Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Self Cite

Lipid emulsions are an integral part of parenteral nutrition, and traditionally have been regarded as an energy‐dense source of calories and essential fatty acids. For many years, lipids used in parenteral nutrition have been based on vegetable oils (eg, soybean‐oil emulsions). However, soybean‐oil emulsions may not have an optimal fatty‐acid composition under some circumstances when used as the only lipid source, as soybean oil is particularly abundant in the ω‐6 polyunsaturated fatty acid (PUFA), linoleic acid. Hence, a progressive series of more complex lipid emulsions have been introduced, typically combining soybean oil with 1 or more alternative oils, such as medium‐chain triglycerides (MCTs) and/or olive oil and/or fish oil. The wide range of lipid emulsions now available for parenteral nutrition offers opportunities to alter the supply of different fatty acids, which potentially modifies functional properties, with effects on inflammatory processes, immune response, and hepatic metabolism. Fish oil has become an important component of modern, composite lipid emulsions, in part owing to a growing evidence base concerning its biological effects in a variety of preclinical models. These biological activities of fish oil are mainly attributed to its ω‐3 PUFA content, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA and EPA have known mechanisms of action, anti‐inflammatory, immunomodulatory, and antioxidative properties. Specialized proresolving mediators, such as resolvins, protectins, and maresins, are synthesized directly from DHA and EPA, are key for the resolution of inflammation, and improve outcomes in many cell‐ and animal‐based models and, recently, in some clinical settings.

Section: Introductionmentioning

confidence: 95%

Lipids in Parenteral Nutrition: Biological Aspects

Calder

Waitzberg

Kłęk³

et al. 2020

Self Cite

“…10 Importantly, a consensus statement at the current meeting stated that based on clinical studies, systematic reviews, and meta-analyses, there is no evidence that fish-oil containing lipids increase the risk of coagulopathy or bleeding abnormalities (Table 1). 1 Nevertheless, controversy remains regarding the use of ω-3 fatty-acid enriched parenteral nutrition. This is not only because of the quality of some RCTs, but also as there are some conflicting results from previous reviews and metaanalysis.…”

Section: Critically Ill Patientsmentioning

confidence: 99%

“…This was also agreed as a consensus statement, which stated that if all-in-one admixtures are used, the preferable infusion duration is 24 hours ( Table 1). 1 Monitoring of clinical nutrition is required as it has become an important part of critical care, evolving from a support tool into a therapy that requires close attention and monitoring. 45 An ESPEN guideline group produced a consensus document that looked into what should be monitored, with particular attention toward triglycerides and energy delivery.…”

Section: Critically Ill Adult Patients: Practical Aspectsmentioning

confidence: 99%

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

Mayer

Kłęk²,

Garcı́a-de-Lorenzo

et al. 2020

Self Cite

In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty‐acid deficiency. However, mixtures of different lipid emulsions have now become widely available, including mixtures of soybean oil, medium‐chain triglycerides, olive oil, and fish oil. Fish oil is high in the ω‐3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω‐3 fatty acids can exert beneficial immunomodulatory, anti‐inflammatory, and inflammation‐resolution effects across a wide range of patient groups including surgical, cancer, and critically ill patients. At least in part, these effects are realized via potent specialized pro‐resolution mediators (SPMs). Moreover, parenteral nutrition including ω‐3 fatty acids can result in additional clinical benefits over the use of standard lipid emulsions, such as reductions in infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding lipid emulsion use in a variety of hospitalized patient groups, including surgical, critically ill, sepsis, trauma, and acute pancreatitis patients. Practical aspects of lipid emulsion use in critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider parenteral nutrition, duration of infusion, and safety monitoring.

“…Note: the full consensus document is also available as part of this supplement. 1 These consensus statements provide practical advice regarding the use of lipid emulsions From the 1 Neonatal NICU, Nepean Hospital, Kingswood, NSW, Australia; 2 Sydney Medical School, Nepean, University of Sydney, Australia; and the 3 Department of Pediatric Surgery, Division of Pediatric Gastroenterology and Nutrition, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.…”

Section: Introductionmentioning

confidence: 99%

Use of Lipids in Neonates Requiring Parenteral Nutrition

Deshpande

Cai

2020

Self Cite

Neonates have limited antioxidative capacity and are at increased risk of infection and inflammation—a situation that is exacerbated in preterm neonates. Together, oxidative stress and inflammation are implicated in many serious conditions affecting neonates, such as bronchopulmonary dysplasia and periventricular leukomalacia. Neonates requiring parenteral nutrition have certain nutritional requirements. For example, very long‐chain ω‐3 polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are regarded as conditionally essential with critical roles during early retinal and brain development, and may also have other benefits such as anti‐inflammatory effects. Because of these factors, the choice of lipid emulsion used as part of parenteral nutrition support may influence clinical outcomes in neonates. There are concerns that lipid emulsions based purely on soybean oil may increase lipid peroxidation, oxidative stress, and inflammation because of their high ω‐6 PUFA and low ω‐3 PUFA concentrations. Composite fish‐oil containing lipid emulsions may provide advantages for neonates owing to their high DHA and EPA content and high antioxidant (α‐tocopherol) levels. Here, we discuss clinical trials of lipid emulsions in preterm and term neonatal populations, with a particular emphasis on markers of oxidative stress and DHA and EPA levels. Olive oil/soybean oil lipid emulsions have shown few advantages in neonates over other lipid emulsions. However, compared with either pure soybean or soybean/olive‐oil based emulsions, composite fish‐oil containing lipid emulsions reduce oxidative stress/lipid peroxidation and also increase DHA and EPA levels. These advantages may translate into clinical benefits for neonates requiring parenteral nutrition.