shift toward anti-inflammatory proresolving lipid mediators

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00106.2013 ◽

2013 ◽

Vol 305 (11) ◽

pp. G818-G828 ◽

Cited By ~ 30

Author(s):

Brian T. Kalish ◽

Hau D. Le ◽

Jonathan M. Fitzgerald ◽

Samantha Wang ◽

Kyle Seamon ◽

...

Keyword(s):

Liver Disease ◽

Fish Oil ◽

Lipid Emulsion ◽

Lipid Mediators ◽

Lipid Emulsions ◽

Serum Samples ◽

Human Infants ◽

Life Threatening ◽

Small Cohort ◽

Anti Inflammatory

Parenteral nutrition (PN)-associated liver disease (PNALD) is a life-threatening complication of the administration of PN. The development of PNALD may be partly due to the composition of the lipid emulsion administered with PN: soybean oil-based lipid emulsions (SOLE) are associated with liver disease, while fish oil-based lipid emulsions (FOLE) are associated with prevention and improvement of liver disease. The objective of this study was to determine how the choice of lipid emulsion modified the production of bioactive lipid mediators (LMs). We utilized a mouse model of steatosis to study the differential effect of FOLE and SOLE. We subsequently validated these results in serum samples from a small cohort of human infants transitioning from SOLE to FOLE. In mice, FOLE was associated with production of anti-inflammatory, proresolving LMs; SOLE was associated with increased production of inflammatory LMs. In human infants, the transition from SOLE to FOLE was associated with a shift toward a proresolving lipidome. Together, these results demonstrate that the composition of the lipid emulsion directly modifies inflammatory homeostasis.

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