Use of Intravenous Soybean and Fish Oil Emulsions in Pediatric Intestinal Failure-Associated Liver Disease: A Multicenter Integrated Analysis Report on Extrahepatic Adverse Events.

OBJECTIVE: To compare extrahepatic adverse events during fish oil lipid emulsion (FOLE) or soybean oil lipid emulsion (SOLE) treatment in children with intestinal failure-associated liver disease (IFALD). STUDY DESIGN: In this multicenter integrated analysis, bleeding, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), infections, and signs of lipid emulsion intolerance were compared between FOLE recipients (1 g/kg/d) (n = 189) and historical controls who received SOLE (≤3 g/kg/d) (n = 73). RESULTS: When compared with SOLE recipients, FOLE recipients had a lower gestational age (30.5 vs 33.0 weeks; P = .0350) and higher baseline direct bilirubin (DB) (5.8 vs 3.0 mg/dL; P < .0001). FOLE recipients had a decreased incidence of bleeding (P < .0001), BPD (P < .001), ROP (P < .0156), bacterial and fungal infections (P < .0001), and lipid intolerance signs (P < .02 for all). Patients with bleeding vs patients without bleeding had higher baseline DB; the ORs for baseline DB (by mg/dL) and treatment (FOLE vs SOLE) were 1.20 (95% CI: 1.10, 1.31; P ≤ .0001) and 0.22 (95% CI: 0.11, 0.46; P ≤ .0001), respectively. In preterm infants, a higher BPD (P < .0001) and ROP incidence (P = .0071) was observed in SOLE recipients vs FOLE recipients. CONCLUSIONS: Children with IFALD who received FOLE had fewer extrahepatic adverse events, including a decreased incidence of bleeding, preterm comorbidities, and lipid intolerance signs compared with children with IFALD who received SOLE. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT00910104 and NCT00738101.

Fish Oil Supplementation Enhances Pulmonary Strength and Endurance in Women Undergoing Chemotherapy.

We investigated the effect of fish oil (FO) supplementation, at 4 g/day, on the respiratory performance and blood lipid profile of 32 patients with breast cancer at the beginning of chemotherapy. They were randomized into two groups: control (C) and FO supplemented (S). Both groups underwent three respiratory evaluations and blood harvest (before chemotherapy-Day 0, and 30 and 60 days after supplementation). The S group showed a significant increase in the maximal inspiratory and expiratory pressure (P ≤ 0.05 vs. Day 0) and in the maximum voluntary ventilation (P ≤ 0.05). In the treadmill 6-min-walk test, the S group had a significant increase in the walked distance (P ≤ 0.05). Blood lactate concentration was significantly lower in the S group after 60 days, at rest, when compared to C (P ≤ 0.05). Plasma high-density lipoprotein (HDL) cholesterol concentration remained the same after 60 days of supplementation, while in the C group, it decreased significantly (P ≤ 0.05 Day 0 vs. Day 60). Triacylglycerol (TAG) plasma concentration in the S group was lower when compared to the C group (P ≤ 0.05 Day 60S vs. Day 60). Supplementation with FO caused improvement in the respiratory muscle strength and endurance, ameliorated functional performance, and kept TAG, HDL cholesterol, and lactate plasma concentration at normal levels.

Omega-3 polyunsaturated fatty acids in treating non-alcoholic steatohepatitis: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: & aims: Few clinical trials have addressed the potential benefits of omega-3 polyunsaturated fatty acids (PUFAs) on non-alcoholic steatohepatitis (NASH). We evaluated the effects of supplementation with omega-3 PUFAs from flaxseed and fish oils in patients with biopsy-proven NASH. METHODS: Patients received three capsules daily, each containing 0.315 g of omega-3 PUFAs (64% alpha-linolenic [ALA], 16% eicosapentaenoic [EPA], and 21% docosahexaenoic [DHA] acids; n-3 group, n = 27) or mineral oil (placebo group, n = 23). Liver biopsies were evaluated histopathologically by the NASH activity score (NAS). Plasma levels of omega-3 PUFAs were assessed as a marker of intake at baseline and after 6 months of treatment. Secondary endpoints included changes in plasma biochemical markers of lipid metabolism, inflammation, and liver function at baseline and after 3 and 6 months of treatment. RESULTS: At baseline, NAS was comparable between the groups (p = 0.98). After intervention with omega-3 PUFAs, plasma ALA and EPA levels increased (p ≤ 0.05). However in the placebo group, we also observed increased EPA and DHA (p ≤ 0.05), suggesting an off-protocol intake of PUFAs. NAS improvement/stabilization was correlated with increased ALA in the n-3 group (p = 0.02) and with increased EPA (p = 0.04) and DHA (p = 0.05) in the placebo group. Triglycerides were reduced after 3 months in the n-3 group compared to baseline (p = 0.01). CONCLUSIONS: In NASH patients, the supplementation of omega-3 PUFA from flaxseed and fish oils significantly impacts on plasma lipid profile of patients with NASH. Plasma increase of these PUFAs was associated with better liver histology. (ID 01992809).

