Administration of an Intravenous Fat Emulsion Enriched with Medium-Chain Triglyceride/ω-3 Fatty Acids is Beneficial Towards Anti-Inflammatory Related Fatty Acid Profile in Preterm Neonates: A Randomized, Double-Blind Clinical Trial.

Panos Papandreou,Olga-Natalia Korda,Aristea Gioxari,Tania Siahanidou,Maria Skouroliakou,Dimitrios Ntountaniotis

doi:10.3390/nu12113526

Panos Papandreou, Olga-Natalia Korda + Show 4 more

Open Access

https://doi.org/10.3390/nu12113526

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Abstract

Intravenous administration of pure soybean oil emulsions high in linoleic acid may lead to inflammation and lipid peroxidation in preterm neonates. We aimed to investigate the effects of a medium-chain triglyceride (MCT)/ω-3 polyunsaturated fatty acid (PUFA)-enriched intravenous fat emulsion (IVFE) on plasma fatty acid (FA) profile and serum interleukin-6 (IL-6) in preterm neonates. In this double-blind randomized study, 92 preterm neonates (gestational age < 32 weeks, birth weight < 1500 g) were assigned to receive either MCT/ω-3 PUFA-enriched IVFE (Intervention Group) or soybean oil-based IVFE (Control Group). Levels of FAs were measured at baseline (day 0) and day 15 of parenteral nutrition with gas-chromatography mass-spectrometry. Serum IL-6 was measured with sandwich ELISA in 59 neonates. Plasma FAs changed significantly over time; the MCT/ω-3 PUFA-IVFE group showed higher ω-3 PUFAs (p = 0.031), eicosapentaenoic acid (p = 0.000), and oleic acid (p = 0.003), and lower ω-6/ω-3 PUFAs ratio (p = 0.001) and ω-6 PUFAs (p = 0.023) compared to control group. Linoleic acid was higher in the soybean oil (SO)-based IVFE arm compared to the MCT/ω-3 PUFAs-IVFE arm (p = 0.006). Both fat emulsion types decreased IL-6 compared to baseline, but changes were insignificant between groups. Administration of MCT/ω-3 PUFA-enriched IVFE in preterm neonates is beneficial in changing the FA profile consistent with attenuated inflammatory response.

Highlights

Preterm neonates are in an energy-deficient state due to oxygen desaturation and hypoxia events, painful and stressful stimuli, illness, and rapid neurodevelopment [1,2]
Serum triglyceride levels were within normal values for age, whereas no local reaction, thrombocytopenia that could be attributed to intravenous fat emulsion (IVFE), or dropout related to any IVFE-associated adverse effect were observed
The results of our study showed that parenteral treatment with medium-chain triglyceride (MCT)/ω-3 polyunsaturated fatty acid (PUFA)-IVFE for 15 days led to significantly elevated plasma total ω-3 PUFAs, eicosapentaenoic acid (EPA), and oleic acid concentrations compared to the soybean oil (SO)-IVFE group

Summary

Introduction

Preterm neonates are in an energy-deficient state due to oxygen desaturation and hypoxia events, painful and stressful stimuli, illness, and rapid neurodevelopment [1,2]. Lipid emulsions contain high amounts of essential fatty acids, such as linoleic acid (LA) and alpha-linolenic acid (ALA) [9]. Following elongation and desaturation via a series of enzymatic reactions, LA and ALA can be converted to more physiologically active compounds, such as arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) [10]. The de novo synthesis rates are insufficient to maintain adequate plasma and erythrocyte concentrations of these long-chain polyunsaturated fatty acids (LC-PUFAs), indicating that DHA and AA should be considered conditionally as essential fatty acids for preterm neonates and should be administered [11,12,13,14]

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