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.
Highlights
Parenteral nutrition (PN) provides a life-saving intervention for patients unable to absorb enteral nutrients secondary to intestinal failure due to inadequate bowel length or function [1]
This review provides an overview of the use of fish oil lipid emulsions (FO) in the clinical setting, and the potential mechanisms for its efficacy in treating intestinal failure-associated liver disease (IFALD)
Stage liver injury is speculated to be hepatic steatosis with progression onto steatohepatitis. This is mediated via tumor necrosis factor α (TNF-α) and other inflammatory mediators released by Kupffer cells during sepsis and/or inflammation related to native disease or surgery [68]
Summary
Parenteral nutrition (PN) provides a life-saving intervention for patients unable to absorb enteral nutrients secondary to intestinal failure due to inadequate bowel length or function [1]. Over the course of its use, the development of intestinal failure-associated liver disease (IFALD) has been the source of significant morbidity and mortality. First described essential fatty acid deficiency (EFAD) manifesting as impaired growth, dermatitis, hepatic steatosis, renal toxicity, and pulmonary abnormalities [11]. This condition which occurs from low dietary intake, severe malabsorption, or increased physical requirements seen in growth, became clinically relevant with the availability of fat-free parenteral nutrition [12]. Oleic acid (omega-9), which can be endogenously produced, via elongation and desaturation, form Mead acid (triene) This mechanism is necessary to maintain the number of double bonds in the cell membrane to provide structural integrity [15]. Human studies have shown that the optimal daily requirements of LA are 1%–3% of the total caloric intake in order to prevent EFAD [16,17]
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