Fish oil-based emulsion for the treatment of parenteral nutrition associated liver disease in an adult patient

Background & aims: Reversal of parenteral nutrition associated liver disease with fish oil emulsion (FO) has been reported in infants. We report a similar case in an adult patient. Methods: A 58 year-old female on home parenteral nutrition for a short bowel syndrome due to Crohn’s disease, showed a progressive worsening of liver steatosis, and a persistent increase of the plasma liver function tests (LFTs). LFTs, serum alpha-tochopherol, red blood cell membrane fatty acids and liver histology were evaluated before and after an 8 month treatment with FO. Results: The patient’s LFT’s improved. There was an increase of the n-3 and a decrease of the n-6 series of fatty acids in erythrocyte membrane. There was an approximate 30% increase in vitamin E status. Before FO, liver histology showed a non-alcoholic steatohepatitis with grade 2 steatosis and inflammation and stage 3 fibrosis. After the treatment, steatosis and inflammation were grade 1, whereas fibrosis remained at stage 3. Conclusions: Infusion of FO was associated with consistent changes of cell membrane fatty acid structure and with mild improvement of vitamin E status. A potential role of FO in decreasing liver steatosis and inflammation with no change of liver fibrosis might be suggested.