Prevention of parenteral nutrition-associated liver disease:  role of omega-3 fish oil.
OBJECTIVE
Parenteral nutrition-associated liver disease (PNALD) is the most severe complication of long-term parenteral nutrition. Its cause remains unclear, although recent studies suggest that the omega-6 polyunsaturated fatty acids in plant oil-based lipid emulsions and the associated phytosterols contribute to the development of hepatotoxicity. In contrast, fish oil-based lipid emulsions are composed mainly of omega-3 polyunsaturated fatty acids and are hypothesized to be hepatoprotective. This review will discuss fish oil-based lipid emulsions in the prevention of PNALD.


RESULTS
In several animal models of PNALD, the use of an intravenous fish oil-based lipid emulsion improved parenteral nutrition-associated cholestasis without resultant essential fatty acid deficiency or growth impairment. Following these results and preliminary human data, an open trial for compassionate use was initiated, followed by a randomized controlled trial to evaluate the current management of pediatric PNALD. To date, at the author's institution, more than 130 children with PNALD have been treated with Omegaven, a fish oil-based emulsion, with improved liver function among most patients.


CONCLUSIONS
PNALD remains the most severe complication of long-term parenteral nutrition with an unclear pathophysiology. However, the use of a fish oil-based emulsion appears efficacious and hepatoprotective.
Fallon
Erica M
EM
Department of Surgery and Vascular Biology Program, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Le
Hau D
HD
Puder
Mark
M
D000818:Animals; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D005228:Fatty Acids, Essential / Q000172:deficiency; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007408:Intestinal Absorption; D007422:Intestines / Q000503:physiopathology; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D008107:Liver Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000009:adverse effects; D012778:Short Bowel Syndrome / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013024:Soybean Oil / Q000008:administration & dosage / Q000009:adverse effects
D005217:Fat Emulsions, Intravenous; D005228:Fatty Acids, Essential; D015525:Fatty Acids, Omega-3; D013024:Soybean Oil