Clinical nutrition

Effect of a fish oil-based lipid emulsion on intestinal failure-associated liver disease in children



The aim of this study was to assess the effects of a fish oil-based lipid emulsion on intestinal failure-associated liver disease (IFALD) in children.


From January 2014 through June 2017, we enrolled 32 children with IF on long-term parenteral nutrition (PN). When the levels of any three of seven liver indicators (TBA, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase, gamma glutamyl transferase (γ-GT), total bilirubin (TB), or direct bilirubin (DB)) were two times higher than normal levels, we switched a 50:50 mix of soybean oil and medium-chain triglycerides (MCT) lipid emulsion (with an average dose of 1.30 g/kg/day) to a fish oil-based lipid emulsion (1 g/kg/day) and measured liver function in the children. Meanwhile, inflammation and oxidative stress-related markers were also measured.


The average fish oil therapy duration was 26 ± 21 days, and the median duration of PN support was 84 days. With fish oil therapy, levels of TBA, ALT, AST, γ-GT, TB, and DB all significantly decreased. Enteral nutrition was introduced following fish oil resulting in higher energy intake (99.88 ± 31.06 kcal/kg/day) compared with before fish oil (67.90 ± 27.31 kcal/kg/day, P = 0.001). No significant difference was found in average PN energy (P = 0.147). In addition, levels of inflammatory indicators like tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and white blood cell (WBC) significantly decreased.


Fish oil therapy alleviates IFALD in children.

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This work was supported by the Shanghai Pujiang Program [grant number 17PJD026]; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition (14DZ2272400); Shanghai Municipal Commission of Health and Family Planning (2013ZYJB0017); Science and Technology Commission of Shanghai Municipality (14411950400/14411950401); and the National Natural Science Foundation of China-Key Program (81630039).

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Correspondence to Ying Wang or Wei Cai.

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Zhang, T., Wang, N., Yan, W. et al. Effect of a fish oil-based lipid emulsion on intestinal failure-associated liver disease in children. Eur J Clin Nutr 72, 1364–1372 (2018).

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