The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia

Llop, Jordi; Sabı́n, Pilar; Garau, Margarita; Burgos, R.; Perez, M. Drake; Masso, Juan Francisco Borrego; Cardona, Daniel; Segura, J. M.; Garriga, R; Redondo, Santiago; Sagalés, María; Ferrer, D.; Pons, Montserrat Espuña; Vuelta, M.; Fábregas, X.; Vitales, M; Casasín, Tomás; Martínez, José Gil; Morató, Laia; Soler, María Rodríguez

doi:10.1016/s0261-5614(03)00082-7

Cited by 54 publications

(51 citation statements)

References 31 publications

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“…In this case, events prior to day 8 (highest TG peak) were considered for analysis [25] found a similar association in 30 ICU patients who received exogenous lipids only from propofol over 50 h. HyperTG induced by propofol has mainly two possible causes: the most likely is the fat emulsion vehicle itself, and possibly but less likely the inhibition of metabolism of fatty acids in the mitochondria [26][27][28] caused by uncoupling of oxidative phosphorylation and energy production [29]. Some authors have reported that hyperTG was not directly associated with the total amount of infused lipids [1,8], which is interesting as the propofol's LCT emulsion is identical to that used for PN [26,30]. Moreover, Theilen et al [16] failed to demonstrate the superiority of a LCT/MCT propofol formulation (supposed to reduce the occurrence of hyperTG), suggesting that lipids associated with propofol were not responsible for the TG alterations.…”

Section: Discussionmentioning

confidence: 66%

“…Similarly, exceeding a cumulative glucose intake of 5 g/kg/day should be avoided to prevent de novo lipogenesis [13]. Despite these recommendations, a multicenter study reported a 33 % incidence of hyperTG, defined as plasma triglycerides (TG) [3 mmol/L, among hospitalized patients receiving a parenteral daily fat intake of 0.83 ± 0.37 g/kg [8]. The type of lipid also influences TG levels: medium-chain triglycerides (MCT) and omega-3 lipid emulsions are alternatives to long-chain triglycerides (LCT) [6,7], even if the metabolic advantages compared with LCT emulsions remain debated [14].…”

Section: Introductionmentioning

confidence: 99%

“…The type of illness influences the lipid profile, the magnitude of the changes being proportional to the severity of the disease [12]; patients with infections are particularly prone. Despite unclear multifactorial etiology, high lipid levels are considered as a source of complications in intensive care unit (ICU) patients [2,6,8] and should be prevented.…”

Section: Introductionmentioning

confidence: 99%

“…The main causes of hyperTG are either genetic or associated with secondary pathology such as pancreatitis [3], sepsis [4], obesity [5], liver failure [6,7], chronic renal failure [2,6,8], alcohol consumption [9] or type 2 diabetes [10,11]. The type of illness influences the lipid profile, the magnitude of the changes being proportional to the severity of the disease [12]; patients with infections are particularly prone.…”

Section: Introductionmentioning

confidence: 99%

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Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

et al. 2012

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Purpose: Hypertriglyceridemia (hyperTG) is common among intensive care unit (ICU) patients, but knowledge about hyperTG risk factors is scarce. The present study aims to identify risk factors favoring its development in patients requiring prolonged ICU treatment. Methods: Prospective observational study in the medicosurgical ICU of a university teaching hospital. All consecutive patients staying C4 days were enrolled. Potential risk factors were recorded: pathology, energy intake, amount and type of nutritional lipids, intake of propofol, glucose intake, laboratory parameters, and drugs. Triglyceride (TG) levels were assessed three times weekly. Statistics was based on twoway analysis of variance (ANOVA) and linear regression with potential risk factors. Results: Out of 1,301 consecutive admissions, 220 patients were eligible, of whom 99 (45 %) presented hyperTG (triglycerides [2 mmol/L). HyperTG patients were younger, heavier, with more brain injury and multiple trauma. Intake of propofol (mg/kg/h) and lipids' propofol had the highest correlation with plasma TG (r 2 = 0.28 and 0.26, respectively, both p \ 0.001). Infection and inflammation were associated with development of hyperTG [C-reactive protein (CRP), r 2 = 0.19, p = 0.004]. No strong association could be found with nutritional lipids or other risk factors.Outcome was similar in normo-and hyperTG patients. Conclusions: HyperTG is frequent in the ICU but is not associated with adverse outcome. Propofol and accompanying lipid emulsion are the strongest risk factors. Our results suggest that plasma TG should be monitored at least twice weekly in patients on propofol. The clinical consequences of propofol-related hyperTG should be investigated in further studies.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

