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

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#humans #soybean-oil #parenteral-nutrition #fat-emulsions-intravenous #fish-oils

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

Pradelli et al., 2023 | Clin Nutr | Systematic Review

Citation

Pradelli Lorenzo, Mayer Konstantin, ... Muscaritoli Maurizio. Omega-3 fatty acids in parenteral nutrition - A systematic review with network meta-analysis on clinical outcomes. Clin Nutr. 2023-Apr;42(4):590-599. doi:10.1016/j.clnu.2023.02.008

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.

Key Findings

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 MC

Outcomes Measured

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Population

Field Value
Population adult patients
Sample Size 47
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Soybean Oil
  • Parenteral Nutrition
  • Fat Emulsions, Intravenous
  • Fish Oils
  • Olive Oil
  • Fatty Acids, Omega-3
  • Sepsis

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Systematic Review, Journal Article, Research Support, Non-U.S. Gov't, Network Meta-Analysis
  • Vertical: omega-3

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09