Administration of an Intravenous Fat Emulsion Enriched with Medium-Chain Triglyceride/ω-3 Fatty Acids is Beneficial Towards Anti-Inflammatory Related Fatty Acid Profile in Preterm Neonates: A Randomized, Double-Blind Clinical Trial

Abstract

Intravenous administration of pure soybean oil emulsions high in linoleic acid may lead to inflammation and lipid peroxidation in preterm neonates. We aimed to investigate the effects of a medium-chain triglyceride (MCT)/ω-3 polyunsaturated fatty acid (PUFA)-enriched intravenous fat emulsion (IVFE) on plasma fatty acid (FA) profile and serum interleukin-6 (IL-6) in preterm neonates. In this double-blind randomized study, 92 preterm neonates (gestational age < 32 weeks, birth weight < 1500 g) were assigned to receive either MCT/ω-3 PUFA-enriched IVFE (Intervention Group) or soybean oil-based IVFE (Control Group). Levels of FAs were measured at baseline (day 0) and day 15 of parenteral nutrition with gas-chromatography mass-spectrometry. Serum IL-6 was measured with sandwich ELISA in 59 neonates. Plasma FAs changed significantly over time; the MCT/ω-3 PUFA-IVFE group showed higher ω-3 PUFAs (p = 0.031), eicosapentaenoic acid (p = 0.000), and oleic acid (p = 0.003), and lower ω-6/ω-3 PUFAs ratio (p = 0.001) and ω-6 PUFAs (p = 0.023) compared to control group. Linoleic acid was higher in the soybean oil (SO)-based IVFE arm compared to the MCT/ω-3 PUFAs-IVFE arm (p = 0.006). Both fat emulsion types decreased IL-6 compared to baseline, but changes were insignificant between groups. Administration of MCT/ω-3 PUFA-enriched IVFE in preterm neonates is beneficial in changing the FA profile consistent with attenuated inflammatory response.

Erythrocyte Membrane Docosahexaenoic Acid (DHA) and Lipid Profile in Preterm Infants at Birth and Over the First Month of Life: A Comparative Study with Infants at Term

“…Also, the balance between metabolites of n-3 and n-6 PUFAs seems to be important in pregnancy maintenance and have a significant role in cervical dilatation and initiation of labour [ 32 ]. In randomized, double-blind clinical trials carried out in preterm neonates, the administration of medium-chain triglyceride/n-3 PUFA-enriched intravenous fat emulsion changed the fatty acid profile consistent with an attenuated inflammatory response [ 33 , 34 ].…”

Association between two different lipid injectable emulsions and parenteral nutrition–associated cholestasis in very low birth weight infants: A retrospective cohort study

“…In this study, there was no significant difference in the daily dose of ursodiol According to the literature, giving preterm neonates fish oil-containing ILEs is linked to reduced inflammatory response. 18 In addition to reducing the supply of potentially oxidative, inflammatory/immunosuppressive, and prothrombotic ω-6 fatty acids, the incorporation of fish oil also brings about biological effects and appears to decrease the risk of infections and the duration of hospital or intensive care unit stay. 10,[19][20][21] Eicosapentaenoic acid and docosahexaenoic acid, as direct precursors of powerful specialized proresolving mediators, possess favorable bioactivities with established mechanisms of action.…”

“…According to the literature, giving preterm neonates fish oil–containing ILEs is linked to reduced inflammatory response 18 . In addition to reducing the supply of potentially oxidative, inflammatory/immunosuppressive, and prothrombotic ω‐6 fatty acids, the incorporation of fish oil also brings about biological effects and appears to decrease the risk of infections and the duration of hospital or intensive care unit stay 10,19–21 .…”

Effects of ω-3 fatty acids and ratio of ω-3/ω-6 for health promotion and disease prevention

“…The ratios ω-6 and ω-3 should be between 2:1 and 4:1, and some health teachers advocate even lower ratios. Studies have shown that a 2-3: 1 ratio between ω-6 and ω-3 helps reduce inflammation in patients with rheumatoid arthritis, a ratio of 5: 1 has a beneficial effect on asthma patients, and the ratio is 10: 1 Has a negative effect: the ratio 2.5: 1 has a reduced effect on the proliferation of rectal cells in patients with colorectal cancer, but the ratio 4: 1 has no effect (Papandreou et al, 2020;Zong et al, 2021).…”