Effect of ω-3 polyunsaturated fatty acids on liver function and inflammatory reaction in patients undergoing hepatectomy: a systematic review and meta-analysis of randomized control trials

ABSTRACT

Introduction: Several studies have investigated the relationship between ω-3 polyunsaturated fatty acids (PUFAs) administration and liver function and inflammatory reaction in patients undergoing liver resection, but the results remain conflicting and inconclusive.

Areas covered: In this meta-analysis, a relevant database search was performed to retrieve all the randomized controlled trials (RCTs) exploring the effect of ω-3 PUFAs administration in patients undergoing hepatectomy until the end of April 2018. A random effect model was used to conduct this meta-analysis with RevMan 5.3.5 software. The quality of evidence for each postoperative outcome was assessed using the GRADEpro analysis.

Expert opinion: 4 RCTs including 553 patients (277 with and 276 without ω-3 PUFAs) were identified. ω-3 PUFAs significantly reduced alanine aminotransferase [Mean difference (MD): −68.82, 95% confidence interval (CI): −108.55 to – 29.08; p = 0.0007]; aspartate aminotransferase (MD: −64.92, 95% CI: −112.87 to −16.98; p = 0.008), white blood cell count (MD: −1.22, 95% CI: −2.15 to −0.29; p = 0.01) and increased the level of pre-albumin on postoperative day 3 (MD: 10.42, 95% CI: 4.84 to 15.99; p = 0.0002). The results indicate that ω-3 PUFAs administration has a positive impact on the liver function and inflammatory reaction in patients undergoing liver resection.

KEYWORDS:

• Hepatectomy
• ω-3 polyunsaturated fatty acids
• liver function
• inflammatory reaction
• randomized controlled trails
• meta-analysis

Article highlights

• Supplementation of ω-3 polyunsaturated fatty acids (PUFAs) has been proved to remarkably reduce the incidence of total postoperative complications and infectious postoperative complications, and shorten the hospital stays for patients undergoing hepatectomy.

• Up to now, a number of researches have explored the effect of ω-3 PUFAs on liver function and inflammatory reaction in patients undergoing liver resection, but the results remain conflicting and inconclusive.

• This is the first systematic review and meta-analysis to comprehensively assess the effect of ω-3 PUFAs on liver function and inflammatory reaction in patients undergoing hepatectomy.

• Supplementation of ω-3 PUFAs has been confirmed to be beneficial in reducing the levels of ALT, AST, and WBC, and increasing the level of pre-Alb on postoperative day 3.

• According to GRADEpro, the quality of evidence on ALT, pre-Alb, and WBC on postoperative day 3 are moderate, indicating the conclusion is reliable.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was funded by the Natural Science Foundation of Liaoning Province [No. 201,602,874] and Clinical Medicine Discipline Promotion Plan-Cultivate Discipline Construction Support Plan of China Medical University [No. 111–3,110,118,051].