et al. 2012

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“…There are only a few studies regarding the pathophysiology of the development of hypertriglyceridemia [42]. Hypertriglyceridemia during PN infusion indicates excess triglyceride synthesis, reduced fat clearance, dextrose overfeeding, or excess lipid infusion.…”

Section: Discussionmentioning

confidence: 99%

Parenteral Nutrition Enriched with Fish Oil after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kim¹,

Shin²,

Choi³

2016

Int J Clin Pharmacol Pharmacother

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Objective: We performed a systematic review and meta-analysis to assesses the effects of parenteral nutrition enriched with fish oil versus without fish oil after gastrointestinal surgery. Methods: A search was conducted on Medline, Embase and the Cochrane Library electronic databases. Results: After the review of 17 trials, parenteral nutrition enriched with fish oil improved the infection complications rate (risk ratio (RR) = 0.43; 95% CI: 0.28 to 0.67), length of hospital stay (mean difference (MD) = -1.69; 95% CI: -2, 72 to -0.66) and length of intensive care unit stay (MD = -0.33; 95% CI: -0.51 to -0.14). Other beneficial effects included improvement of liver function AST (MD = -18.25; 95% CI,-30.10 to -6.41), immune function CD 4+ /CD 8+ (MD = 0.16; 95% CI: 0.01 to 0.31), reduction of inflammation markers IL-6 (MD = -7.03; 95% CI: -11.10 to -2.97) and TNF-a (MD = -1.18; 95% CI: -1.71 to -0.66), and increased concentrations of EPA (standard mean difference (SMD) = 5.41; 95% CI: 2.47 to 8.34) and DHA (SMD = 3.20; 95% CI: 1.27 to 5.14). Conclusion: Through these results, we conclude that parenteral nutrition enriched with fish oil is safe and effective. However, further studies in larger patient populations with more extensive investigation are needed to reassess the role of FO.

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Adverse events associated with parenteral nutrition support therapy: A pharmacovigilance study

Jing,

Hongyan,

Jingjing

et al. 2024

J Parenter Enteral Nutr

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BackgroundParenteral nutrition (PN) plays a crucial role in nutrition support therapy, yet data on related adverse events (AEs) in practical settings are scarce. To address this, we analyzed AE signals associated with PN treatment from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database.MethodsWe extracted data from the FAERS database, covering the period from the first quarter (Q1) of 2004 to Q1 of 2024. Drug names and AEs were standardized. We then conducted disproportionality analyses using four different algorithms to evaluate the association between PN and its associated AEs.ResultsWe collected a total of 48,890,925 reports from the FAERS database, of which 1642 involved PN‐related AEs. After categorization, we identified 21 system organ classes (SOCs), and hepatobiliary disorders were the only significant SOC across all four algorithms. At the preferred term (PT) level, we identified 99 PTs that showed significant disproportionality in all four algorithms. Fat overload syndrome, fatty acid deficiency, parenteral nutrition–associated liver disease (PNALD), Malassezia infection, and Pantoea agglomerans infection were the most prominent PTs. In addition, several potential new AE signals included nervous, cardiac, immune, psychiatric, blood, renal, urinary, and eye disorders.ConclusionOur study identified several common and rare PN‐related AEs reported in the FAERS database. Patients and healthcare providers should remain vigilant about these AEs. Understanding the risks of PN therapy and establishing practical procedures can help reduce AEs.

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The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia

Cited by 54 publications

References 31 publications

Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

Parenteral Nutrition Enriched with Fish Oil after Gastrointestinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Adverse events associated with parenteral nutrition support therapy: A pharmacovigilance study

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