Parenteral fish oil (FO) in Gastrointestinal Surgery:

A Review of the Literature

Introduction

Intravenous lipid emulsions (IVFEs), which are a dense form of energy in parenteral nutrition (PN) and provide essential fatty acids (FA), have evolved over time. Original IVFE formulations were made from 100% soybean oil (SO), with newer formulations made from alternative lipids, such as medium-chain triglycerides (MCTs), olive oils (OOs), and fish oils (FO). Lipids consist of triglycerides and each triglyceride differs in its FA, phytosterol and α-tocopherol content (Table 1). Thus the different manufactured IVFE have different proportions of ω-3:ω-6 FAs (Table 2). For example, FO is rich in ω-3 FA, which is highly bioactive compared with MCT and OO (Vanek et al., 2012). Clinically, ω-3 FAs are relatively less proinflammatory and are considered to have anti-inflammatory effects compared to ω-6 FAs (Vanek et al., 2012). Therefore patients are thought to have better clinical outcomes when using fish oil containing IVFEs (FO-IVFE) as it reduces the intake of the potentially proinflammatory ω-6 FA, linoleic acid, which comprises more than 50% of the FA profile in SO (Vanek et al., 2012; Raman et al., 2017).

Table 1.  Oils in IVFEs (Fell et al., 2015)

Table 2. Comparison between commercially available IVFE

(adapted from Vanek et al., 2012; Leguina-Ruzzi and Ortiz, 2018; Abbasoglu et al., 2019)