Microscopic view of fish oil molecules in bloodstream aiding cellular recovery.

Fish Oil in Surgical Recovery: Can It Improve Outcomes?

Lena Voss in Health & Wellness August 2025 • 4 min read.

"Discover how intravenous fish oil emulsions are changing post-operative care for critically ill patients, reducing inflammation and improving recovery times."

For years, the standard intravenous lipid emulsions (ILEs) used in U.S. hospitals were primarily composed of soybean oil. While these provided necessary nutrition, clinicians observed a potential downside: the pro-inflammatory nature of soybean oil's long-chain triglycerides (LCTs). This sparked interest in alternative ILE blends already in use in Europe and China, which incorporated fish oil (FO), olive oil (OO), and medium-chain triglycerides (MCTs).

In 2016, the FDA approved the first alternative composite mixed-oil ILE for use in adult patients. This blend contains soybean oil (30%), MCTs (30%), OO (25%), and fish oil (15%). This approval has opened the door to new strategies for managing nutrition in critically ill surgical patients, especially those requiring parenteral nutrition (PN).

This article examines the evidence surrounding fish oil-containing ILEs (FO ILEs) and their impact on clinical outcomes. By reviewing recent studies, we aim to understand whether FO ILEs can improve recovery, reduce complications, and support overall health in surgical patients.

What the Research Says: Fish Oil's Benefits for Surgical Patients

Microscopic view of fish oil molecules in bloodstream aiding cellular recovery.

Research suggests that FO ILEs offer several advantages over traditional soybean oil-based emulsions, particularly in managing triglyceride levels, reducing inflammation, and supporting liver function. These benefits can lead to improved morbidity and mortality outcomes in critically ill surgical patients.

One of the key concerns with parenteral nutrition is the potential for increased serum triglyceride concentrations. Studies show that FO ILEs may help mitigate this risk:

Lower Incremental Increases: A study of gastrointestinal surgery patients found that an FO ILE blend led to significantly lower incremental increases in serum triglycerides compared to a traditional MCT/LCT emulsion.
Protective Against Rapid Spikes: Another study in surgical ICU patients demonstrated that an MCT:LCT:FO emulsion resulted in significantly lower serum triglyceride levels by day 4 compared to an MCT:LCT emulsion.
Maintaining Healthy Levels: While some studies showed increases in triglyceride levels in both FO and non-FO groups, levels remained within safe limits (<250 mg/dL), with FO groups often showing better control.

Surgical patients often experience high levels of inflammation, which can hinder recovery and increase the risk of complications. FO ILEs have demonstrated anti-inflammatory effects in several studies:

The Future of Surgical Nutrition: Embracing Fish Oil Emulsions

The research is compelling: incorporating fish oil into intravenous lipid emulsions offers significant benefits for surgical patients. From managing triglyceride levels and tamping down inflammation to potentially improving liver function and clinical outcomes, FO ILEs represent a promising advancement in nutritional support.

While more research is always valuable, the existing evidence makes a strong case for considering FO ILEs as a standard of care for surgical patients requiring parenteral nutrition. As healthcare providers, staying informed about these advancements allows for providing the best possible care and promoting faster, more complete recoveries.

By understanding the potential of FO ILEs and carefully considering individual patient needs, clinicians can leverage these innovative emulsions to optimize nutrition, reduce complications, and improve overall outcomes in the surgical setting.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1002/ncp.10224, Alternate LINK

Title: Impact Of Intravenous Lipid Emulsions Containing Fish Oil On Clinical Outcomes In Critically Ill Surgical Patients: A Literature Review

Subject: Nutrition and Dietetics

Journal: Nutrition in Clinical Practice

Publisher: Wiley

Authors: Samantha Honeywell, Rena Zelig, Diane Rigassio Radler

Published: 2018-12-05

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Everything You Need To Know

1

How do fish oil-containing intravenous lipid emulsions (FO ILEs) differ from traditional intravenous lipid emulsions (ILEs) composed of soybean oil, and why is this difference important in surgical settings?

