ω‐3 Fatty‐Acid Enriched Parenteral Nutrition in Hospitalized Patients: Systematic Review With Meta‐Analysis and Trial Sequential Analysis

• Published in: JPEN. Journal of parenteral and enteral nutrition 2020-01, Vol.44 (1), p.44-57
• Main Authors: Pradelli, Lorenzo, Mayer, Konstantin, Klek, Stanislaw, Omar Alsaleh, Abdul Jabbar, Clark, Richard A. C., Rosenthal, Martin D., Heller, Axel R., Muscaritoli, Maurizio
• Format: Article
• Language: English
• Subjects: Adult; Cross Infection - prevention & control; Fatty Acids, Omega-3 - administration & dosage; fish oil; Humans; intensive care; Intensive Care Units; Length of Stay; lipid emulsion; meta‐analysis; omega‐3; Original Communication; Original Communications; Parenteral Nutrition; Randomized Controlled Trials as Topic; Sepsis - prevention & control; surgery; systematic review
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1002/jpen.1672

This systematic review and meta‐analysis investigated ω‐3 fatty‐acid enriched parenteral nutrition (PN) vs standard (non‐ω‐3 fatty‐acid enriched) PN in adult hospitalized patients (PROSPERO 2018 CRD42018110179). We included 49 randomized controlled trials (RCTs) with intervention and control groups given ω‐3 fatty acids and standard lipid emulsions, respectively, as part of PN covering ≥70% energy provision. The relative risk (RR) of infection (primary outcome; 24 RCTs) was 40% lower with ω‐3 fatty‐acid enriched PN than standard PN (RR 0.60, 95% confidence interval [CI] 0.49‐0.72; P < 0.00001). Patients given ω‐3 fatty‐acid enriched PN had reduced mean length of intensive care unit (ICU) stay (10 RCTs; 1.95 days, 95% CI 0.42‐3.49; P = 0.01) and reduced length of hospital stay (26 RCTs; 2.14 days, 95% CI 1.36‐2.93; P < 0.00001). Risk of sepsis (9 RCTs) was reduced by 56% in those given ω‐3 fatty‐acid enriched PN (RR 0.44, 95% CI 0.28‐0.70; P = 0.0004). Mortality rate (co‐primary outcome; 20 RCTs) showed a nonsignificant 16% reduction (RR 0.84, 95% CI 0.65‐1.07; P = 0.15) for the ω‐3 fatty‐acid enriched group. In summary, ω‐3 fatty‐acid enriched PN is beneficial, reducing risk of infection and sepsis by 40% and 56%, respectively, and length of both ICU and hospital stay by about 2 days. Provision of ω‐3‐enriched lipid emulsions should be preferred over standard lipid emulsions in patients with an indication for PN.