The Potential Role of Fish Oil/Omega-3 Polyunsaturated Fatty Acids Supplementation on Liver Size Before Bariatric Surgery

Background: An enlarged liver, which is resulted from fatty liver and/or steatohepatitis, makes difficulties in gastric bypass surgery procedure and increases the risk of liver laceration. omega-3 polyunsaturated fatty acids (ω-3 PUFAs) recently have been suggested as a potential intervention to reduce liver inflammation and volume. This review aimed to provide a comprehensive overview of the recent advances on fish oil/ ω-3 PUFAs supplementation to reduce the liver volume proceeding to bariatric surgery. Methods: This review summarizes studies that were investigated the influence of fish oil/omega-3 PUFA in the liver volume of bariatric surgery candidates. Scopus and PubMed databases were systematically searched up to May 2021, for studies providing knowledge relating to the effects of omega-3 and/or fish oil supplementation on liver size, fatty liver, or steatohepatitis. Results: Most of the randomized controlled trials showed that ω-3 PUFA supplementation, mostly due to its anti-inflammatory and antioxidative properties, is a practical and effective treatment for fatty liver, and to decrease ALT, AST, and GGT. Omega-3 fatty acids as important regulators of hepatic gene transcription can reduce hepatic steatosis and inflammation markers, also improve insulin sensitivity. As well, the access to the gastroesophageal junction was reported as simple. Conclusion: The collective data suggest that preoperative fish oil ω-3 PUFA supplementation could be an effective approach in improving liver function and decrease liver volume before bariatric surgery. Although, well-designed randomized clinical trials are needed to confirm these results and determine a clear protocol of supplementation regarding the optimal dose and duration before surgery.