Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Material and Method
2.1. Literature Search Strategy
Database | Search Strategy |
---|---|
MEDLINE (Through PubMed) | (“Omega-3 fatty acids” [Title/Abstract] OR “fish oil” [Title/Abstract] OR “n-3 fatty acids” [Title/Abstract]” OR “eicosapentaenoic acid” [Title/Abstract] OR “docosahexaenoic acid” [Title/Abstract]) AND (“parenteral nutrition” [Title/Abstract] OR “TPN” [Title/Abstract] OR “PN” [Title/Abstract] OR “enteral nutrition” [Title/Abstract] OR “EN” [Title/Abstract]) AND (“critical” [Title/Abstract] OR “severe” [Title/Abstract] OR “intensive care” [Title/Abstract] OR “ICU”) |
Cochrane Library | (“Omega-3 fatty acids” OR “fish oil” OR “n-3 fatty acids”) AND (“parenteral nutrition” OR “TPN” OR “PN” OR “enteral nutrition” OR “EN”) AND (“critical” OR “severe” OR “intensive care” OR “ICU”) |
Chinese Biomedicine Database and CNKI | (“Yu You” OR “Omega-3” OR “Duo Bu Bao He Zhi Fang Suan”) AND (“Chang Wai Ying Yang” OR “TPN” OR “PN” OR “Chang Nei Ying Yang” OR “EN”) AND (“Wei Zhong Bing” OR “Wei Zhong Zheng” OR “ICU”) |
2.2. Study Selection
Inclusion and Exclusion Criteria
2.3. Methodological Quality Evaluation
Items | Points | |
---|---|---|
Randomization | Appropriate | 2 |
Did not describe the details of randomization | 1 | |
Inappropriate | 0 | |
Concealment | Appropriate | 2 |
Did not describe the details of concealment | 1 | |
Inappropriate or no concealment | 0 | |
Blinded | Appropriate | 2 |
Did not describe the details of blinded | 1 | |
Inappropriate or not blinded | 0 | |
Withdraw or drop-out | Described | 1 |
Did not describe | 0 |
2.4. Measurements and Analytical Methods
3. Results
3.1. Study Identification and Selection
Author, year | M.J.S | P.T. | N.O.P(ITT) | R.O.F | R.O.A. | Mortality n/N (ITT) | Calorie administered (kcal/day) | ||
---|---|---|---|---|---|---|---|---|---|
Omega-3 Group | Control Group | Omega-3 Group | Control Group | ||||||
Gadek, J., 1999 [24] | 5 | ARDS | 146 | EN | EN | 11/70 | 19/76 | 1728 ± 74 | 1692 ± 60 |
Grecu, I., 2003 [25] | 5 | Abdominal Sepsis | 54 | PN | PN | 2/28 | 2/26 | NR | NR |
Mayer, K., 2003 [26] | 4 | sepsis | 21 | PN | PN | 5/10 | 3/11 | NR | NR |
Pontes-Arruda, A., 2006 [27] | 5 | sepsis | 103 | EN | EN | 18/55 | 25/48 | 1621 ± 48 | 1647 ± 74 |
Singer, P., 2006 [28] | 5 | ALI | 100 | EN | EN | 13/46 | 28/49 | 1624 ± 512 | 1420 ± 437 |
Friesecke, S., 2008 [12] | 7 | Patients in medical ICU | 166 | PN + EN | PN | 18/83 | 22/82 | 22.2 ± 5.5 (kcal/kg/day) | 21.6 ± 5.6 (kcal/kg/day) |
Wang, X., 2008 [11] | 4 | SAP | 56 | PN | PN | 0/28 | 2/28 | 27(kcal/kg/day) | 27 (kcal/kg/day) |
Barbosa, V., 2010 [29] | 3 | sepsis | 23 | PN | PN | 2/13(5D), 4/13(28D) | 1/10(5D), 4/10(28D) | 2057 ± 418 | 1857 ± 255 |
Grau-Carmona, T., 2011 [30] | 5 | sepsis | 132 | EN | EN | 11/61 | 11/71 | 1718 (1189–1956) | 1599 (1351–1976) |
Gupta, A., 2011 [31] | 7 | ARDS | 61 | EN | PN | 7/31 | 13/30 | 1800 | 1800 |
Stapleton, R.D., 2011 [32] | 5 | ALI | 90 | EN | EN | 9/41(14 days) 9/40(60 days) | 10/49(14 days) 11/45 (60 days) | NR | NR |
Rice, T., 2011 [13] | 7 | ALI | 272 | EN | EN | 38/143 | 21/129 | 800–900 | 800–900 |
3.2. Primary Outcome: Mortality
3.2.1 Overall Analysis
3.2.2. Sensitivity Analysis for All-Included Trials
3.2.3. Sub-Group Analysis
3.2.3.1. Parenteral Omega-3 Studies
3.2.3.2. Sensitivity Analysis for PN Omega-3 Studies
3.2.3.3. Enteral Omega-3 Studies
3.3. An Advanced Heterogeneity Test: O/E Ratio
ALT Study | APACHE III | Sample size | Mortality (%) |
---|---|---|---|
Shenoy, V. [45] | 60 | 30 | 36.7 |
Wiesen, J.: Influenza [46] | 66 | 23 | 39.0 |
Wiesen, J.: Non-influenza [46] | 89 | 22 | 77.0 |
Lee, K.[47] | 85 | 50 | 54.0 |
Treggiari, M.: Open ICU [48] | 88.1 | 391 | 45.0 |
Treggiari, M.: Closed ICU [48] | 86.9 | 684 | 35.0 |
Rana, S.[49] | 81.5 | 38 | 68.0 |
Ware, L.[50] | 92 | 528 | 37.5 |
Rice, T.: Omega-3[13] | 93.8 | 143 | 26.6 |
Rice, T.: Control [13] | 91.8 | 129 | 16.3 |
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Chen, W.; Jiang, H.; Zhou, Z.-Y.; Tao, Y.-X.; Cai, B.; Liu, J.; Yang, H.; Lu, C.D.; Zeng, J. Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis. Nutrients 2014, 6, 2148-2164. https://doi.org/10.3390/nu6062148
Chen W, Jiang H, Zhou Z-Y, Tao Y-X, Cai B, Liu J, Yang H, Lu CD, Zeng J. Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis. Nutrients. 2014; 6(6):2148-2164. https://doi.org/10.3390/nu6062148
Chicago/Turabian StyleChen, Wei, Hua Jiang, Zhi-Yuan Zhou, Ye-Xuan Tao, Bin Cai, Jie Liu, Hao Yang, Charles Damien Lu, and Jun Zeng. 2014. "Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis" Nutrients 6, no. 6: 2148-2164. https://doi.org/10.3390/nu6062148