The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease

Parenteral nutrition associated liver disease (PNALD) is the major source of morbidity and mortality in children with short bowel syndrome (SBS). There is emerging evidence that omega-6 fatty acids (omega 6FA) within the parenteral solution play a major role in PNALD and their effects may be reversed or ameliorated by substitution with omega-3 fatty acids (omega 3FA). This paper reviews the mechanisms whereby omega 3FAs may influence PNALD by improving bile flow, inhibiting steatosis, and having immunomodulatory effects. The early clinical experience with omega 3FAs in SBS and PNALD is briefly reviewed and the implications of such, and future directions are considered.