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Intravenous Fish Oil and Serum Fatty Acid Profiles in Pediatric Patients With Intestinal Failure–Associated Liver Disease
Author(s) -
Ong Margaret L.,
Venick Robert S.,
Shew Stephen B.,
Dunn James C. Y.,
Reyen Laurie,
Grogan Tristan,
Calkins Kara L.
Publication year - 2019
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1532
Subject(s) - docosahexaenoic acid , eicosapentaenoic acid , interquartile range , arachidonic acid , linoleic acid , fish oil , medicine , parenteral nutrition , gastroenterology , fatty acid , prospective cohort study , liver disease , essential fatty acid , polyunsaturated fatty acid , endocrinology , biology , biochemistry , fish <actinopterygii> , fishery , enzyme
Background Intravenous fish oil (FO) treats pediatric intestinal failure–associated liver disease (IFALD). There are concerns that a lipid emulsion composed of ω‐3 fatty acids will cause an essential fatty acid deficiency (EFAD). This study's objective was to quantify the risk for abnormal fatty acid concentrations in children treated with FO. Methods Inclusion criteria for this prospective study were children with intestinal failure. Intravenous soybean oil (SO) was replaced with FO for no longer than 6 months. Serum fatty acids were analyzed using linear and logistic models, and compared with age‐based norms to determine the percentage of subjects with low and high concentrations. Results Subjects (n = 17) started receiving FO at a median of 3.6 months (interquartile range 2.4–9.6 months). Over time, α‐linolenic, linoleic, arachidonic, and Mead acid decreased, whereas docosahexaenoic and eicosapentaenoic acid increased ( P < 0.001 for all). Triene‐tetraene ratios remained unchanged ( P = 1). Although subjects were 1.8 times more likely to develop a low linoleic acid while receiving FO vs SO (95% CI: 1.4–2.3, P < 0.01), there was not a significant risk for low arachidonic acid. Subjects were 1.6 times more likely to develop high docosahexaenoic acid while receiving FO vs SO; however, this was not significant (95% CI: 0.9–2.6, P = 0.08). Conclusion In this cohort of parenteral nutrition–dependent children, switching from SO to FO led to a decrease in essential fatty acid concentrations, but an EFAD was not evident. Low and high levels of fatty acids developed. Further investigation is needed to clarify if this is clinically significant.