Background
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Supplementation with omega 3 fatty acids (n3PUFA) exerts immune-modulating and organ-protective effects, even after short-term infusion in both postoperative and critically ill patients \[[@B1],[@B2]\]. The aim of this study was to evaluate dose-dependent effects of a fish oil (FO) emulsion on the clinical course of patients with different diagnoses. Primary study endpoint was survival; secondary endpoints were length of hospital stay and use of antibiotics.

Materials and methods
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After approval by the National Board for Drug Safety (BfArM) and the Institutional Ethics Board we analyzed a database containing 661 patients from 82 German hospitals who received total parenteral nutrition (TPN) for at least 3 days. The cohort was divided into five groups according to the administered FO dose (Omegaven, Fresenius Kabi).

Results
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The patients of this survey were 62 ± 17 years old (SAPS II 32 ± 14). Diagnoses and patient numbers are shown in Fig. [1](#F1){ref-type="fig"}. In multivariate analysis the absolute dose of FO per kg/day had a 2--20 times higher impact on respective outcome parameters than the ratio of n3/n6 PUFA, which is considered to be a major determinant of beneficial n3 effects in the current literature. TPN including FO had most favourable effects on survival, infection rates and length of stay when administered in doses between 0.1 and 0.2 g/kg/day. Diagnosis-related optimum FO doses are given in Fig. [1](#F1){ref-type="fig"}.

![](cc3423-1){#F1}

Conclusion
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FO administration may reduce mortality, antibiotic use, and length of hospital stay. Individual optimum FO doses and effect sizes are diagnosis dependent.

Acknowledgements
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The authors thank R Koch and J Novotny for biomathematical advice.
