New Parenteral Lipid Emulsions for Clinical Use

Abstract

Routine use of parenteral lipid emulsions (LE) in clinical practice began in 1961, with the development of soybean oil (SO) - based LE. Although clinically safe, experimental reports indicated that SO-based LE could exert a negative influence on immunological functions. Those findings were related to its absolute and relative excess of omega-6 polyunsaturated fatty acids (PUFA) and the low amount of omega-3 PUFA and also to its high PUFA content with an increased peroxidation risk. This motivated the development of new LE basically designed along the reduction of omega-6 PUFA and the omega-3 PUFA addition in order to obtain balanced levels of the omega-6/omega-3 ratio. The new LE for clinical use (available in Europe and South America) are differentiated by their content in polyunsaturated (omega-6 and omega-3), monounsaturated, and saturated fatty acids (FA), as well as FA source of their origin, including soy, coconut, olive, and fish oil. This article presents the new LE nutrition and energy functions but also its biochemical, metabolic, and immunomodulating aspects, according to their FA content. LE at 20% when infused from 1.0 to 2.0 g/kg body weight/day rates, either alone or in association with amino acids and glucose, are safe and well tolerated in routine clinical practice. LE combining SO with medium-chain triglycerides and/or olive oil have less omega-6 PUFA and are better metabolized, with less inflammatory and immunosuppressive effects than in relation to pure SO-based LE. The omega-3 PUFA used alone or as component of a new and complex LE (soy, MCT, olive and fish oil) has demonstrated anti-inflammatory and immunomodulatory effects.

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

“…This emulsion is designed to increase the amount of n-3 fatty acids, thereby reducing the ratio of n-6 to n-3 fatty acids (in accordance with current recommended levels). 43 SMOFlipid 20% is well tolerated in infants without changing lipid peroxidation parameters, 31,44 and beneficial effects on liver function and serum triglyceride concentrations have been described. 31 …”

Evaluation of Liver Function Tests in Preterm Infants Receiving Parenteral Lipid Emulsions Based on Fish Oil or Olive Oil

“…Balık yağı içeren karışım lipid emülsiyonunun içeriğindeki yüksek omega-3, alfa-tokoferol ve orta-zincirli yağ asiti düzeyleri sayesinde daha iyi antioksidan kapasite sağlarken ve lipid peroksidasyonun azalmasına neden olmaktadır (6,8). Buna karşın, zeytinyağından zengin lipid emülsiyonları ise oksidatif strese daha dirençli olan tekli doymamış yağ asitlerinden yüksek miktarda içerir (20). Daha önce yaptığımız bir çalışmada prematüre yenidoğanlarda karışım lipid emülsiyonun antioksidan etkisinin infüzyon süresince sınırlı kaldığı ancak PN tedavisi kesildikten sonra devam etmediği gösterilmiştir (15).…”

Nuevas Emulsiones Lipídicas Enriquecidas Con Omega-3: ¿beneficios Reales en Nutrición Parenteral?

“…Sin embargo, se plantea un posible efecto perjudicial en dosis excesivas, ya que teóricamente el efecto antiinflamatorio podría aumentar la severidad de la respuesta antiinflamatoria de contra regulación y deteriorar la inmunidad de pacientes muy comprometidos, lo que aumentaría el riesgo de infecciones (6). Este punto podría aclarar el efecto controversial con respecto al beneficio real del Omega-3 reportado por algunos autores.…”

“…Las características fisicoquímicas de la estructura de un ácido graso determinan su metabolización hacia distintos eicosanoides, las cuales pueden modular el sistema inmune y ejercer un efecto biológico en el organismo (6). El objetivo de esta actualización fue detallar y profundizar sobre los posibles beneficios a nivel de sistema inmune que plantea el soporte nutricional con emulsiones lipídicas ricas en ácidos grasos Omega-3.…”