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. 2023 Apr;42(4):590-599.
doi: 10.1016/j.clnu.2023.02.008. Epub 2023 Feb 18.

Omega-3 fatty acids in parenteral nutrition - A systematic review with network meta-analysis on clinical outcomes

Lorenzo Pradelli  1 , Konstantin Mayer  2 , Stanislaw Klek  3 , Martin D Rosenthal  4 , Massimiliano Povero  5 , Axel R Heller  6 , Maurizio Muscaritoli  7
Affiliations
Free article

Omega-3 fatty acids in parenteral nutrition - A systematic review with network meta-analysis on clinical outcomes

Lorenzo Pradelli et al. Clin Nutr. 2023 Apr.
Free article

Abstract

Background & aims: Accumulating scientific evidence supports the benefits of parenteral nutrition (PN) with fish oil (FO) containing intravenous lipid emulsions (ILEs) on clinical outcomes. Yet, the question of the most effective ILE remains controversial. We conducted a network meta-analysis (NMA) to compare and rank different types of ILEs in terms of their effects on infections, sepsis, ICU and hospital length of stay, and in-hospital mortality in adult patients.

Methods: MEDLINE, EMBASE, and Web of Science databases were searched for randomized controlled trials (RCTs) published up to May 2022, investigating ILEs as a part of part of PN covering at least 70% of total energy provision. Lipid emulsions were classified in four categories: FO-ILEs, olive oil (OO)-ILEs, medium-chain triglyceride (MCT)/soybean oil (SO)-ILEs, and pure SO-ILEs. Data were statistically combined through Bayesian NMA and the Surface Under the Cumulative RAnking (SUCRA) was calculated for all outcomes.

Results: 1651 publications were retrieved in the original search, 47 RCTs were included in the NMA. For FO-ILEs, very highly credible reductions in infection risk versus SO-ILEs [odds ratio (OR) = 0.43 90% credibility interval (CrI) (0.29-0.63)], MCT/soybean oil-ILEs [0.59 (0.43-0.82)], and OO-ILEs [0.56 (0.33-0.91)], and in sepsis risk versus SO-ILEs [0.22 (0.08-0.59)], as well as substantial reductions in hospital length of stay versus SO-ILEs [mean difference (MD) = -2.31 (-3.14 to -1.59) days] and MCT/SO-ILEs (-2.01 (-2.82 to -1.22 days) were shown. According to SUCRA score, FO-ILEs were ranked first for all five outcomes.

Conclusions: In hospitalized patients, FO-ILEs provide significant clinical benefits over all other types of ILEs, ranking first for all outcomes investigated.

Registration no: PROSPERO 2022 CRD42022328660.

Keywords: Fish oil; Lipid emulsion; Network meta-analysis; Omega 3 fatty acids; Parenteral nutrition.

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Conflict of interest statement

Conflict of interest L. Pradelli is a director and employee of AdRes, which has received project funding from Fresenius Kabi. K. Mayer has received fees from Abbott, AstraZeneca, Baxter, BBraun, Fresenius Kabi, MSD, Nestlé, Novartis, and Pfizer. S. Klek has received speaker’s honoraria from Baxter, Braun, Fresenius Kabi, Nestlé, Nutricia, Shire, and Vipharm and acted as an advisory board member for Fresenius Kabi, Shire, and Tracheron. M. Rosenthal has received fees from Fresenius, Nestle, and Abbott. M. Povero is an employee of AdRes, which has received project funding from Fresenius Kabi. A. R. Heller has received project funding from Fresenius Kabi. M. Muscaritoli has received speaker’s fees from Fresenius Kabi.

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