Fish oil-based lipid emulsion: current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease.

S Bharadwaj,T Gohel,O J Deen,R Dechicco,A Shatnawei

doi:10.1093/gastro/gov011

S Bharadwaj, T Gohel + Show 3 more

Open Access

https://doi.org/10.1093/gastro/gov011

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Journal: Gastroenterology report	Publication Date: Apr 8, 2015
Citations: 42	License type: cc-by

Affiliation: Cleveland Clinic

Abstract

Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain life. Parenteral nutrition (PN) is a lifesaving therapeutic modality for patients with intestinal failure. Lifelong PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with malabsorption. However, prolonged PN is associated with short-term and long-term complications. Parenteral nutrition-associated liver disease (PNALD) is one of the long-term complications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients. PNALD affects 30–60% of the adult population on long-term PN. Further, PNALD is one of the indications for isolated liver or combined liver and intestinal transplantation. There is no consensus on how to manage PNALD, but fish oil-based lipid emulsion (FOBLE) has been suggested to play an important role both in its prevention and reversal. There is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid emulsion. Studies have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term PN. Future prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD.

Highlights

Intestinal failure is defined as the inability of enterocytes to absorb necessary nutrients, water, electrolytes, vitamins and minerals either due to reduced length of the intestine or loss of its normal function [1]
Parenteral nutrition-associated liver disease (PNALD) is one of the long-term complications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients
Studies have demonstrated that fish oil-based lipid emulsion (FOBLE) reverses hepatic steatosis and reduces markers of inflammation in patients on long-term PN

Summary

Introduction

Intestinal failure is defined as the inability of enterocytes to absorb necessary nutrients, water, electrolytes, vitamins and minerals either due to reduced length of the intestine or loss of its normal function [1]. Parenteral nutrition-associated liver disease (PNALD) is one of the long-term complications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients. There is no consensus on how to manage PNALD, but fish oil-based lipid emulsion (FOBLE) has been suggested to play an important role both in its prevention and reversal.

Results

Conclusion