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

Shishira Bharadwaj, Tushar Gohel, Omer J Deen, Robert DeChicco, Abdullah Shatnawei, Shishira Bharadwaj, Tushar Gohel, Omer J Deen, Robert DeChicco, Abdullah Shatnawei

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.

Keywords: fish oil-based lipid emulsion; intestinal failure; parenteral nutrition; parenteral nutrition-associated liver disease.

© The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

References

    1. O'Keefe SJ, Buchman AL, Fishbein TM, et al. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol 2006;4:6–10.
    1. Pironi L, Joly F, Forbes A, et al. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut 2011;60:17–25.
    1. Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology 2006;130(2 Suppl 1):S16–28.
    1. Andorsky DJ, Lund DP, Lillihei CW, et al. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes . J Pediatr 2001;139:27–33.
    1. Rhoda KM, Suryadevara S, Steiger E. Home parenteral nutrition support for intestinal failure. Surg Clin North Am 2011;91:913–32.
    1. Rhoda KM, Parekh NR, Lennon E, et al. The multidisciplinary approach to the care of patients with intestinal failure at a tertiary care facility. Nutr Clin Pract 2010;25:183–91.
    1. Kaufman SS, Atkinson JB, Bianchi A, et al. Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant 2001;5:80–7.
    1. Kelly DA. Intestinal failure-associated liver disease: what do we know today? Gastroenterology 2006;130(2 Suppl):S70–7.
    1. Beath SV, Davies P, Papadopoulou A, et al. Parenteral nutrition-related cholestasis in postsurgical neonates: multivariate analysis of risk factors. J Pediatr Surg 1996;31:604–6.
    1. Candusso M, Faraguna D, Sperlì D, et al. Outcome and quality of life in paediatric home parenteral nutrition . Curr Opin Clin Nutr Metab Care 2002;5:309–14.
    1. Drongowski RA, Coran AG. An analysis of factors contributing to the development of total parenteral nutrition induced cholestasis. JPEN J Parenter Enteral Nutr 1989;13:586–9.
    1. Luman W, Shaffer JL. Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition. Clin Nutr 2002;21:337–43.
    1. Cavicchi M, Beau P, Crenn P, et al. Prevalence of liver disease and permanent intestinal failure. Ann Intern Med 2000;132:525–32.
    1. Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr 1999;70(3 Suppl):560S–569S.
    1. Das UN. Essential Fatty acids - a review. Curr Pharm Biotechnol 2006;7:467–82.
    1. Holman RT, Johnson SB, Hatch TF. A case of human linolenic acid deficiency involving neurological abnormalities. Am J Clin Nutr 1982;35:617–23.
    1. Lowe NJ, DeQuoy PR. Linoleic acid effects on epidermal DNA synthesis and cutaneous prostaglandin levels in essential fatty acid deficiency . J Invest Dermatol 1978;70:200–3.
    1. Uauy R, Peirano P, Hoffman D, et al. Role of essential fatty acids in the function of the developing nervous system. Lipids 1996;31:S167–76.
    1. Lands B. Consequences of essential fatty acids . Nutrients 2012;4:1338–57.
    1. Calder PC, Jensen GL, Koletzko BV, et al. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med 2010;36:735–49.
    1. Pittiruti M, Hamilton H, Biffi R, et al. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009;28:365–77.
    1. Mirtallo J, Canada T, Johnson D, et al. Safe Practices for Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2004;28:S39–70.
    1. Mascioli EA, Lopes SM, Champagne C, et al. Essential fatty acid deficiency and home total parenteral nutrition patients. Nutrition 1996;12:245–9.
    1. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics 1985;76:976–86.
    1. Adolph M. Lipid emulsions in parenteral nutrition. Ann Nutr Metab 1999;43:1–13.
    1. Shenkin A, Wretlind A. Parenteral nutrition. World Rev Nutr Diet 1978;28:1–111.
    1. Wanten GJ, Calder PC. Immune modulation by parenteral lipid emulsions. Am J Clin Nutr 2007;85:1171–84.
    1. Wanten G. An update on parenteral lipids and immune function: only smoke, or is there any fire? Curr Opin Clin Nutr Metab Care 2006;9:79–83.
    1. Lewis RA. Interactions of eicosanoids and cytokines in immune regulation. Adv Prostaglandin Thromboxane Leukot Res 1990;20:170–8.
    1. Tilley SL, Coffman TM, Koller BH. Mixed messages: modulation of inflammation and immune responses by prostaglandins and thromboxanes. J Clin Invest 2001;108:15–23.
    1. Heller A, Koch T, Schmeck J, et al. Lipid mediators in inflammatory disorders. Drugs 1998;55:487–96.
