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Parenteral fish oil lipid emulsion use in adults: a case series and review from an intestinal failure referral center

European Journal of Clinical Nutrition volume 78, pages 796–800 (2024)Cite this article

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Abstract

Background

Intestinal failure-associated liver disease (IFALD) is a complication of long-term PN use, attributed to the use of ω-6 injectable lipid emulsions (ILE). Fish oil (FO) ILE have been successful in reversing liver injury in neonates. Evidence for pure FO ILE use in adult patients is limited.

Methods

Case series of the use of FO lipid emulsions in adults with IFALD from the University of Chicago PN registry. Analysis of medical charts and PN formulations was performed.

Results

Three cases of IFALD treated with FO ILE were identified. The first case was a 30-year-old man with short bowel syndrome (SBS), hyperbilirubinemia, and biopsy-proven IFALD. Following a change from a soy lipid emulsion to FO lipid emulsion, his liver tests rapidly improved and remained stable over 202 weeks of use. The second case was a 76-year-old woman with intestinal failure (IF) due to a frozen bowel. A change from a soy ILE to a composite lipid and later to a pure FO ILE did not result in improvement in her liver tests. The third case was a 28-year-old man with SBS and biopsy-proven IFALD. Change to a composite ILE and subsequently FO lipid emulsion resulted in a gradual improvement in liver tests. No clinical essential fatty acid (EFA) deficiencies were identified during treatment.

Conclusion

FO ILE may be effective in the treatment of adult patients with cholestatic IFALD. Use is safe with no EFA deficiencies detected in up to 4 years of use.

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Fig. 1: Percent change in liver enzymes from baseline while on fish oil lipid emulsion for case I.
Fig. 2: Trend in liver enzymes on varying lipid emulsions for case II.
Fig. 3: Trend in liver enzymes on varying lipid emulsions for case III.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA

    David Hakimian, Edwin McDonald, Carol Semrad & Dejan Micic

  2. Nutrition Support Service, University of Chicago Medicine, Chicago, IL, USA

    Elizabeth Wall, Jean Herlitz & Edward Scott Lozano

Authors
  1. David Hakimian
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  2. Elizabeth Wall
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  3. Jean Herlitz
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  4. Edward Scott Lozano
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  5. Edwin McDonald
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  6. Carol Semrad
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  7. Dejan Micic
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Contributions

DH and DM wrote the paper and analyzed the data. EW and CS reviewed the paper and analyzed the data. JH, ESL and EM reviewed the paper.

Corresponding author

Correspondence to David Hakimian.

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Competing interests

DM reports Advisory Boards for Takeda Pharmaceuticals and VectivBio, educational grant support from Fresnius Kabi. No other conflicts of interest are reported by the authors.

Ethics approval and consent to participate

The study was approved by the University of Chicago Institutional Review Board (IRB21-0874). Informed consent was obtained from all subjects or remaining relatives.

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Hakimian, D., Wall, E., Herlitz, J. et al. Parenteral fish oil lipid emulsion use in adults: a case series and review from an intestinal failure referral center. Eur J Clin Nutr 78, 796–800 (2024). https://doi.org/10.1038/s41430-024-01462-4

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