Impact of the monounsaturated fatty acid-rich parenteral nutrition on lipid peroxidation, liver function and clinical outcomes in elderly patients undergoing liver resection

Abstract

Objective To evaluate the impact of the monounsaturated fatty acid-rich parenteral nutrition on lipid peroxidation, immunologic function and clinical outcomes in elderly patients undergoing liver resection surgery. Methods A prospective, randomized, double-blind and controlled study of 44 elderly patients undergoing liver resection surgery were conducted. All patients were given total parenteral nutrition with glucose 3 g·kg-1·d-1, triglyceride 1.2 g·kg-1·d-1, nitrogen intake0.2 g·kg-1·d-1. 2-6 days after operation, 22 cases in the control group were given soybean oil–based fat emulsion (long-chain fatty acid), and the other 22 cases in the study group were given olive oil-based fat emulsion. The changes in lipid peroxidation indicator of malondialdehyde (MDA), inflammation cytokines including C-reactive protein (CRP), interleukin (IL) - 6 and tumor necrosis factor (TNF)-alpha, liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and alkaline phosphatase (ALP) and plasma proteins such as albumin and prealbumin (PA) were observed. The systemic inflammatory response syndrome (SIRS), clinical outcomes, complications, infections, length of hospitalization and the medical expense were recorded. Results 44 patients completed the trial with no case quitting. Baseline data were comparable between the two groups (all P>0.05). After 5 days of parenteral nutrition, the decreases of MDA and IL-6 from POD7 to POD1 were more significant in the study group than in the control group〔(4.9±1.0) vs. (4.0±1.3)μmol/L, (33.5±8.4)ng/L vs. (28.7±6.3)ng/L, P=0.014 and 0.038〕. The decreases of CRP and TNF-α from 7 d to 1 d of postoper ation were similar between two groups 〔(34.8±9.2) vs. (31.0±6.8), (30.3±6.2) vs. (33.6±8.1), P=0.182 and 0.136〕. The mean differences of ALB and PA from POD7 to POD1 were decreased, then increased in the two groups, which had no significant differences between the two groups (P=0.314 and 0.314). The decreases of AST and TBIL from POD7 to POD1 were higher in the study group than in the control group (P=0.037 and 0.040), but the decreases of ALT and ALP from 7 d to 1 d of postoper ation had no significant difference (P=0.094 and 0.193). The patients with infectious complications or SIRS were less in the study group than in the control group (2 cases vs. 5 cases, 8 cases vs. 11 cases, P=0.409 and 0.362). Total postoperative complications, hospital stay and total postoperative medical costs had no significant difference between the two groups (all P>0.05). Conclusions Olive oil-based lipid emulsion-supplemented parenteral nutrition? can improve liver function, alleviate lipid peroxidation and inflammatory reaction, and may reduce postoperative infection complications in elderly patients undergoing liver resection surgery. Key words: Fatty acids, monounsaturated; Parenteral nutrition; Liver neoplasms