Parenteral fish oil monotherapy in the management of patients with parenteral nutrition-associated liver disease.
OBJECTIVE
To update knowledge on the management of parenteral nutrition-associated liver disease (PNALD) and to review the clinical data on the use of parenteral fish oil for reversal of PNALD.


METHODS
A literature review was conducted by searching the MEDLINE database (May 1, 2009) using the keywords parenteral nutrition-associated liver disease, fish oil, omega-3, Omegaven, and lipid emulsion.


METHODS
All articles reporting clinical cases with the use of parenteral fish oil for management of PNALD.


METHODS
Three reviewers independently analyzed the epidemiological, clinical, and treatment data of the articles.


RESULTS
Six case reports (10 patients) and 2 cohort studies (12 and 18 patients) were analyzed.


CONCLUSIONS
Fish oil-derived emulsions have been demonstrated to reverse preexisting PNALD and to prevent and treat essential fatty acid deficiency. Its ability to prevent PNALD is currently under investigation. Although the mechanism has yet to be fully understood, the advantages of fish oil-based lipid emulsions over soybean oil-based lipid emulsions seen to date suggest that fish oil-based emulsions would be better suited for use in long-term parenteral nutrition.
de Meijer
Vincent E
VE
Vascular Biology Program, Department of Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115, USA.
Gura
Kathleen M
KM
Meisel
Jonathan A
JA
Le
Hau D
HD
Puder
Mark
M
D000818:Animals; D004195:Disease Models, Animal; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D051379:Mice; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils