Parenteral fish-oil–based lipid emulsion improves fatty acid profiles and lipids in parenteral nutrition–dependent children123

• Published in: The American journal of clinical nutrition 2011-09, Vol.94 (3), p.749-758
• Main Authors: Le, Hau D, de Meijer, Vincent E, Robinson, Elizabeth M, Zurakowski, David, Potemkin, Alexis K, Arsenault, Danielle A, Fallon, Erica M, Malkan, Alpin, Bistrian, Bruce R, Gura, Kathleen M, Puder, Mark
• Format: Article
• Language: English
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.110.008557

Background: Total parenteral nutrition (PN), including fat administered as a soybean oil–based lipid emulsion (SOLE), is a life-saving therapy but may be complicated by PN-induced cholestasis and dyslipidemia. A fish-oil–based lipid emulsion (FOLE) as a component of PN can reverse PN-cholestasis and has been shown to improve lipid profiles. Objective: The objective was to describe changes in the fatty acid and lipid profiles of children with PN-cholestasis who were treated with a FOLE. Design: Lipid and fatty acid profiles of 79 pediatric patients who developed PN-cholestasis while receiving standard PN with a SOLE were examined before and after the switch to a FOLE. All patients received PN with the FOLE at a dose of 1 g · kg−1 · d−1 for ≥1 mo. Results: The median (interquartile range) age at the start of the FOLE treatment was 91 (56–188) d. After a median (interquartile range) of 18.3 (9.4–41.4) wk of receiving the FOLE, the subjects’ median total and direct bilirubin improved from 7.9 and 5.4 mg/dL to 0.5 and 0.2 mg/dL, respectively (P < 0.0001). Serum triglyceride, total cholesterol, LDL, and VLDL concentrations significantly decreased by 51.7%, 17.4%, 23.7%, and 47.9%, respectively. Conclusions: The switch from a SOLE to a FOLE in PN-dependent children with cholestasis and dyslipidemia was associated with a dramatic improvement in serum triglyceride and VLDL concentrations, a significant increase in serum omega-3 (n−3) fatty acids (EPA and DHA), and a decrease in serum omega-6 fatty acids (arachidonic acid). A FOLE may be the preferred lipid emulsion in patients with PN-cholestasis, dyslipidemia, or both. This trial is registered at clinicaltrials.gov as NCT00910104.