Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long-chain triacylglycerols

Abstract

It has been claimed that lipid emulsions with a restricted linoleic acid content can improve the safety of total parenteral nutrition (TPN). The tolerability of TPN and its effects on the metabolism of fatty acids were assessed in this prospective, double-blind, randomised study comparing an olive/soyabean oil long-chain triacylglycerol (LCT) with a medium-chain triacylglycerol (MCT)/LCT; 50:50 (w) based lipid emulsion in two groups (O and M, respectively; eleven per group) of severely burned patients. After resuscitation (48-72 h), patients received TPN providing 147 kJ/kg per d (35 kcal/kg per d) with fat (1·3 g/kg per d) for 6 d Plasma fatty acids, laboratory parameters including liver function tests, and plasma cytokines were assessed before and after TPN. Adverse events encountered during TPN and the clinical outcomes of patients within the subsequent 6 months were recorded. With both lipid emulsions, the conversion of linoleic acid in its higher derivatives (di-homo-g-linolenic acid) improved and essential fatty acid deficiency did not appear. Abnormalities of liver function tests occurred more frequently in the M (nine) than in the O (three) group (P¼0·04, Suissa-Shuster test). Seven patients (four from group O and three from group M) died as a consequence of severe sepsis 3-37 d after completion of the 6 d TPN period. When compared with the surviving patients, those who died were older (P¼0·01) and hyperglycaemic at baseline (P,0·001), and their plasma IL-6 levels continued to increase (P,0·04). Although fatty acid metabolism and TPN tolerability were similar with both lipid emulsions, the preservation of liver function noted with the use of the olive oil-based lipid emulsions deserves confirmation.

Estudio comparativo de la efi cacia y seguridad de una nutrición parenteral formulada con dos lípidos distintos: SMOFlipid® frente a Clinoleic®. Estudio preliminar

“…Existen por tanto múltiples estudios que comparan SMOFlipid ® frente a otros lípidos (no con oleico) (23-25) y de Clinoleic ® frente a otros lípidos no enriquecidos en omega 3 (26)(27)(28)(29), pero muy pocos comparativos entre el oleico y SMOFlipid ® en adultos. En las Guías de Nutrición Parenteral para el paciente crítico realizadas por la ESPEN se reconoce que el lípido basado en omega 9 (Clinoleic ® ) es bien tolerado en pacientes críticos, y que la adición de ácido eicosapentaenoico (EPA) y ácido docosahexaenoico (DHA) a las emulsiones lipídicas ha demostrado un efecto beneficioso sobre los procesos inflamatorios (30).…”

Maximizing efficacy from parenteral nutrition in critical care: Appropriate patient populations, supplemental parenteral nutrition, glucose control, parenteral glutamine, and alternative fat sources

“…There are limited data evaluating the benefit of this emulsion in critically ill patients. Garcia-de-Lorenzo et al [70] randomized 22 severely burned patients to receive an olive oil-based lipid emulsion or a MCT/LCT emulsion. Although they observed no differences in outcome, a statistically higher number of patients experienced liver function abnormalities with the MCT/LCT emulsion.…”

Émulsions lipidiques : indication des différentes émulsions lipidiques

“…En ce qui concerne la prévention des complications et en particulier des complications hépatiques, sur six études de nutrition parentérale de courte durée (six à dix jours), la moitié des études montre une moindre augmentation des gamma GT alors que l'autre moitié ne montre pas de différence sur les altérations du bilan hépatique [18,[25][26][27][28][29]. Dans une étude ouverte en nutrition parentérale au long cours, le Médialipide ® aurait permis la normalisation des gamma GT à six mois [27].…”

“…Cependant, il y a peu d'études cliniques référencées [29,[48][49][50][51][52][53]. Dans ces études, cette émulsion lipidique a été aussi bien tolérée et aussi efficace que l'émulsion composée de triglycé-rides à chaînes longues.…”