Traditional intravenous lipid emulsions (ILEs) in the U.S. were primarily composed of soybean oil, containing long-chain triglycerides (LCTs). These soybean oil-based emulsions, while providing nutrition, were observed to potentially promote inflammation. Fish oil-containing intravenous lipid emulsions (FO ILEs) incorporate fish oil, and often olive oil (OO) and medium-chain triglycerides (MCTs), aiming to reduce inflammation and improve other clinical outcomes. The FDA approved a composite mixed-oil ILE containing soybean oil (30%), MCTs (30%), OO (25%), and fish oil (15%) in 2016. This is crucial in surgical settings because surgical patients often experience heightened inflammation, which can impede recovery. FO ILEs aim to counteract this by offering anti-inflammatory benefits compared to the pro-inflammatory nature of soybean oil-based emulsions.

2

What specific benefits have studies shown regarding the impact of fish oil ILEs (FO ILEs) on triglyceride levels in surgical patients receiving parenteral nutrition (PN)?

Studies indicate that fish oil-containing intravenous lipid emulsions (FO ILEs) can help manage triglyceride levels in surgical patients receiving parenteral nutrition (PN). Research has demonstrated that FO ILEs lead to lower incremental increases in serum triglycerides compared to traditional medium-chain triglycerides/long-chain triglycerides (MCT/LCT) emulsions. Additionally, certain studies have shown that using a medium-chain triglycerides:long-chain triglycerides:fish oil (MCT:LCT:FO) emulsion results in significantly lower serum triglyceride levels compared to a medium-chain triglycerides:long-chain triglycerides (MCT:LCT) emulsion by day 4. While some studies noted increases in triglyceride levels in both FO and non-FO groups, the levels generally remained within safe limits (<250 mg/dL), with the FO groups often exhibiting better control.

3

Beyond triglyceride management, how do fish oil ILEs (FO ILEs) influence inflammation in surgical patients, and what are the implications for their recovery?

Fish oil-containing intravenous lipid emulsions (FO ILEs) have demonstrated anti-inflammatory effects, which is particularly beneficial for surgical patients who often experience high levels of inflammation that can hinder recovery and elevate the risk of complications. Although the specific mechanisms aren't detailed, the key takeaway is that FO ILEs help mitigate inflammation, potentially leading to improved clinical outcomes and faster recovery times. The article does not detail any potential impacts to the immune response due to a suppressed inflamation response. Further research is needed to evaluate these potential impacts.

4

How might the incorporation of fish oil into intravenous lipid emulsions (FO ILEs) represent an advancement in nutritional support for surgical patients, and what are the potential future directions for its use?

The incorporation of fish oil into intravenous lipid emulsions (FO ILEs) signifies a significant advancement in nutritional support for surgical patients because it addresses key challenges such as managing triglyceride levels and reducing inflammation, which are critical for improving morbidity and mortality outcomes. The future use of FO ILEs may involve more personalized approaches to nutritional support, tailoring the composition of ILEs to individual patient needs and surgical contexts. Additional research could explore the optimal dosages and combinations of fish oil with other lipids like olive oil and medium-chain triglycerides to maximize benefits and minimize potential side effects. Further investigation into long-term outcomes and cost-effectiveness will also be essential for widespread adoption.

5

What are the clinical implications of using a composite mixed-oil ILE containing soybean oil, MCTs, olive oil, and fish oil for adult surgical patients requiring parenteral nutrition (PN)?

The clinical implications of using a composite mixed-oil ILE containing soybean oil (30%), medium-chain triglycerides (MCTs) (30%), olive oil (OO) (25%), and fish oil (15%) for adult surgical patients requiring parenteral nutrition (PN) are substantial. This blend aims to provide a balanced nutritional profile while mitigating the pro-inflammatory effects associated with pure soybean oil emulsions. The inclusion of fish oil helps to reduce inflammation and better manage triglyceride levels. The MCTs offer a readily available energy source, and olive oil contributes additional beneficial fatty acids. By using this composite ILE, clinicians aim to improve liver function, reduce complications, and support overall recovery in critically ill surgical patients. The long-term effects and optimal use of this specific blend compared to other formulations require further study.