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Importance of
omega-3s in PN

As an innovator in parenteral nutrition, Fresenius Kabi is committed to supporting research that advances the field for all patients on PN. To that end, we have spent considerable time understanding and documenting the effects of fish oil and omega-3s on patients receiving PN. We pioneered the introduction of omega-3 containing lipids into PN products, representing a new development and advancement for critically ill patients.

In a large meta-analysis including 49 studies and 3,641 ICU and non-ICU patients:

  • Omega-3s have been shown to be less pro-inflammatory and have a less negative impact on liver function than standard (non-omega-3 fatty-acid enriched) PN.1
  • Use of omega-3 containing PN in critically ill patients has been shown to contribute to a reduced risk of infection and a reduced hospital stay of nearly 2 days versus standard (non-omega-3 fatty-acid enriched) PN however 30-day mortality was not statistically different.1
A Goldfish swimming

What are omega-3s?

The omega-3 family of fatty acids includes alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) and they are known for the following characteristics:

  • The essential fatty acid, ALA (18:3n-3)2
    • Displaces proinflammatory arachidonic acid pathway
    • Produces anti-inflammatory eicosanoids and leukotrienes
    • Reduces free radical formation
    • EPA and DHA are downstream metabolites
  • Enhance central nervous system development in infants3
  • Contribute to retina health in infants4
  • Lack the essential fatty acid linoleic acid
  • May prevent elevated triglyceride levels5
  • Lower circulating inflammatory markers compared with a higher omega-6 containing lipid emulsion6

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ASPEN – American Society for Parenteral and Enteral Nutrition

“Alternative oil-based IVFEs are safe and effective alternatives to SO IVFEs for a source of energy and essential (fatty acids) and may have potential biochemical and/or clinical benefits.”6

“Based on substantial bio-chemical and clinical evidence, alternative oil-based [intravenous fat emulsions (IVFEs)] may have less pro-inflammatory effects than the standard [soybean oil (SO) IVFEs and may potentially be a better alternative energy source.”6

CCCN – Canadian Critical Care Nutrition Guidelines

“When parenteral nutrition with intravenous lipids is indicated, IV lipids that reduce the load of omega-6 fatty acids/soybean oil emulsions should be considered.”7

ESPEN – European Society for Parenteral and Enteral Nutrition

ESPEN guidelines for critically ill patients

“Lipids should be an integral part of PN for energy and to ensure essential fatty acid provision in long-term [intensive care unit (ICU)] patients.”8

“Addition of EPA and DHA to lipid emulsions has demonstrable effects on cell membranes and inflammatory processes. Fish oil-enriched lipid emulsions probably decrease length of stay in critically ill patients.”8

ESPEN guidelines for surgical patients

“Postoperative parenteral nutrition including omega-3 fatty acids should be considered only in patients who cannot be adequately fed enterally and, therefore, require parenteral nutrition.”9

ASPEN/SCCM guidelines

“Alternative IVFEs may provide outcome benefit over soy-based IVFEs; however, we cannot make a recommendation at this time due to lack of availability of these products in the United States.”10

“When these alternative IVFEs (SMOF [soybean oil, MCT, olive oil, and fish oil emulsion], MCT, OO, and FO) become available in the United States, based on expert opinion, we suggest that their use be considered in the critically ill patient who is an appropriate candidate for PN.”10

References: 1. Pradelli L, Mayer K, Klek S, et al. JPEN J Parenter Enteral Nutr. 2019. First published: 27 June 2019. https://onlinelibrary.wiley.com/doi/full/10.1002/jpen.1672. 2. Calder PC. Functional Roles of Fatty Acids and Their Effects on Human Health. JPEN J Parenter Enteral Nutr. 2015;30(1Suppl):18S-32S. 3. Gow RV, Hibbeln JR. Omega-3 fatty acid and nutrient deficits in adverse neurodevelopment and childhood behaviors. Child Adolesc Psychiatr Clin N Am. 2014; 23(3):555-590. 4. Malamas A, Chranioti A, Tsakalidis C, Dimitrakos SA, Mataftsi A. The omega-3 and retinopathy of prematurity relationship. Int J Ophthalmol. 2017;10(2): 300-305. 5. Preston Mason R. New insights into mechanisms of action for omega-3 fatty acids in atherothrombotic cardiovascular disease. Curr Atheroscler Rep. 2019;21(1):2. 6. Vanek VW, et al. A.S.P.E.N. position paper: Clinical role for alternative intravenous fat emulsions. Nutr Clin Pract. 2012;27(2):150-192. 7. 2015 Canadian Critical Care Nutrition Clinical Practice Guidelines. https://www.criticalcarenutrition.com/resources/cpgs/past-guidelines/2015. 8. Singer P, BergerMM, Van den Berghe G, et al. ESPEN guidelines on parenteral nutrition intensive care. Clin Nutr. 2009; 28(4):387-400. 9. Weimann A, Braga M, Carl F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623-650. 10. McClave SA, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.

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