Abstract
Background: Nutritional support plays an essential role for recovery in infants who undergo gastrointestinal surgery. The current standard type of intravenous lipid emulsion (IVLE) used as parenteral nutrition is the mixture of medium-chain triglyceride (MCT) and long chain triglyceride (LCT) rich in ω-6. Studies showed that ω-6 is associated with higher level of proinflammatory cytokines, leading to increased mortality rate, morbidity rate, and postoperative recovery time. The latest generation of emulsion is a mixture of MCT, LCT, olive oil (OO), and fish oil (FO) which may optimize the ω6/ω3 ratio. This study aimed to compare the effect of MCT/LCT/OO/FO IVLE to standard IVLE on IL-1β, IL-8 and plasma fatty acid composition in infants who had undergone gastrointestinal surgery. Methods: A single-blind, randomised controlled, pretest-posttest design study was done in twelve subjects that were classified into two groups. Group 1 received standard IVLE, group 2 received MCT/LCT/OO/FO IVLE. The type of standard and MCT/LCT/OO/FO IVLE used in this study were Lipofundin 20% and SMOFlipid 20%, respectively, both administered for three consecutive days in 1-4 gram/kilogram/day. IL-1β and IL-8 were examined using ELISA while fatty acid composition was analyzed using gas chromatography tandem mass spectrometry (GC-MS). Statistical analyses were performed using SPSS for Mac 23. Results: No statistical difference was found in age, gender, birth weight and diagnosis, between both groups. Leukocyte level was significantly lower in MCT/LCT/OO/FO group 3 days after surgery (p=0.025). CRP level was lower in MCT/LCT/OO/FO group 3 days after surgery (p=0.01) and in changes within 3 days (p=0.016). There were no differences in IL-1β and IL-8 but ω-6 was higher in standard IVFE group on third day after surgery (p=0,048). Conclusion: MCT/LCT/OO/FO IVLE can significantly lower leukocyte, CRP and ω-6 levels and is comparable with standard IVLE on IL-1β & IL-8 levels in infants underwent gastrointestinal surgery.
Highlights
Surgical interventions may stimulate physiological inflammatory response as body’s attempt towards general recovery[1]
The balance of inflammatory response brings about good recovery, while excessive level of proinflammatory cytokines such as interleukin (IL) )-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α, may cause organ damage and severe complications, leading to the rise of postoperative mortality and morbidity rate[2]
De Mooij stated that IL-1β plays an important role in infection control, homeostasis, and tissue repair, while IL-8 plays an important role in inflammation and wound healing[3,4,5]
Summary
Surgical interventions may stimulate physiological inflammatory response as body’s attempt towards general recovery[1]. The current standard type of fat emulsion used as parenteral nutrition is a mixture of mediumchain triglyceride (MCT) and soy oil enriched with long-chain triglyceride (LCT)[9]. This emulsion is rich in ω-6 and contains linoleic acid (LA, C18:2 ω -6) and α-linolenic acid (ALA, C18:3 ω-3). Several studies showed that ω-6 is associated with impaired cell-mediated immunity and higher potential risk of elevated proinflammatory biomarkers and severe inflammatory response These mechanisms may bring about the rise in mortality rate, morbidity rate and may prolong the duration of treatment and postoperative recovery time[10,11,12].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
