Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 39; no. 9; pp. 2686 - 2694
• Main Authors: Wolbrink, Daniel R.J., Grundsell, Jessica R., Witteman, Ben, Poll, Marcel van de, Santvoort, Hjalmar C.van, Issa, Eyad, Dennison, Ashley, Goor, Harry van, Besselink, Marc G., Bouwense, Stefan A.W.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2020
• Subjects: Acute pancreatitis; Anti-inflammatory; Omega-3 fatty acids; Organ failure; Safety; Sepsis; Organ failure; Sepsis; Acute pancreatitis; Safety; Anti-inflammatory; Omega-3 fatty acids
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2019.12.006

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.
Evaluate the safety and efficacy of an intervention with omega-3 FA in acute pancreatitis and additionally in sepsis.
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.
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.
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.