n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis
Open accessAbstract
Introduction: Previous studies and a meta-analysis in surgical patients indicate that supplementing parenteral nutrition regimens with n-3 polyunsaturated fatty acids (PUFAs), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is associated with improved laboratory and clinical outcomes in the setting of hyper-inflammatory conditions. Refined or synthetic fish oils are commonly used as a source of EPA and DHA. The objective of the present meta-analysis was to evaluate n-3 PUFA-enriched parenteral nutrition regimens in elective surgical and intensive care unit (ICU) patients. Methods: Medline was searched for randomized controlled trials comparing n-3 PUFA-enriched lipid emulsions with standard non-enriched lipid emulsions (i.e. soybean oil, MCT/LCT or olive/soybean oil emulsions) in surgical and ICU patients receiving parenteral nutrition. Extracted data were pooled by means of both random and fixed effects models, and subgroup analyses were carried forward to compare findings in ICU versus non-ICU patients. Results: A total of 23 studies (n = 1502 patients: n = 762 admitted to the ICU) were included. No statistically significant difference in mortality rate was found between patients receiving n-3 PUFA-enriched lipid emulsions and those receiving standard lipid emulsions (RR= 0.89; 0.59, 1.33), possibly reflecting a relatively low underlying mortality risk. However, n-3 PUFA-enriched emulsions are associated with a statistically and clinically significant reduction in the infection rate (RR =0.61; 0.45, 0.84) and the lengths of stay, both in the ICU (-1.92; -3.27, -0.58) and in hospital overall (-3.29; -5.13, -1.45). Other beneficial effects included reduced markers of inflammation, improved lung gas exchange, liver function, antioxidant status and fatty acid composition of plasma phospholipids, and a trend towards less impairment of kidney function. Conclusions: These results confirm and extend previous findings, indicating that n-3 PUFAs-enriched parenteral nutrition regimens are safe and effective in reducing the infection rate and hospital/ICU stay in surgical and ICU patients.
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Grau et al. showed a significant decrease in infection rate using a lipid emulsion with long chain triglycerides (soybean oil), MCT and fish oil compared to an emulsion with LCT/MCT alone.
“Grau et al. in a multicenter prospective randomized double blind study, showed a significant decrease in infection rate using a lipid emulsion with long chain triglycerides (LCT; soybean oil), MCT and fish oil compared to an emulsion with LCT/MCT alone (265).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [265]
The Results > Clinical Outcomes report a statistically significant reduction in infection rate across the pooled n-3-enriched regimens. The source does not report a Grau et al. trial or establish that Grau found this result in the specified LCT/MCT-plus-fish-oil versus LCT/MCT comparison; the reported pooled effect is also not statistically significant when restricted to ICU patients. (LLM, conf=0.84)
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- Authors
- Pradelli, L., Mayer, K., Muscaritoli, M., & Heller, A. R.
- Affiliations
- Justus-Liebig-Universität Gießen (DE)
- Sapienza University of Rome (IT)
- Technische Universität Dresden (DE)
- Corresponding author
- Pradelli, Lorenzo
- Venue
- Critical Care
- Published
- 2012-10-04
- Volume
- 16
- Issue
- 5
- Pages
- R184-R184
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC3682286
- OpenAlex
- W2112605216
- Cited by
- 172
- References
- 30
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 3 · 2023: 8 · 2022: 6 · 2021: 6 · 2020: 14 · 2019: 9 · 2018: 10 · 2017: 18 · 2016: 15 · 2015: 22 · 2014: 29 · 2013: 20 · 2012: 2
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- OPUS (Augsburg University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- omega-3 fatty acids, parenteral nutrition, eicosapentaenoic acid, docosahexaenoic acid, surgical patients, intensive care unit patients, infection rate, length of hospital stay, mortality, inflammatory markers, pulmonary gas exchange, liver function, renal function, antioxidant status
- MeSH terms
- Humans, Intensive Care Units, Parenteral Nutrition, Postoperative Complications, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Elective Surgical Procedures
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