Comment on the OMEGA Trial

Submitted by Dr. Luisito Llido, Clinical Nutrition Service, St. Luke's Medical Center, Quezon City, Philippines (March 1, 2015)

Slide 1: The OMEGA Trial junked the value of fish oils in the management of acute lung injury

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Slide 2: Final Output of the Omega Trial: The study group (fish oil) had more deaths thus the study was stopped before its termination schedule > fish oils do more harm in Acute Lung Injury (ALI)

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Slide 3: Comments on the Final Output and Conclusion of the Trial: the study group received a diet that put the patients at risk of more malnutrition related complications

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Comments:

  • The study diet had unphysiologic contents of macronutrients
    • very low protein dose at 3.8 gm/day: should be similar to the control diet of 20 gm/day
    • very low carbohydrate dose at 4.2 gm/day: should also be similar to the control diet of 31.8 gm/day
    • very high fat dose at 44.6 gm/day: should be only 22gm similar to that of the control
  • This combination would lead to the following adverse event of the patients in the study group:
    • loss of lean body mass due to low protein intake which leads to gluconeogenesis
    • the low carbohydrate content would further lead to more loss of lean body mass
    • a higher fat load will not be fully utilized due to the high inflammatory status which would preferentially utilize glucose
    • A high loss of lean body mass will lead to a higher mortality which was shown in this study
  • Recommendations for the study:
    • the control and study diets should be similar in content as far as the protein, fat and carbohydrate
    • the study macronutrient (=fat) should be be the only difference e.g. study diet: more fish oils and control diet: less fish oils
    • this maneuver would show the real difference for the value of fish oils whether positive or negative

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