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The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease

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Abstract

Parenteral nutrition associated liver disease (PNALD) is the major source of morbidity and mortality in children with short bowel syndrome (SBS). There is emerging evidence that omega-6 fatty acids (ω6FA) within the parenteral solution play a major role in PNALD and their effects may be reversed or ameliorated by substitution with omega-3 fatty acids (ω3FA). This paper reviews the mechanisms whereby ω3FAs may influence PNALD by improving bile flow, inhibiting steatosis, and having immunomodulatory effects. The early clinical experience with ω3FAs in SBS and PNALD is briefly reviewed and the implications of such, and future directions are considered.

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Acknowledgments

Ivan Diamond was supported by a Fellowship award from the Canadian Institutes of Health Research with additional support from the Surgeon Scientist Training Program, Department of Surgery, University of Toronto.

The authors wish to acknowledge the following member of the GIFT team (our multidisciplinary intestinal rehabilitation team) for their contributions: A. Bossert, J. Bowers, J. Brennan, M. Carricato, G. Courtney-Martin, L. Coxson, E. Dales, N. de Silva, M. De Angelis, A. Fecteau, D. Fierheller, D. Grant, D. Harrison, J. Hawes, L. Ives-Baine, P. Kean, C. Koziolek, K. Lang, S. Ling, M. Mackenzie, J. Maxwell, A. Moore, K. Murch, C. Newman, V. Ng, E. Rosen, J. Tyrell, A. Wheat, and M. Zachos.

Disclosure

The authors have received preliminary approval of funding from Fresenius Kabi, the manufacturer of Omegaven®, for an investigator initiated randomized trial to examine a novel omega-3 containing parenteral emulsion for the prevention of parenteral nutrition associated liver disease in children with short bowel syndrome.

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Authors and Affiliations

  1. Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada, M5G 1X8

    Ivan R. Diamond, Anca Sterescu, Paul B. Pencharz & Paul W. Wales

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  1. Ivan R. Diamond
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  2. Anca Sterescu
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Correspondence to Paul W. Wales.

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Diamond, I.R., Sterescu, A., Pencharz, P.B. et al. The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease. Pediatr Surg Int 24, 773–778 (2008). https://doi.org/10.1007/s00383-008-2174-0

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