• Vincent E de Meijer, Kathleen M Gura, Jonathan A Meisel, Hau D Le, and Mark Puder.
• Vascular Biology Program, Department of Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115, USA.
• Arch Surg. 2010 Jun 1; 145 (6): 547-51.

ObjectivesTo update knowledge on the management of parenteral nutrition-associated liver disease (PNALD) and to review the clinical data on the use of parenteral fish oil for reversal of PNALD.Data SourcesA literature review was conducted by searching the MEDLINE database (May 1, 2009) using the keywords parenteral nutrition-associated liver disease, fish oil, omega-3, Omegaven, and lipid emulsion.Study SelectionAll articles reporting clinical cases with the use of parenteral fish oil for management of PNALD.Data ExtractionThree reviewers independently analyzed the epidemiological, clinical, and treatment data of the articles.Data SynthesisSix case reports (10 patients) and 2 cohort studies (12 and 18 patients) were analyzed.ConclusionsFish oil-derived emulsions have been demonstrated to reverse preexisting PNALD and to prevent and treat essential fatty acid deficiency. Its ability to prevent PNALD is currently under investigation. Although the mechanism has yet to be fully understood, the advantages of fish oil-based lipid emulsions over soybean oil-based lipid emulsions seen to date suggest that fish oil-based emulsions would be better suited for use in long-term parenteral nutrition.

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