Changes in Antioxidant Defense System Using Different Lipid Emulsions in Parenteral Nutrition in Children after Hematopoietic Stem Cell Transplantation

Abstract

Background: Traditionally, lipids used in parenteral nutrition (PN) are based on ω-6 fatty acid-rich vegetable oils, such as soybean oil, with potential adverse effects involving oxidative stress. Methods: We evaluated the antioxidant defense system in children, after hematopoietic stem cell transplantation (HSCT), who were randomized to use a lipid emulsion with fish oil or soybean oil. Blood samples at baseline, at 10 days, and at the end of the PN were taken to analyze plasma retinol, α-tocopherol, β-carotene, coenzyme Q9 and coenzyme Q10 levels, and catalase (CAT), glutathione reductase (GR), glutathione peroxidase (GPOX), and superoxide dismutase (SOD) levels in lysed erythrocytes. Results: An increase in plasma α-tocopherol levels in the group of patients receiving the fish oil-containing emulsion (FO) compared with the group receiving the soybean emulsion was observed at day 10 of PN. Concurrently, plasma α-tocopherol increased in the FO group and β-carotene decreased in both groups at day 10 compared with baseline levels, being more significant in the group receiving the FO emulsion. Conclusion: FO-containing emulsions in PN could improve the antioxidant profile by increasing levels of α-tocopherol in children after HSCT who are at higher risk of suffering oxidative stress and metabolic disorders.

Revisiting nutritional support for allogeneic hematologic stem cell transplantation—a systematic review

“…20 These first results support current efforts to further investigate the value of EN in large, prospective randomized controlled trials as the ongoing study authored by Lemal et al 51 Current literature also questions the role of antioxidants, mainly glutamine, vitamins, trace elements and immunomudulants, for example, omega 3 fatty acids. [52][53][54][55][56] Except for vitamin D, there is no proven benefit of those substances. 57,58 Unfortunately, there were no studies of high quality to integrate into this review.…”

Variability of nutritional practices in peritransplant period after allogeneic hematopoietic stem cell transplantation: a survey by the Complications and Quality of Life Working Party of the EBMT

“…Today, at least a third of EBMT centers uses glutamine as an oral supplement and/or added to PN. However, more recent studies question the role of this antioxidant and other immune-nutrients [49][50][51]. Owing to the lack of proven benefit, the use of these substances should not be recommended anymore.…”

The ω-3 Polyunsaturated Fatty Acids and Oxidative Stress in Long-Term Parenteral Nutrition Dependent Adult Patients: Functional Lipidomics Approach

“…Most of the in vivo studies addressing the issue of beneficial or adverse effects of FO-based nutrition mixtures were performed on a short-term (up to 14 days) basis. As far as oxidative stress is concerned, no effect of FO-based emulsions was reported in six studies [9][10][11][12][13][14] while their anti-oxidative effect was found in two studies [15,16]. One human study reported the pro-oxidative effect of FO emulsions [17].…”