Review Supports Clinically-Meaningful Benefit of Omega-3 in Patients with Acute Pancreatitis
Lei, Q. C. et al., Nutrients , 7: 2261- 2273, 2015
Southern Medical University , Guangzhou , China
Acute pancreatitis is a sudden inflammation of the pancreas often associated with upper abdominal pain (often radiating to the back), nausea, loss of appetite, and vomiting. Less severe cases can be treated without hospitalization while severe cases often require aggressive treatment in the hospital. The risk of mortality is increased in patients with severe acute pancreatitis. Since the long-chain omega-3 fatty acids in fish oil (EPA/DHA) have been established to exert anti-inflammatory effects via various mechanisms as found in different inflammatory conditions (egs., rheumatoid arthritis , dry eye syndrome) , the present authors conducted a systematic review of previous clinical trials wherein omega-3 fatty acids were evaluated for potential benefit in patients with acute pancreatitis.
A total of 8 previously-published clinical trials were combined in this overall review which employed appropriate experimental designs. A total of 181 patients with acute pancreatitis received daily supplemental omega-3 treatment (varied doses) and 183 were assigned as ‘controls’ (no omega-3 supplementation). In 2 of these studies, the omega-3 was given via enteral nutrition (orally/tube feeding – via the gastrointestinal tract) while in 6 studies it was given via parenteral nutrition (intravenously). The duration of omega-3 administration ranged from 3-15 days and the daily intake of EPA plus DHA omega-3 fatty acids in the patients treated with omega-3 from fish oil was up to 10 grams (10,000 mgs daily). Combining the overall results for the omega-3 treatment (relative to the controls) indicated a significantly-reduced risk of total mortality (lower by 65 %), infectious complications (lower by 46 %), as well as a significant reduction in the length of hospital stay.
Dr. Holub's Comments:
There have been an increasing number of clinical trials recently showing the benefit of administrating EPA/DHA omega-3 fatty acids from fish oil intravenously (via parenteral nutrition) in select patient groups with serious liver disease and other acute medical conditions . As reviewed herein in patients with acute pancreatitis, these omega-3 lipid emulsions can provide clinical benefit by favourably modifying inflammatory responses and enhancing immune functioning. In general, the use of intravenously-administered EPA/DHA in those with acute and serious pancreatitis appeared to be somewhat more effective on the short-term in the hospital setting. It is noted that, in many of these trials, the amount of EPA/DHA provided intravenously on a daily basis was much higher (often approaching 10,000 mgs) than that used in high-dose oral supplementation trials to provide health benefits for other medical conditions. The US Food and Drug Administration has indicated that adults can safely consume up to a total of 3,000 mgs per day of combined DHA and EPA with no more than 2,000 mgs per day coming from dietary supplements. Health Canada has an even higher upper limit of 5,000 mgs per day. There has been a considerable surge in research interest recently in conducting clinical trials for numerous health outcomes using much higher intakes of EPA/DHA taken as oral supplements than employed previously. This interest has been fuelled by published reports showing health/disease benefits in certain medical conditions with higher but not lower doses of EPA/DHA whether given orally or via intravenous administration in hospitalized patients as indicated herein.