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

Background: An enlarged liver, resulting from fatty liver and or steatohepatitis, may cause complications in gastric bypass surgery and increase the risk of liver laceration. Recently, ω-3 polyunsaturated fatty acids (ω-3 PUFAs) 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 before the bariatric surgery. Methods and Materials: This review summarizes studies investigating the influence of fish oil/ ω-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 about the effects of ω-3 and or fish oil supplementation on liver size, fatty liver, or steatohepatitis. Results: Most randomized controlled trials showed that ω-3 PUFA supplementation, primarily due to its anti-inflammatory and antioxidative properties, is a practical and effective treatment for fatty liver. It also decreases Alanine Transaminase (ALT), Aspartate Transaminase (AST), and Gamma-Glutamyl Transferase (GGT). ω-3 Fatty acids as essential regulators of hepatic gene transcription can reduce hepatic steatosis and inflammation markers; they also improve insulin sensitivity. As well, the access to the gastroesophageal junction was reported as simple. Conclusion: The observed data suggest that preoperative fish oil/ω-3 PUFA supplementation could effectively improve liver function and decrease liver volume before bariatric surgery. However, well-designed randomized clinical trials are needed to confirm these results and determine a clear supplementation protocol regarding the optimal dose and duration before surgery