n-3 Polyunsaturated Fatty Acid Supplementation Affects Oxidative Stress Marker Levels in Patients with Type II Intestinal Failure: A Randomized Double Blind Trial

Parenteral Nutrition Containing Fish Oil for Hospitalized Non-Intensive Care Unit (ICU) Patients: A Systematic Review, Meta-Analysis, and Cost-Effectiveness Analysis

Background and aims: We investigated parenteral nutrition (PN) containing fish oil (FO-PN) vs. standard PN without fish oil (NF-PN) in adult patients hospitalized in the non-intensive care unit (general ward). Methods: Searches in Medline, Embase, and Web of Science (any date to 10 October 2024) were screened, data were extracted, and the quality of the studies was assessed by two independent researchers. Meta-analyses were performed, with outcomes included in random effects models, and heterogeneity for clinical outcomes was explored via subgroup analyses and meta-regression. Pharmacoeconomic analyses used data from the current meta-analysis. Results: In this study, 29 randomized controlled trials (RCTs) were included, with intervention and control groups given FO-PN and NF-PN, respectively, as part of PN covering ≥70% energy provision. Compared to NF-PN, FO-PN was associated with a 37% lower relative risk (RR) of infection (19 RCTs; RR 0.63, 95% confidence interval [CI] 0.50-0.78; p < 0.0001), 2.03 days shorter length of hospital stay (18 RCTs; 95% CI 1.23-2.84; p < 0.00001), and a 51% reduction in the risk of sepsis (10 RCTs; RR 0.49, 95% CI 0.32-0.74; p = 0.0009). There was a non-significant 54% reduction in the 30-day mortality rate (11 RCTs; RR 0.46, 95% CI 0.20-1.08; p = 0.07) for FO-PN. FO-PN was associated with better clinical outcomes and financial savings (i.e., dominance) compared to NF-PN in all five countries studied. Conclusions: FO-PN is a cost-effective option compared to NF-PN for adult patients hospitalized in a general ward across a range of healthcare systems.

Targeted changes in blood lipids improves fibrosis in renal allografts

BACKGROUND

Chronic interstitial fibrosis is the primary barrier against the long-term survival of transplanted kidneys. Extending the lifespan of allografts is vital for ensuring the long-term health of patients undergoing kidney transplants. However, few targets and their clinical applications have been identified. Moreover, whether dyslipidemia facilitates fibrosis in renal allograft remains unclear.

METHODS

Blood samples were collected from patients who underwent kidney transplantation. Correlation analyses were conducted between the Banff score and body mass index, and serum levels of triacylglycerol, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. A rat model of renal transplantation was treated with the lipid-lowering drug, fenofibrate, and kidney fibrosis levels were determined by histochemical staining. Targeted metabolomic detection was conducted in blood samples from patients who underwent kidney transplantation and were divided into fibrotic and non-fibrotic groups. Rats undergoing renal transplantation were fed either an n-3 or n-6 polyunsaturated fatty acid (PUFA)-enriched diet. Immunohistochemical and Masson's trichrome staining were used to determine the degree of fibrosis.

RESULTS

Hyperlipidemia was associated with fibrosis development. Treatment with fenofibrate contributed to improve fibrosis in a rat model of renal transplantation. Moreover, n-3 PUFAs from fibrotic group showed significant downregulation compared to patients without fibrotic renal allografts, and n-3 PUFAs-enriched diet contributed to delayed fibrosis in a rat model of renal transplantation.

CONCLUSIONS

This study suggests that hyperlipidemia facilitates fibrosis of renal allografts. Importantly, a new therapeutic approach was provided that may delay chronic interstitial fibrosis in transplanted kidneys by augmenting the n-3 PUFA content in the diet.