Article Abstract

A randomised controlled trial comparing the use of omega-3 polyunsaturated fatty acid supplements versus very low calorie dietary restriction in obese Malaysian patients awaiting bariatric surgery

Authors: Zainal Adwin Zainal Abidin, Nik Ritza Kosai, Mustafa Mohd Taher, Iman Ghoneim, Mohd Aznan Shuhaili, Nur Yasmin Yaacob, Reynu Rajan


Background: A large liver can be a bariatric surgeon’s nightmare as it interferes with the operative field particularly during posterior fundal and hiatal dissection. Various methods have been employed to achieve hepatic volume reduction (HVR) prior to surgery. This study aims to compare the effect of ome-ga-3-polyunsaturated fatty acid (PUFA) supplements and very low calorie diet (VLCD) restriction on hepatic volume.
Methods: A total of 52 obese patients were randomized into two groups. For various reasons only 41 patients were included for final analysis; VLCD group (n=20) and omega-3-PUFA group (n=21). MRI vo-lumetry of liver, weight, and serum alanine transaminase (ALT) levels were measured at enrollment and again at 4 weeks.
Results: Mean HVR of VLCD group and omega-3-PUFA group at day-30 was 37.10±15.76 and 34.88±9.99 cm3. Comparative analysis of HVR between the two groups showed no statistical dif-ference (P=0.29). Similarly there was no statistical difference in ALT levels of both groups. Significant weight loss (kg) was noted in both VLCD and omega-3-PUFA group, measuring up to 2.21±2.29 and 2.85±4.62, although no sta-tistical difference was noted when compared between the two (P=0.58).
Conclusions: Pre-operative hepatic volume and weight reduction were noted in both groups with no superiority of one modality over the other. As dietary restriction is often confronted with non-compliance, omega-3-PUFA does appear to be a more attractive alternative. A larger study including cost effec-tiveness analysis may be able to further ascertain the economic impact and feasibility of pre-bariatric surgery ome-ga-3-PUFA supplementation in a developing economy such as Malaysia.