Effect of a fish oil-based lipid emulsion on intestinal failure-associated liver disease in children

• Published in: European journal of clinical nutrition 2018-10, Vol.72 (10), p.1364-1372
• Main Authors: Zhang, Tian, Wang, Nan, Yan, Weihui, Lu, Lina, Tao, Yijing, Li, Fang, Wang, Ying, Cai, Wei
• Format: Article
• Language: English
• Subjects: 692/699/1503/1581; 692/700/2814; Alanine; Alanine transaminase; Alanine Transaminase - blood; Alkaline phosphatase; Aspartate Aminotransferases - blood; Aspartate transaminase; Bilirubin; Bilirubin - blood; C-reactive protein; Child; Child, Preschool; Children; Clinical Nutrition; Dietary Fats - administration & dosage; Dietary Fats - therapeutic use; Emulsions; Energy intake; Enteral nutrition; Epidemiology; Fat Emulsions, Intravenous - chemistry; Fat Emulsions, Intravenous - pharmacology; Fat Emulsions, Intravenous - therapeutic use; Female; Fish; Fish oils; Fish Oils - administration & dosage; Fish Oils - pharmacology; Fish Oils - therapeutic use; gamma-Glutamyltransferase - blood; Humans; Indicators; Infant; Infant, Newborn; Inflammation; Inflammation - blood; Inflammation - drug therapy; Internal Medicine; Intestinal Diseases - complications; Intestine; Introduced fish; Leukocytes; Lipids; Liver; Liver - drug effects; Liver - enzymology; Liver - pathology; Liver diseases; Liver Diseases - drug therapy; Liver Diseases - etiology; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Nutrition; Oils & fats; Oxidative stress; Parenteral Nutrition; Plant Oils - therapeutic use; Proteins; Public Health; Soybean oil; Soybeans; Therapy; Transaminase; Triglycerides; Triglycerides - therapeutic use; Tumor necrosis factor-TNF; Tumor necrosis factor-α
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/s41430-018-0096-z

Background/Objectives The aim of this study was to assess the effects of a fish oil-based lipid emulsion on intestinal failure-associated liver disease (IFALD) in children. Subjects/Methods From January 2014 through June 2017, we enrolled 32 children with IF on long-term parenteral nutrition (PN). When the levels of any three of seven liver indicators (TBA, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase, gamma glutamyl transferase (γ-GT), total bilirubin (TB), or direct bilirubin (DB)) were two times higher than normal levels, we switched a 50:50 mix of soybean oil and medium-chain triglycerides (MCT) lipid emulsion (with an average dose of 1.30 g/kg/day) to a fish oil-based lipid emulsion (1 g/kg/day) and measured liver function in the children. Meanwhile, inflammation and oxidative stress-related markers were also measured. Results The average fish oil therapy duration was 26 ± 21 days, and the median duration of PN support was 84 days. With fish oil therapy, levels of TBA, ALT, AST, γ-GT, TB, and DB all significantly decreased. Enteral nutrition was introduced following fish oil resulting in higher energy intake (99.88 ± 31.06 kcal/kg/day) compared with before fish oil (67.90 ± 27.31 kcal/kg/day, P  = 0.001). No significant difference was found in average PN energy ( P  = 0.147). In addition, levels of inflammatory indicators like tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and white blood cell (WBC) significantly decreased. Conclusions Fish oil therapy alleviates IFALD in children.