Intravenous fish oil lipid emulsions in critically ill patients: an updated systematic review and meta-analysis.

INTRODUCTION: Intravenous fish oil (FO) lipid emulsions (LEs) are rich in ω-3 polyunsaturated fatty acids, which exhibit anti-inflammatory and immunomodulatory effects. We previously demonstrated that FO-containing LEs may be able to decrease mortality and ventilation days in patients who are critically ill. Since 2014, several additional randomized controlled trials (RCTs) of FO-containing LEs have been published. Therefore, the purpose of this systematic review was to update our previous systematic review with the aim of elucidating the efficacy of FO-containing LEs on clinical outcomes of patients who are critically ill. METHODS: We searched electronic databases from 1980 to 2014. We included four new RCTs conducted in critically ill adult patients in which researchers evaluated FO-containing LEs in parenterally or enterally fed patients. RESULTS: A total of 10 RCTs (n = 733) met inclusion criteria. The mean methodological score was 8 (range, 3 to 12). No effect on overall mortality was found. When we aggregated the results of five RCTs in which infections were reported, we found that FO-containing LEs significantly reduced infections (risk ratio (RR) = 0.64; 95% confidence interval (CI), 0.44 to 0.92; P = 0.02; heterogeneity I (2) = 0%). Subgroup analysis demonstrated that predominantly enteral nutrition-based trials showed a tendency toward a reduction in mortality (RR = 0.69; 95% CI, 0.40 to 1.18; P =0.18; heterogeneity I (2) =35%). High-quality trials showed a significant reduction in hospital length of stay (LOS) (weighted mean difference = -7.42; 95% CI, -11.89 to -2.94; P = 0.001), whereas low-quality trials had no effect (P = 0.45). The results of the test for subgroup differences in hospital LOS was significant (P = 0.001). CONCLUSION: FO-containing LEs may be associated with a reduction in infections and also could be associated with a reduction in duration of ventilation and hospital LOS. Further large-scale RCTs are warranted and should be aimed at consolidating potential positive treatment effects.

Dietary docosahexaenoic acid and eicosapentaenoic acid influence liver triacylglycerol and insulin resistance in rats fed a high-fructose diet.

This study aimed to examine the benefits of different amounts of omega-3 (n-3) polyunsaturated fatty acids from fish oil (FO) on lipid metabolism, insulin resistance and gene expression in rats fed a high-fructose diet. Male Wistar rats were separated into two groups: Control (C, n = 6) and Fructose (Fr, n = 32), the latter receiving a diet containing 63% by weight fructose for 60 days. After this period, 24 animals from Fr group were allocated to three groups: FrFO2 (n = 8) receiving 63% fructose and 2% FO plus 5% soybean oil; FrFO5 (n = 8) receiving 63% fructose and 5% FO plus 2% soybean oil; and FrFO7 (n = 8) receiving 63% fructose and 7% FO. Animals were fed these diets for 30 days. Fructose led to an increase in liver weight, hepatic and serum triacylglycerol, serum alanine aminotransferase and HOMA1-IR index. These alterations were reversed by 5% and 7% FO. FO had a dose-dependent effect on expression of genes related to hepatic ß-oxidation (increased) and hepatic lipogenesis (decreased). The group receiving the highest FO amount had increased markers of oxidative stress. It is concluded that n-3 fatty acids may be able to reverse the adverse metabolic effects induced by a high fructose diet.

Bedside to bench: The risk of bleeding with parenteral omega-3 lipid emulsion therapy.

Our clinical experience led us to reassess the effect of sole omega-3 lipid therapy on hemostasis. We compared thromboelastography platelet mapping in neonatal piglets given sole omega-3 lipid. We identified abnormalities in reaction time (P = .025) and the arachidonic acid pathway (P = .025). The potential for bleeding complications from parenteral omega-3 lipid emulsion therapy in high-risk infants with liver disease has been dismissed but, on the basis of this data, should be reconsidered.

Flaxseed, olive and fish oil influence plasmatic lipids, lymphocyte migration and morphometry of the intestinal of Wistar rats / Óleo de linhaça, oliva e peixe influenciam os lipídios plasmáticos, migração de linfócitos e morfometria intestinal de ratos Wistar

PURPOSE: Evaluate the effect of flaxseed, olive and fish oil on the lipid profile, preservation of villosities and lymphocyte migration in the intestinal mucosa of Wistar rats. METHODS: Thirty Wistar male rats were divided into four groups, which received the AIN-93M diet, with changes only to their lipid source: flaxseed, olive, fish, and soy oil (control group). The serum was separated for the biochemical parameter analysis. A histological evaluation was performed in the ileal portion. RESULTS: The group which was fed fish oil presented lower values when compared to the other treatments for Total Cholesterol, High-density Lipoprotein Cholesterol and Triacylglycerol (p<0.05). The animals treated with fish and olive oils presented better intestinal villosities preservation. Less deposition of lymphocytes was observed in the flaxseed group (p<0.001). CONCLUSIONS: This study demonstrated that flaxseed, olive and fish oils present different responses than soy oil for the intestinal mucosa preservation and lymphocyte proliferation in Wistar rats.(AU)

