To update knowledge on the management of parenteral nutrition–associated liver disease (PNALD) and to review the clinical data on the use of parenteral fish oil for reversal of PNALD.
A literature review was conducted by searching the MEDLINE database (May 1, 2009) using the keywords parenteral nutrition–associated liver disease, fish oil, omega-3, Omegaven, and lipid emulsion.
All articles reporting clinical cases with the use of parenteral fish oil for management of PNALD.
Three reviewers independently analyzed the epidemiological, clinical, and treatment data of the articles.
Six case reports (10 patients) and 2 cohort studies (12 and 18 patients) were analyzed.
Fish oil–derived emulsions have been demonstrated to reverse preexisting PNALD and to prevent and treat essential fatty acid deficiency. Its ability to prevent PNALD is currently under investigation. Although the mechanism has yet to be fully understood, the advantages of fish oil–based lipid emulsions over soybean oil–based lipid emulsions seen to date suggest that fish oil–based emulsions would be better suited for use in long-term parenteral nutrition.