Composition and Functionality of Lipid Emulsions in Parenteral Nutrition: Examining Evidence in Clinical Applications

Published on Apr 29, 2020in Frontiers in Pharmacology3.845
· DOI :10.3389/FPHAR.2020.00506
Birinder Kaur Sadu Singh (UKM: National University of Malaysia), Sreelakshmi Sankara Narayanan2
Estimated H-index: 2
(Taylors University)
+ 5 AuthorsTilakavati Karupaiah12
Estimated H-index: 12
(Taylors University)
: Lipid emulsions (LEs), an integral component in parenteral nutrition (PN) feeding, have shifted from the primary aim of delivering non-protein calories and essential fatty acids to defined therapeutic outcomes such as reducing inflammation, and improving metabolic and clinical outcomes. Use of LEs in PN for surgical and critically ill patients is particularly well established, and there is enough literature assigning therapeutic and adverse effects to specific LEs. This narrative review contrarily puts into perspective the fatty acid compositional (FAC) nature of LE formulations, and discusses clinical applications and outcomes according to the biological function and structural functionality of fatty acids and co-factors such as phytosterols, α-tocopherol, emulsifiers and vitamin K. In addition to soybean oil-based LEs, this review covers clinical studies using the alternate LEs that incorporates physical mixtures combining medium- and long-chain triglycerides or structured triglycerides or the unusual olive oil or fish oil. The Jaded score was applied to assess the quality of these studies, and we report outcomes categorized as per immuno-inflammatory, nutritional, clinical, and cellular level FAC changes. It appears that the FAC nature of LEs is the primary determinant of desired clinical outcomes, and we conclude that one type of LE alone cannot be uniformly applied to patient care.
  • References (142)
  • Citations (0)
📖 Papers frequently viewed together
16 Citations
1 Author (T. P. Stein)
5 Citations
1 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1S. OsowskaH-Index: 3
#2M. KuneckiH-Index: 4
Last. Philip C. Calder (University of Southampton)H-Index: 109
view all 9 authors...
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 ...
1 CitationsSource
#1Helene Bohnert (Charité)H-Index: 1
#2Max Magnus Maurer (Charité)H-Index: 2
Last. Verena Müller (Charité)H-Index: 7
view all 6 authors...
Background Data on the use of lipid emulsions containing fish-oil (FO) derived n-3 polyunsaturated fatty acids (n-3 PUFAs) in addition to medium- and long-chain triglycerides (MCT/LCT) for long-term home parenteral nutrition (HPN) are limited. This study aimed to compare HPN regimens containing either MCT/LCT/FO-derived n-3 PUFAs (test group) or MCT/LCT (control group) with respect to efficacy and safety during 8 weeks of HPN using a non-inferiority trial design with change of body mass index (B...
#1Wei CaiH-Index: 1
#2Phillip C. CalderH-Index: 1
Last. Gary P. ZalogaH-Index: 30
view all 6 authors...
Intravenous lipid emulsions (ILEs) have been an integral component of parenteral nutrition for more than 50 years. Numerous formulations are available and are based on vegetable (soybean, olive, coconut) and animal (fish) oils. Therefore, each of these formulations has a unique fatty acid composition that offers both benefits and limitations. As clinical experience and our understanding of the effects of fatty acids on various physiological processes has grown, there is evidence to suggest that ...
2 CitationsSource
#1Amy PeacockH-Index: 16
#2Delyse HutchinsonH-Index: 21
Last. Richard P. MattickH-Index: 55
view all 10 authors...
The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), se...
24 CitationsSource
#1Huaisheng Chen (JNU: Jinan University)H-Index: 2
#2Wei Wang (JNU: Jinan University)H-Index: 2
Last. Huadong Zhang (JNU: Jinan University)H-Index: 3
view all 7 authors...
Background: Sepsis plays an important role in acute gastrointestinal injury (AGI). Our research was designed to determine the effects of omega-3 fish oil (FO) in patients suffering from severe sepsis combined with AGI III, and the ability of FO to modulate immune function. Methods: Seventy-eight patients diagnosed with severe sepsis with AGI III and a need for mechanical ventilation were randomized to two groups. In the FO group, 50 g of long chain fatty acid soybean oil (n = 6) and 10 g of FO (...
6 CitationsSource
#1Maitreyi RamanH-Index: 18
#2A AlmutairdiH-Index: 5
Last. Leah GramlichH-Index: 30
view all 6 authors...
Lipids have multiple physiological roles that are biologically vital. Soybean oil lipid emulsions have been the mainstay of parenteral nutrition lipid formulations for decades in North America. Utilizing intravenous lipid emulsions in parenteral nutrition has minimized the dependence on dextrose as a major source of nonprotein calories and prevents the clinical consequences of essential fatty acid deficiency. Emerging literature has indicated that there are benefits to utilizing alternative lipi...
12 CitationsSource
#1Guo Hao WuH-Index: 2
#2Orietta ZanioloH-Index: 6
Last. Lorenzo PradelliH-Index: 12
view all 5 authors...
Summary Introduction New generations of parenteral lipid emulsions combine Long Chain Triglycerides (LCTs) with Medium Chain Triglycerides (MCTs) either by physically mixing MCT- and LCT-containing oils or by using synthetically structured triglycerides (STGs). In order to clarify some open issues relating to their comparative effect, in particular in terms of clinical outcomes, pertinent evidence was systematically identified, reviewed and meta-analyzed. Methods PubMed, Scopus, Wanfang Data, Ch...
11 CitationsSource
#1Graciela Delgado (Heidelberg University)H-Index: 23
#2Bernhard K. Krämer (Heidelberg University)H-Index: 50
Last. Marcus E. Kleber (FSU: University of Jena)H-Index: 54
view all 6 authors...
Background The association of polyunsaturated omega-3 and omega-6 fatty acids with mortality has been extensively studied. Far less is known about the association of omega-9 monounsaturated fatty acids (omega-9 MUFA) with mortality. Objective We aimed to study the association of individual omega-MUFA with all-cause and cardiovascular mortality. Methods Omega-9 MUFA concentrations were measured in erythrocytes in 3259 patients participating in the Ludwigshafen Risk and Cardiovascular Health Study...
12 CitationsSource
#1Seher Demirer (Ankara University)H-Index: 13
#2Ali SapmazH-Index: 1
Last. Kenan Köse (Ankara University)H-Index: 12
view all 8 authors...
Purpose This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery.
5 CitationsSource
#1E.D. Olthof (Radboud University Nijmegen)H-Index: 6
#2Hennie M.J. Roelofs (Radboud University Nijmegen)H-Index: 27
Last. Geert J. A. Wanten (Radboud University Nijmegen)H-Index: 28
view all 5 authors...
Background: Home parenteral nutrition (HPN) patients depend on lipid emulsions as part of their parenteral nutrition regimen to provide essential fatty acids (EFAs). Mixed-oil sources are used in modern lipid emulsions to decrease the amount of proinflammatory EFAs, mainly linoleic acid, which is present in large amounts in soybean oil. It is unknown whether patients who fully depend on such mixed lipids have adequate EFA supply. We therefore evaluated whether HPN patients who depend on mixed ol...
8 CitationsSource
Cited By0