Abstract

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.

Highlights

  • Enteral nutrition is the first option in patients that require nutritional support, total parenteral nutrition is a more appropriate technique to reduce complications and mortality in malnourished patients or in those at risk of being malnourished and who cannot use their digestive tract [1].Lipid emulsions containing fish oil are rich in n-3 polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which exhibit anti-inflammatory, immunomodulatory, and antioxidative properties in preclinical models

  • 80 patients (49.7%) were on intravenous lipid emulsions (ILE) enriched with n-3 PUFA

  • Lipid emulsions are used in parenteral nutrition (PN) with the objective of supplying an energy-dense source of calories, reducing the glycemic load, supplying essential fatty acids, and lowering osmolarity [8]

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Summary

Introduction

Enteral nutrition is the first option in patients that require nutritional support, total parenteral nutrition is a more appropriate technique to reduce complications and mortality in malnourished patients or in those at risk of being malnourished and who cannot use their digestive tract [1].Lipid emulsions containing fish oil are rich in n-3 polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which exhibit anti-inflammatory, immunomodulatory, and antioxidative properties in preclinical models. Enteral nutrition is the first option in patients that require nutritional support, total parenteral nutrition is a more appropriate technique to reduce complications and mortality in malnourished patients or in those at risk of being malnourished and who cannot use their digestive tract [1]. In recent years the evidence to support the use of intravenous lipid emulsions (ILEs) enriched with fish oil has grown increasingly [2,3,4], showing that they could lower triglyceride concentrations, inflammatory markers, and liver function enzymes, and improve morbidity (risk of infection and sepsis and length of stay) and even mortality outcomes in hospitalized patients especially in post-surgical and oncology patients [5,6,7,8], when compared with ILEs based on soybean oil. Intravenously infused n-3 PUFA preserves insulin signaling and glucose uptake compared to the infusion of n-6 PUFA [12]

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