Meta-analysis of the efficacy and safety of structured triglyceride lipid emulsions in parenteral nutrition therapy in China. Issue 4 (August 2019)

• Record Type: Journal Article
• Authors: Li, Chao; Ni, Qian; Pei, Yifang; Ren, Yi; Feng, Yufei
• Is Part Of: Clinical nutrition. Volume 38:Issue 4(2019)
• Page Start: 1524
• Page End: 1535
• Publication Date: 2019-08
• Subjects: Structured triglycerides (STG) -- Parenteral nutrition -- Randomized controlled trial -- Meta-analysis; 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.2018.07.013
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: We performed a meta-analysis of data from recent studies to evaluate the safety and efficacy of parenteral nutrition (PN) with structured triglyceride (STG) lipid emulsions compared to medium-chain triglyceride (MCT)/long-chain triglyceride (LCT) lipid emulsions in Chinese patients. Methods: PubMed, Embase, Cochrane Library, China National Knowledge Internet, Wanfang, and VIP were searched for randomized controlled trials comparing STGs with MCTs/LCTs published in English or Chinese between January 1987 and October 2017. Two independent investigators screened and selected studies according to prespecified selection criteria. Data were pooled and analysed using RevMan ® version 5.3. Results: Thirty-two studies comprising 1944 patients were included in the meta-analysis. Compared with MCT/LCT emulsions, STGs resulted in a shorter hospital length of stay (LOS) (weighted mean difference [WMD], −1.65 days; 95% confidence interval [CI]: −2.63, −0.67; P = 0.001) and lower adverse event rates (relative risk, 0.64; 95% CI: 0.48, 0.85; P = 0.002). STGs were associated with a significantly better cumulative nitrogen balance (WMD, 4.04 g/24 h; 95% CI: 3.10, 4.97; P < 0.0001) as well as higher concentrations of pre-albumin (WMD 35.20 mg/L; 95% CI: 26.59, 43.81; P < 0.0001) and albumin (WMD, 1.64 g/L; 95% CI: 1.17, 2.10; P < 0.0001) compared with MCTs/LCTs. In contrast, significantly lower concentrations of plasma triglycerides (WMD, −0.21 mmol/L; 95% CI: −0.30, −0.12; P < 0.0001), total cholesterol (WMD, −0.45 mmol/L; 95% CI: −0.60, −0.29; P < 0.0001), alanine aminotransferase (WMD, −7.68 IU/L; 95% CI: −9.68, −5.68; P < 0.0001) and aspartate aminotransferase (WMD, −10.27 IU/L; 95% CI: −16.05, −4.49; P = 0.0005) were observed in patients receiving STGs compared with MCT/LCTs. STGs were also associated with reduced inflammation and improved immunological function, as reflected by significantly lower C-reactive protein concentrations (WMD, −2.67 mg/L; 95% CI: −4.55, −0.79; P = 0.005) and increased concentrations of IgG (WMD, 2.11 g/L; 95% CI: 0.23, 3.99; P = 0.03), IgA (WMD, 0.21 g/L; 95% CI: 0.14, 0.28; P < 0.0001), CD3+ (WMD, 5.81%; 95% CI: 0.92, 10.70; P = 0.02), and CD4+/CD8+ (WMD, 0.12; 95% CI: 0.00, 0.24; P = 0.04) compared with MCT/LCTs. Conclusions: Administration of STGs was shown to improve hepatic function, nutrition status, and immunological function and reduce inflammation, LOS, and adverse events compared with MCT/LCTs in Chinese patients receiving PN.