Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis
Is Omega-3 Fatty Acids Enriched Nutrition Support Safe for Critical Ill Patients? A Systematic Review and Meta-Analysis
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DOI：
10.3390/nu6062148
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发表时间：
2014-06-01
期刊：
影响因子：
5.9
通讯作者：
Zeng, Jun
中科院分区：
文献类型：
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作者：
Chen, Wei;Jiang, Hua;Zeng, Jun
目的：系统评价富含omega-3多不饱和脂肪酸（FA）的营养支持对危重病患者死亡率的影响。研究方法：检索Medline、ISI、科克伦图书馆和中国生物医学数据库，检索随机对照试验（RCT）。我们纳入了比较鱼油强化营养支持和标准营养支持的RCT。主要结局是死亡率。方法学质量评价采用改良Jadad评分量表。对于对照异质性，我们开发了一种综合I-2检验、营养支持途径亚组分析和严重程度临床状况的方法。使用RevMan 5.0软件（北欧科克伦中心，哥本哈根，丹麦）进行荟萃分析。结果：12项试验涉及1208例患者，符合所有纳入标准。试验之间存在异源性。使用随机模型，对死亡率无显著影响RR，0.82，95%置信区间（CI）（0.62，1.09），p = 0.18。由于知道鱼油给药途径可能影响异质性，我们将试验分为两个亚组：omega-3的肠外给药（PN）和omega-3的肠内给药（EN）。6项试验通过PN给予omega-3 FA。汇总结果表明，omega-3 FA对死亡率无显著影响，RR 0.76，95% CI（0.52，1.10），p = 0.15。6项试验使用富含omega-3脂肪酸的EN。排除一项被确定为异质性来源的试验后，汇总数据表明富含omega-3 FA的EN显著降低死亡率，RR= 0. 69，95% CI [0. 53，0. 91]（p = 0. 007）。结论：富含Omega-3 FA的营养支持是安全的。由于纳入试验的样本量有限，需要进一步开展大规模的RCT。
Objective: To systematically review the effects of omega-3 poly unsaturated fatty acids (FA) enriched nutrition support on the mortality of critically illness patients. Methods: Databases of Medline, ISI, Cochrane Library, and Chinese Biomedicine Database were searched and randomized controlled trials (RCTs) were identified. We enrolled RCTs that compared fish oil enriched nutrition support and standard nutrition support. Major outcome is mortality. Methodological quality assessment was conducted based on Modified Jadad's score scale. For control heterogeneity, we developed a method that integrated I-2 test, nutritional support route subgroup analysis and clinical condition of severity. RevMan 5.0 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for meta-analysis. Results: Twelve trials involving 1208 patients that met all the inclusion criteria. Heterogeneity existed between the trials. A random model was used, there was no significant effect on mortality RR, 0.82, 95% confidence interval (CI) (0.62, 1.09), p = 0.18. Knowing that the route of fish oil administration may affect heterogeneity, we categorized the trials into two sub-groups: parenteral administration (PN) of omega-3 and enteral administration (EN) of omega-3. Six trials administered omega-3 FA through PN. Pooled results indicated that omega-3 FA had no significant effect on mortality, RR 0.76, 95% CI (0.52, 1.10), p = 0.15. Six trials used omega-3 fatty acids enriched EN. After excluded one trial that was identified as source of heterogeneity, pooled data indicated omega-3 FA enriched EN significant reduce mortality, RR=0.69, 95% CI [0.53, 0.91] (p = 0.007). Conclusion: Omega-3 FA enriched nutrition support is safe. Due to the limited sample size of the included trials, further large-scale RCTs are needed.