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The right kind of oil

Long-term parenteral nutrition (PN) can cause serious liver injury, especially in infants, for unknown reasons. In the July Pediatrics, Children's Hospital Boston surgeon Mark Puder, MD, and pharmacist Kathleen Gura, PharmD, report saving two infants' lives—with one able to come off a liver- transplant list—simply by changing the type of fat used in the PN solution.

Originally studying mice, they found that Intralipid, the standard lipid in PN, was causing fat accumulation that leads to liver injury. Made from soybean oil, Intralipid is high in omega-6 fatty acids that are known to be pro-inflammatory. When Dr. Puder and Dr. Gura substituted Omegaven, a fish-oil derivative containing omega-3 fatty acids, liver damage was prevented. And when they tried Omegaven in two infants, both had complete resolution of PN-associated liver disease. To date, 21 patients at Children's have received the Omegaven PN formulation, and Dr. Puder hopes to begin a clinical trial soon.

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