    1. Serhan CN, Arita M, Hong S, et al. Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their endogenous aspirin-triggered epimers. Lipids 2004;39:1125–32.
    1. Kosters A, Karpen SJ. The role of inflammation in cholestasis: clinical and basic aspects. Semin Liver Dis 2010;30:186–94.
    1. Beckh K, Kneip S, Arnold R. Direct regulation of bile secretion by prostaglandins in perfused rat liver. Hepatology 1994;19:1208–13.
    1. Colomb V, Jobert-Giraud A, Lacaille F, et al. Role of lipid emulsions in cholestasis associated with long-term parenteral nutrition in children. JPEN J Parenter Enteral Nutr 2000;24:345–50.
    1. Lauriti G1, Zani A, Aufieri R, et al. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intestinal failure-associated liver disease in infants and children: a systematic review. JPEN J Parenter Enteral Nutr 2014;38:70–85.
    1. Eloranta JJ, Kullak-Ublick GA. The role of FXR in disorders of bile acid homeostasis. Physiology 2008;23:286–95.
    1. Tillman EM. Review and clinical update on parenteral nutrition-associated liver disease. Nutr Clin Pract 2013;28:30–9.
    1. Fürst P, Kuhn KS. Fish oil emulsions: what benefits can they bring? Clin Nutr 2000;19:7–14.
    1. Mayer K, Grimm H, Grimminger F, et al. Parenteral nutrition with n-3 lipids in sepsis. Br J Nutr 2002;87:S69–75.
    1. de Meijer VE, Gura KM, Le HD, et al. Fish oil-based lipid emulsions prevent and reverse parenteral nutrition-associated liver disease: the Boston experience. JPEN J Parenter Enteral Nutr 2009;33:541–7.
    1. Liang B, Wang S, Ye YJ, et al. Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World J Gastroenterol 2008;14:2434–9.
    1. Wachtler P, König W, Senkal M, et al. Influence of a total parenteral nutrition enriched with omega-3 fatty acids on leukotriene synthesis of peripheral leukocytes and systemic cytokine levels in patients with major surgery. J Trauma 1997;42:191–8.
    1. Weiss G, Meyer F, Matthies B, et al. Immunomodulation by perioperative administration of n-3 fatty acids. Br J Nutr 2002;87:S89–94.
    1. Mayer K, Gokorsch S, Fegbeutel C, et al. Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis. Am J Respir Crit Care Med 2003;167:1321–8.
    1. Pscheidl EM, Schywalsky M, Tschaikowsky K, et al. Fish oil-supplemented parenteral diets normalize splanchnic blood flow and improve killing of translocated bacteria in a low-dose endotoxin rat model. Crit Care Med 2000;28:1489–96.
    1. Pscheidl EM, Wan JM, Blackburn GL, et al. Influence of omega-3 fatty acids on splanchnic blood flow and lactate metabolism in an endotoxemic rat model. Metabolism 1992;41:698–705.
    1. Van Aerde JE, Duerksen DR, Gramlich L, et al. Intravenous fish oil emulsion attenuates total parenteral nutrition–induced cholestasis in newborn piglets. Pediatr Res 1999;45:202–8.
    1. Meisel JA, Le HD, de Meijer VE, et al. Comparison of 5 intravenous lipid emulsions and their effects on hepatic steatosis in a murine model. J Pediatr Surg 2011;46:666–73.
    1. Gura KM, Duggan CP, Collier SB, et al. Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management. Pediatrics 2006;118:e197–201.
    1. Gura KM, Lee S, Valim C, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 2008;121:e678–86.
    1. Heller AR, Rössel T, Gottschlich B, et al. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients . Int J Cancer 2004;111:611–6.
    1. Wang J, Yu JC, Kang WM, et al. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition 2012;28:623–9.
    1. Mertes N, Grimm H, Fürst P, et al. Safety and efficacy of a new parenteral lipid emulsion (SMOFlipid) in surgical patients: a randomized, double-blind, multicenter study. Ann NutrMetab 2006;50:253–9.
    1. Klek S, Chambrier C, Singer P. Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid)–a double-blind, randomised, multicentre study in adults. Clin Nutr 2013;32:224–31.
    1. Burns DL, Gill BM. Reversal of parenteral nutrition-associated liver disease with a fish oil-based lipid emulsion (Omegaven) in an adult dependent on home parenteral nutrition. JPEN J Parenter Enteral Nutr 2013;37:274–80.
    1. Jurewitsch B, Gardiner G, Naccarato M, et al. Omega-3-enriched lipid emulsion for liver salvage in parenteral nutrition-induced cholestasis in the adult patient. JPEN J Parenter Enteral Nutr 2011;35:386–90.
    1. Mallah HS, Brown MR, Rossi TM, et al. Parenteral fish oil-associated burr cell anemia. J Pediatr 2010;156:324–6.

Source: PubMed

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