Fish oil lipid emulsion shows promise in adults with IFALD

Using fish oil injectable lipid emulsions (ILE) in managing adults with cholestatic intestinal failure-associated liver disease (IFALD) seems effective and is safe, with no essential fatty acid (EFA) deficiencies observed up to 4 years of use, suggests a study. 

A team of investigators conducted a case series of the use of fish oil ILE in adults with IFALD from the University of Chicago parenteral nutrition (PN) registry. They also performed an analysis of medical charts and PN formulation. 

The case series identified three patients with IFALD treated with fish oil ILE.  

The first case was a man aged 30 years with short bowel syndrome (SBS), hyperbilirubinemia, and biopsy-proven IFALD. After a change from soy to fish oil lipid emulsion, his liver tests showed rapid improvement, which remained stable for 202 weeks of use. 

In the second case, a woman aged 76 years with intestinal failure due to a frozen bowel, switching from soy to a composite lipid and later to a pure fish oil ILE fell short of improving her liver tests. 

The third case, a 28-year-old man with SBS and biopsy-proven IFALD, showed a gradual improvement in liver tests following a change to a composite ILE and subsequently fish oil lipid emulsion. 

None of the patients had EFA deficiencies during treatment. 

"IFALD is a complication of long-term PN use, attributed to the use of ω-6 ILE,” the investigators said. “Fish oil ILE have been successful in reversing liver injury in neonates.”