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 languageEnglish
Pages (from-to)2686-2694
Number of pages9
JournalClinical Nutrition
Volume39
Issue number9
Early online date16 Dec 2019
DOIs
Publication statusPublished - 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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