title: Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review the effects of omega-3 poly unsaturated fatty acids (FA) enriched nutrition support on the mortality of critically illness patients.
  
  
  METHODS
  Databases of Medline, ISI, Cochrane Library, and Chinese Biomedicine Database were searched and randomized controlled trials (RCTs) were identified. We enrolled RCTs that compared fish oil enriched nutrition support and standard nutrition support. Major outcome is mortality. Methodological quality assessment was conducted based on Modified Jadad's score scale. For control heterogeneity, we developed a method that integrated I2 test, nutritional support route subgroup analysis and clinical condition of severity. RevMan 5.0 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for meta-analysis.
  
  
  RESULTS
  Twelve trials involving 1208 patients that met all the inclusion criteria. Heterogeneity existed between the trials. A random model was used, there was no significant effect on mortality RR, 0.82, 95% confidence interval (CI) (0.62, 1.09), p = 0.18. Knowing that the route of fish oil administration may affect heterogeneity, we categorized the trials into two sub-groups: parenteral administration (PN) of omega-3 and enteral administration (EN) of omega-3. Six trials administered omega-3 FA through PN. Pooled results indicated that omega-3 FA had no significant effect on mortality, RR 0.76, 95% CI (0.52, 1.10), p = 0.15. Six trials used omega-3 fatty acids enriched EN. After excluded one trial that was identified as source of heterogeneity, pooled data indicated omega-3 FA enriched EN significant reduce mortality, RR=0.69, 95% CI [0.53, 0.91] (p = 0.007).
  
  
  CONCLUSIONS
  Omega-3 FA enriched nutrition support is safe. Due to the limited sample size of the included trials, further large-scale RCTs are needed.
authors.affiliation: Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Beijing 100730, China. chenw@pumch.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Beijing 100730, China. hua.jiang@traumabank.org.
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. cdzhouzhiyuan@gmail.com.
authors.forename: Zhi-Yuan
authors.initials: ZY
authors.lastname: Zhou
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. taoyx@163.com.
authors.forename: Ye-Xuan
authors.initials: YX
authors.lastname: Tao
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. bin.cai@traumabank.org.
authors.forename: Bin
authors.initials: B
authors.lastname: Cai
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. liuxiaoxiao1s@126.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. hao.yang@traumbank.org.
authors.forename: Hao
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. damienla@gmail.com.
authors.forename: Charles Damien
authors.initials: CD
authors.lastname: Lu
authors.affiliation: Department of Computational Mathematics and Bio-statistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu 610101, China. zengjun@medmail.com.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Zeng
mesh_terms: D016638:Critical Illness; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D018529:Nutritional Support / Q000009:adverse effects*
chemical_list: D015525:Fatty Acids, Omega-3