Effect of changing the lipid component of home parenteral nutrition in adults. Issue 3 (June 2019)

• Record Type: Journal Article
• Authors: Osowska, Sylwia; Kunecki, Marek; Sobocki, Jacek; Tokarczyk, Joanna; Majewska, Krystyna; Omidi, Mohamed; Radkowski, Marek; Fisk, Helena L.; Calder, Philip C.
• Is Part Of: Clinical nutrition. Volume 38:Issue 3(2019)
• Page Start: 1355
• Page End: 1361
• Publication Date: 2019-06
• Subjects: Intestinal failure -- Home parenteral nutrition -- Lipid emulsion -- Fatty acid -- Inflammation -- Essential fatty acid deficiency; ALT alanine aminotransferase -- AST aspartate aminotransferase -- DHA docosahexaenoic acid -- EFA essential fatty acid -- EPA eicosapentaenoic acid -- GGT gamma-glutamyltranspeptidase -- HPN home parenteral nutrition -- IFN interferon -- IL interleukin -- LE lipid emulsion -- PC phosphatidylcholine -- PN parenteral nutrition -- PUFA polyunsaturated fatty acid -- TNF tumour necrosis factor; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.05.028
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background: The effect of different lipid emulsions (LEs) within the parenteral nutrition (PN) regimen of adult home PN (HPN) patients is not clear. This study investigated the effect of changing adult HPN patients from a soybean oil based LE (Intralipid) to either a fish oil containing LE (providing n-3 fatty acids) (SMOFLipid) or an olive oil based LE (ClinOleic). Methods: Thirty two adults receiving long-term HPN with Intralipid as the LE were transferred to receive either SMOFLipid (n = 13) or ClinOleic (n = 19) for 60 days. Liver function markers, cholesterol, triglycerides, a full profile of fatty acids, and several cytokines were measured at study entry and after 60 days. Results: SMOFLipid did not affect liver function markers, blood lipids or plasma cytokines. ClinOleic lowered both gamma-glutamyltranspeptidase ( P = 0.044) and interleukin-8 ( P = 0.030) concentrations. Both LEs induced marked changes in the fatty acid profile of plasma. SMOFLipid resulted in significant decreases in the proportions of linoleic acid, several other n-6 fatty acids and the essential fatty acid (EFA) deficiency indicator mead acid and significant increases in the proportions of the n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. ClinOleic resulted in significant decreases in the proportions of some saturated fatty acids, linoleic acid, several n-6 fatty acids, all n-3 fatty acids and mead acid and a significant increase in the proportion of oleic acid. The ratio of mead to arachidonic acid in plasma was not altered by either SMOFLipid or ClinOleic. No patient had a mead acid to arachidonic acid ratio of >0.2, the cut-off used to indicate EFA deficiency. Conclusion: Both SMOFLipid and ClinOleic significantly alter the fatty acid profile of plasma in adult HPN patients previously using Intralipid. Neither LE induces EFA deficiency in these patients. SMOFLipid did not alter liver function markers or inflammation. In contrast, ClinOleic decreased some, though not all, markers of liver function and inflammation. SMOFLipid and ClinOleic may both be considered for use in adult HPN patients.