Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis?: A systematic review and meta-analysis

Daniel R J Wolbrink; Jessica R Grundsell; Ben Witteman; Marcel van de Poll; Hjalmar C van Santvoort; Eyad Issa; Ashley Dennison; Harry van Goor; Marc G Besselink; Stefan A W Bouwense; Dutch Pancreatitis Study Group

doi:10.1016/j.clnu.2019.12.006

Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis

Daniel R J Wolbrink^*, Jessica R Grundsell, Ben Witteman, Marcel van de Poll, Hjalmar C van Santvoort, Eyad Issa, Ashley Dennison, Harry van Goor, Marc G Besselink, Stefan A W Bouwense, Dutch Pancreatitis Study Group

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

4 Citations (Web of Science)

Abstract

BACKGROUND: Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.

AIM: Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.

METHODS: A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.

RESULTS: After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13-1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12-0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28-0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.

CONCLUSIONS: Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.

Original language	English
Pages (from-to)	2686-2694
Number of pages	9
Journal	Clinical Nutrition
Volume	39
Issue number	9
Early online date	16 Dec 2019
DOIs	https://doi.org/10.1016/j.clnu.2019.12.006
Publication status	Published - Sep 2020

Keywords

Acute pancreatitis
Anti-inflammatory
CONTROLLED-TRIAL
CRITICALLY-ILL PATIENTS
DOUBLE-BLIND
FISH-OIL
IMPACT
INFLAMMATION
LIPID EMULSION
MANAGEMENT
N-3 FATTY-ACIDS
Omega-3 fattyacids
Organ failure
PARENTERAL-NUTRITION
Safety
Sepsis
MORTALITY

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10.1016/j.clnu.2019.12.006

Cite this

Wolbrink, D. R. J., Grundsell, J. R., Witteman, B., Poll, M. V. D., Santvoort, H. C. V., Issa, E., Dennison, A., Goor, H. V., Besselink, M. G., Bouwense, S. A. W., & Dutch Pancreatitis Study Group (2020). Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis. Clinical Nutrition, 39(9), 2686-2694. https://doi.org/10.1016/j.clnu.2019.12.006

@article{6e31ede75c184ea0a9be8cc58e67ef90,

title = "Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis?: A systematic review and meta-analysis",

abstract = "BACKGROUND: Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.AIM: Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.METHODS: A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.RESULTS: After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13-1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12-0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28-0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.CONCLUSIONS: Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.",

keywords = "Acute pancreatitis, Anti-inflammatory, CONTROLLED-TRIAL, CRITICALLY-ILL PATIENTS, DOUBLE-BLIND, FISH-OIL, IMPACT, INFLAMMATION, LIPID EMULSION, MANAGEMENT, N-3 FATTY-ACIDS, Omega-3 fattyacids, Organ failure, PARENTERAL-NUTRITION, Safety, Sepsis, MORTALITY",

author = "Wolbrink, {Daniel R J} and Grundsell, {Jessica R} and Ben Witteman and Poll, {Marcel van de} and Santvoort, {Hjalmar C van} and Eyad Issa and Ashley Dennison and Goor, {Harry van} and Besselink, {Marc G} and Bouwense, {Stefan A W} and {Dutch Pancreatitis Study Group}",

year = "2020",

month = sep,

doi = "10.1016/j.clnu.2019.12.006",

language = "English",

volume = "39",

pages = "2686--2694",

journal = "Clinical Nutrition",

issn = "0261-5614",

publisher = "Churchill Livingstone",

number = "9",

}

Wolbrink, DRJ, Grundsell, JR, Witteman, B, Poll, MVD, Santvoort, HCV, Issa, E, Dennison, A, Goor, HV, Besselink, MG, Bouwense, SAW & Dutch Pancreatitis Study Group 2020, 'Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis', Clinical Nutrition, vol. 39, no. 9, pp. 2686-2694. https://doi.org/10.1016/j.clnu.2019.12.006

TY - JOUR

T1 - Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis?

T2 - A systematic review and meta-analysis

AU - Wolbrink, Daniel R J

AU - Grundsell, Jessica R

AU - Witteman, Ben

AU - Poll, Marcel van de

AU - Santvoort, Hjalmar C van

AU - Issa, Eyad

AU - Dennison, Ashley

AU - Goor, Harry van

AU - Besselink, Marc G

AU - Bouwense, Stefan A W

AU - Dutch Pancreatitis Study Group

PY - 2020/9

Y1 - 2020/9

N2 - BACKGROUND: Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.AIM: Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.METHODS: A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.RESULTS: After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13-1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12-0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28-0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.CONCLUSIONS: Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.

AB - BACKGROUND: Acute pancreatitis (AP) is marked by a strong pro-inflammatory response, which may cause a systemic inflammatory response syndrome (SIRS), organ failure, and death. Early administration of omega-3 fatty acids (FA) may reduce the pro-inflammatory response and improve outcome in AP. A systematic review focusing on the safety and efficacy of omega-3 FA in AP is lacking.AIM: Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.METHODS: A systematic review and meta-analysis was performed using the PubMed, Embase, and Cochrane databases including only randomized controlled trials in AP and, for safety endpoints, in sepsis investigating intervention including omega-3 FA without other active components (e.g. addition of glutamine to the intervention). The primary outcome was mortality.RESULTS: After screening 1186 studies, five randomized trials (n = 229) with omega-3 FA in AP were included. In AP patients treated with omega-3 FA within 48 h after hospitalization, a non-significant reduction of mortality was seen (OR 0∙50, 95%CI 0∙13-1∙99, p = 0∙33), compared to controls. In two studies (n = 85), omega-3 FA reduced the risk of new onset of organ failure (OR 0∙33, 95%CI 0∙12-0∙93, p = 0∙04). Nine randomized trials with 312 patients suffering from sepsis (not pancreatitis related) demonstrated a reduced mortality (OR 0∙52, 95%CI 0∙28-0∙97, p = 0·04). None of these 14 randomized trials reported safety concerns.CONCLUSIONS: Administration of omega-3 FA could reduce the risk of new-organ failure in patients with AP. There were no safety issues reported of the early administration of omega-3 FA in any of the included studies. To show the real clinical benefit of omega-3 FA in AP, a large and pragmatic randomized controlled trial is needed.

KW - Acute pancreatitis

KW - Anti-inflammatory

KW - CONTROLLED-TRIAL

KW - CRITICALLY-ILL PATIENTS

KW - DOUBLE-BLIND

KW - FISH-OIL

KW - IMPACT

KW - INFLAMMATION

KW - LIPID EMULSION

KW - MANAGEMENT

KW - N-3 FATTY-ACIDS

KW - Omega-3 fattyacids

KW - Organ failure

KW - PARENTERAL-NUTRITION

KW - Safety

KW - Sepsis

KW - MORTALITY

U2 - 10.1016/j.clnu.2019.12.006

DO - 10.1016/j.clnu.2019.12.006

M3 - (Systematic) Review article

C2 - 31959476

VL - 39

SP - 2686

EP - 2694

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

IS - 9

ER -