title: Fish oil-based lipid emulsion in the treatment of parenteral nutrition-associated liver disease.
abstract: OBJECTIVE
  Parenteral nutrition-associated liver disease (PNALD) is a major cause of morbidity and mortality in the parenteral nutrition-dependent population. Here, we review the most recent literature involving a fish oil-based lipid emulsion (FOLE) and its effects on PNALD.
  
  
  RESULTS
  Vegetable oil-based lipid emulsions (VBLEs) contribute to PNALD. This may be due to parenteral phytosterols and/or the presence of pro-inflammatory mediators. Whereas a small reduction in the dose of VBLE does not appear to prevent PNALD, a significant reduction in the dose may reverse PNALD; however, it carries the risk of essential fatty acid deficiency. Furthermore, the impact of extreme lipid restriction on subsequent neurodevelopment is unknown. Combination lipid emulsions containing fish oil are associated with decreased bilirubin levels, though no studies compare these emulsions with the outcomes with FOLE alone. The utility of FOLE in the reversal of PNALD has been demonstrated and its administration does not lead to essential fatty acid deficiency. Furthermore, there is evidence that FOLE may prevent PNALD.
  
  
  CONCLUSIONS
  FOLE appears to be an efficacious treatment to reverse PNALD. However, more studies are necessary to determine if FOLE might also be beneficial in the prevention of PNALD. Future studies should additionally focus on the preterm infant population, as they represent a major population requiring parenteral nutrition support for survival.
authors: Department of Surgery and the Vascular Biology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
authors: Eileen
authors: E
authors: Cowan
authors: Prathima
authors: P
authors: Nandivada
authors: Mark
authors: M
authors: Puder
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D005395:Fish Oils / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010938:Plant Oils / Q000009:adverse effects
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D010938:Plant Oils