Functional lipidomics in patients on home parenteral nutrition: Effect of lipid emulsions

Abstract

AIMTo investigate the fatty acid-based functional lipidomics of patients on long-term home parenteral nutrition receiving different intravenous lipid emulsions.METHODSA cross-sectional comparative study was carried out on 3 groups of adults on home parenteral nutrition (HPN), receiving an HPN admixture containing an olive-soybean oil-based intravenous lipid emulsion (IVLE) (OO-IVLE; n = 15), a soybean- medium-chain triacylglycerol-olive-fish oil-based IVLE (SMOF-IVLE; n = 8) or HPN without IVLE (No-IVLE; n = 8) and 42 healthy controls (HCs). The inclusion criteria were: duration of HPN ≥ 3 mo, current HPN admixtures ≥ 2 mo and HPN infusions ≥ 2/wk. Blood samples were drawn 4-6 h after the discontinuation of the overnight HPN infusion. The functional lipidomics panel included: the red blood cell (RBC) fatty acid (FA) profile, molecular biomarkers [membrane fluidity: saturated/monounsaturated FA ratio = saturated fatty acid (SFA)/monounsaturated fatty acid (MUFA) index; inflammatory risk: n-6/n-3 polyunsaturated fatty acid (PUFA) ratio = n-6/n-3 index; cardiovascular risk: sum of n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) = n-3 index; free radical stress: sum of FA trans isomers = %trans index] and FA pathway enzyme activity estimate (delta-9-desaturase = D9D; delta-6-desaturase = D6D; delta-5-desaturase = D5D; elongase = ELO). Statistics were carried out using nonparametric tests. The amount of each FA was calculated as a percentage of the total FA content (relative%).RESULTSIn the OO-IVLE group, the percentage of oleic acid in the RBCs was positively correlated with the weekly load of OO-IVLE (r = 0.540, P = 0.043). In the SMOF-IVLE cohort, the RBC membrane EPA and DHA were positively correlated with the daily amount of SMOF-IVLE (r = 0.751, P = 0.044) and the number of HPN infusions per week (r = 0.753; P = 0.046), respectively. The SMOF-IVLE group showed the highest EPA and DHA and the lowest arachidonic acid percentages (P < 0.001). The RBC membrane linoleic acid content was lower, and oleic and vaccenic acids were higher in all the HPN groups in comparison to the HCs. Vaccenic acid was positively correlated with the weekly HPN load of glucose in both the OO-IVLE (r = 0.716; P = 0.007) and the SMOF-IVLE (r = 0.732; P = 0.053) groups. The estimated activity of D9D was higher in all the HPN groups than in the HCs (P < 0.001). The estimated activity of D5D was lower in the SMOF-IVLE group than in the HCs (P = 0.013). The SFA/MUFA ratio was lower in all the HPN groups than in the HCs (P < 0.001). The n-6/n-3 index was lower and the n-3 index was higher in the SMOF-IVLE group in comparison to the HCs and to the other HPN groups (P < 0.001). The %trans index did not differ among the four groups.CONCLUSIONThe FA profile of IVLEs significantly influenced the cell membrane functional lipidomics. The amount of glucose in the HPN may play a relevant role, mediated by the insulin regulation of the FA pathway enzyme activities.

Use of Mixed‐Oil Fat Emulsion to Improve Intestinal Failure–Associated Liver Disease in Long‐Term Home Parenteral Nutrition: A Case Report

“…Eventually, he was placed on a MO IV fat emulsion, and his IFALD improved with no further episodes of pancreatitis. He has tolerated MO IV fat emulsion for 246 days (current dose 7 days per week, 70 g/d), which is longer than in any of the previously published studies or case reports (in adult patients) in which 28 days was the maximum reported duration of therapy until recently 4 , 5 …”

“…A recently published cross‐sectional study from Europe evaluated adult patients (n = 31) on HPN in 3 IV fat emulsion groups—(1) MO IV fat emulsion (Smoflipid), (2) 80% OO and 20% SO IV fat emulsion (Clinoleic; Baxter, France), or (3) no IV fat emulsion—and compared them with healthy controls (n = 42) 4 . They included patients who were on HPN >3 months, and evaluated fatty acid profiles as well as a number of other functional lipid measurements, including ω‐3/ω‐6 PUFA ratio.…”

Emergence of Mixed‐Oil Fat Emulsions for Use in Parenteral Nutrition

“…In addition to increasing antioxidant levels, the reduction in SO and increase in FO tend to lead to improved ω‐3 to ω‐6 PUFA ratios, producing a less proinflammatory profile, including higher levels of EPA and DHA 93 – 95 , 114 , 115 . Due to the small number of subjects and short duration of current trials, the impact of higher ω‐3 PUFA on clinical markers has been mixed, with many studies revealing no significant change in systemic inflammatory makers 91 , 95 .…”

Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

“…Since 2016, ILEs with alternative formulations, including fish oil, mixed soy and olive oil (OO) and a blend including soy, medium‐chain triglycerides, OO, and fish oils, have become available in the United States . Although still in its nascent stage, research on these novel oils has demonstrated that they are safe, well tolerated, and may offer benefits over IL relative to progression of liver disease …”