Abstract
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 lipids such as olive/soy-based formulations, and combination lipids such as soy/MCT/olive/fish oil, compared with soybean based lipids, as they have less inflammatory properties, are immune modulating, have higher antioxidant content, decrease risk of cholestasis, and improve clinical outcomes in certain subgroups of patients. The objective of this article is to review the history of IVLE, their composition, the different generations of widely available IVLE, the variables to consider when selecting lipids, and the complications of IVLE and how to minimize them.
Highlights
Background of Intravenous LipidEmulsions (IVLEs)Intravenous lipid emulsions (IVLEs) are a source of essential fatty acids (EFAs) and energy-dense non-protein calories
No changes on infectious complications or ICU length of stay (LOS) were observed. Another meta-analysis published by Palmer and colleagues investigated the impact of ω-3 FA supplemented parenteral nutrition (PN) in critically-ill adults concluded that parenteral fish oil (FO) did not improve mortality, infectious compilations, and ICU LOS compared with standard PN [29]
Omega-6 polyunsaturated fatty acids and the associated phytosterols in lipid emulsions have been thought to contribute to the development of hepatotoxicity, Ng and colleagues [33] have recently shown that the addition of phytosterols to FO Intravenous LipidEmulsions (IVLEs) did not increase biomarkers of PN associated liver disease (PNALD) [34]
Summary
Trials of parenteral lipids for nutritional support date back to the eighteenth century. Between 1920 and 1960, scientists in both the United States and Japan developed and tested hundreds of fat emulsions of varying compositions [8,9]. These studies led to development of the first IVLE in the United States (Lipomul, produced by Upjohn Co. Kalamazoo, MI, USA). In 1968, the glucose system was introduced by Wilmore and Dudrick [13,14] that was based on administering high dose of glucose, amino acids and other nutrients without fat because IVLEs were not available at that time in the United States.
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