OBJETIVO: Avaliar o efeito dos óleos de linhaça, oliva e peixe no perfil lipídico, preservação das vilosidades e migração de linfócitos na mucosa intestinal de ratos Wistar. MÉTODOS: Trinta ratos Wistar foram divididos em quarto grupos e receberam dieta AIN-93M, modificando para cada grupo apenas a fonte lipídica: óleo de linhaça, oliva, peixe e soja ( grupo controle). O soro foi separado para análise dos parâmetros bioquímicos. A análise histológica foi realizada na porção ileal. RESULTADOS: O grupo que recebeu óleo de peixe apresentou menores valores de colesterol total, lipoproteína de alta densidade e triacilglicerol (p<0.05). Os animais tratados com óleo de peixe e oliva apresentaram melhor preservação das vilosidades intestinais. Menor deposição de linfócitos foi observado no grupo tratado com óleo de linhaça (p<0.001). CONCLUSÃO: Este estudo demonstrou que os óleos de linhaça, oliva e peixe apresentam diferentes respostas em relação ao óleo de soja na preservação da mucosa intestinal e proliferação de linfócitos em ratos Wistar.(AU)

Parenteral fish oil-associated burr cell anemia.

We report the development of burr cell anemia in an infant with short bowel syndrome who received parenteral fish oil (Omegaven, Fresenius-Kabi, Graz, Austria) after development of total parenteral nutrition-associated liver disease. Parenteral fish oil was discontinued, and the burr cell anemia disappeared, suggesting that parenteral fish oil might be associated with hemolytic anemia.

Cápsulas de óleo de peixe: percepção da dosagem e finalidade de consumo / Capsules of fish oil: the perception of strength and purpose of consumption

O objetivo desse estudo foi conhecer o perfil do consumidor de cápsulas de óleo de peixe compradas em farmácias de manipulação, localizadas no Estado do Rio de Janeiro tendo como referencial a finalidade de consumo. O projeto foi desenvolvido no município do Rio de Janeiro e município de Duque de Caxias que apresentaram maior número de farmácias de manipulação regularizadas no Conselho Regional de Farmácia do Rio de Janeiro (CRF-RJ). Como estratégia para obtenção de informações sobre o consumo, utilizou-se o banco de dados Pharma, programa de gerenciamento de farmácias de manipulação, e entrevistas realizadas com os consumidores. A população pesquisada foi majoritariamente feminina, na faixa etária de 15 a 24 anos, solteiras e cursando nível superior. Em relação aos objetivos de consumo de cápsulas de óleo de peixe na amostra pesquisada, verificou-se que a maioria dos consumidores (41,32%) utilizou o produto visando a diminuição dos níveis de colesterol e 32,6% desta população a obtenção de ação antioxidante com fins estéticos. Concluiu-se que o consumidor não possui conhecimento a respeito das dosagens adequadas farmacologicamente a finalidade de consumo desse produto. Somente 3,94% da população estudada conhecia a dosagem adequada para alcançar os respectivos objetivos terapêuticos. Pode-se observar que a maioria dos consumidores de cápsulas de óleo de peixe da amostra pesquisada utilizou o produto baseando-se em informações de amigos, internet, revistas e televisão. Dos sujeitos da pesquisa do sexo masculino, somente 6,06% consultou um médico enquanto que esta frequência foi de 16,66% na população do sexo feminino. Este estudo visou ainda fornecer subsídios para a formulação de propostas de controle para a utilização de alimentos funcionais e fundamentar parâmetros que garantam a proteção à saúde da população pelos órgãos competentes, através da venda segura de suplementos alimentares no Brasil.

The aim of this study was to identify consumer capsules of fish oil purchased in pharmacies, located in Rio de Janeiro referencing the purpose of consumption. The project was developed in Rio de Janeiro and Duque de Caxias with the highest number of pharmacies in regularized by the Regional PharmacyConcil (CRF-RJ). We used information from the database Pharma is a management program for pharmacies, and interviews with consumers. The research population was predominantly female, aged 15 to 24, unmarried and studying in higher education. For the purposes of consumption in the sample surveyed, it was found that most consumers (41.32%) used the capsules of fish oil in order to reduce the levels of cholesterol and 32.6% of this population had the goal of consumption to obtain an antioxidant for cosmetic purposes. One of the possible conclusions is the ignorance of consumers regarding appropriate dosages pharmacologically the goal of consumption of this product. Only 3.94% of the women knew the correct dosage to achieve their therapeutic goals, while 96.06% did not know the proper dosage. This study found that most consumers of capsules of fish oil from our sample used the product based on information from friends, internet, magazines and television. Among men surveyed, only 6.06% consulted a doctor while this rate was 16.66% for female audience. This result represents a risk to the health of consumers by undermining the goals of consumption when the dosage of functional food is not eaten as recommended pharmacological. This study also aimed to provide information for formulating proposals for the control and use of functional foods and establish parameters that ensure the protection of health of the population by the competent bodies, through the sale of dietary supplements safe in Brazil.