Intralipid Research Articles

Early Optimal Parenteral Nutrition During NICU Stay and Neurodevelopmental Outcomes in Very Preterm Infants: State of the Art

Background: Preterm infants (PIs) are more susceptible to neurodevelopmental impairment compared with term newborns. Adequate postnatal growth has been associated with improved neurocognitive outcomes; therefore, optimization of nutrition may positively impact the neurodevelopment of PIs. Objective: This study focused on macronutrient parenteral nutrition (PN) intake during the Neonatal Intensive Care Unit stay and their associations with neurodevelopmental outcomes in PIs in the first two years of life. Methods: The Embase, MEDLINE, and Cochrane Library databases were searched using the following subject headings and terms (MeSH): “premature infants”, “parenteral nutrition”, “growth”, “brain”, “neurodevelopment”, and “central nervous system diseases”. All relevant papers’ reference lists were manually searched. PN and neurodevelopment studies concerning the first two years of life were collected and analyzed. Results: 275 potential studies were retrieved, 64 were selected for full-text reading, and 22 were included (12 randomized controlled trials). While glucose intakes should be immediately provided and strictly monitored avoiding hyperglycemia, the long-term outcomes of aggressive PN caloric intakes are uncertain. Early amino acid (AA) supplementation is mandatory and improves short-term growth, though it is questionable whether increased AA and better neurodevelopment are directly related. Lipid infusion should be initiated right after birth, and further investigation will enable us to ascertain the potential impacts of lipid emulsions, particularly fish oil, on PI neurodevelopment. Conclusions: An aggressive PN and its possible metabolic complication could not favor neurodevelopment; the way forward could be a customized approach, depending on the patient’s clinical state and tolerance. Long-term follow-up studies and the search for specific markers of tolerance are warranted.

Impact of Omega-3 Enriched Lipid Emulsions on Retinopathy of Prematurity in Very Low Birth Weight Infants: A Retrospective Cohort Analysis.

To assess the effects of ω-3 long-chain polyunsaturated fatty acid (LCPUFA)-enriched lipid emulsions (SMOFlipid) vs. traditional soybean oil-based lipid emulsions (Intralipid) on the occurrence and severity of retinopathy of prematurity (ROP) in infants with very low birth weight (VLBW). In this retrospective cohort study, 301 VLBW infants who received either SMOFlipid or Intralipid for a minimum of 14 d were included. The main outcome measured was the frequency and severity of ROP, with secondary outcomes covering other complications associated with preterm birth. Of the infants studied, 180 were administered SMOFlipid, while 121 received Intralipid. The incidence of ROP was notably lower in the SMOFlipid group (32.8% vs. 45.5%; RR 0.59; 95% CI 0.36-0.94; P = 0.026). Additionally, the occurrence of severe ROP was reduced by 66.06% in infants given SMOFlipid (5.6% vs. 16.5%; RR 0.30; 95% CI 0.13-0.66; P = 0.002). Multivariate logistic regression suggested that using SMOFlipid was linked to a reduced risk of both ROP (OR 0.44; 95% CI 0.24-0.82; P = 0.010) and severe ROP (OR 0.09; 95% CI 0.03-0.30; P < 0.001). There were no considerable differences noted in other complications associated with preterm birth between the two groups. Compared to Intralipid, SMOFlipid treatment reduced both the risk and severity of ROP. Parenteral supplementation with fish oil-containing emulsions might offer a novel approach to lowering the incidence and severity of ROP in VLBW infants.

What is the role of parenteral nutrition in the management of the patient with severe acute pancreatitis?

Severe acute pancreatitis often presents as a complex critical illness associated with a high rate of infectious morbidity, multiple organ failure, and in-hospital mortality. Breakdown of gut barrier defenses, dysbiosis of intestinal microbiota, and exaggerated immune responses dictate that early enteral nutrition (EN) is preferred over parenteral nutrition (PN) as the primary route of nutrition therapy. EN, however, is not feasible in all cases because of intolerance, risk of complications, or a direct contraindication to enteral feeding. For these patients, PN can be provided in a manner that is safe, is metabolically appropriate, and follows the principles of modern critical care nutrition. Adherence to goal-directed fluid resuscitation, provision of trophic doses of PN to meet 20%-25% of protein and/or calorie requirements through the acute phases of illness, use of less-inflammatory intravenous lipid emulsions, and close monitoring of electrolytes, triglyceride levels, and signs of refeeding syndrome all serve to optimize the response to this route of nutrition support. For these reasons, prescribing PN remains an important strategy in the management of this difficult population of patients.

Fish oil lipid emulsion compared with soybean oil lipid emulsion in pediatric patients with parenteral nutrition-associated cholestasis: A cost-effectiveness study.

Evidence indicates that, in pediatric patients with parenteral nutrition-associated cholestasis (PNAC), the use of a 100% fish oil lipid emulsion (FOLE) increased the likelihood of PNAC resolution and reduced the likelihood of liver transplantation compared with a 100% soybean oil lipid emulsion (SOLE). To evaluate the potential economic benefit, we conducted a cost-effectiveness analysis comparing FOLE with SOLE. A discrete event simulation model evaluated cost-effectiveness by simulating clinical outcomes and estimating associated healthcare costs in pediatric patients with PNAC receiving parenteral nutrition (PN) with FOLE (1 g/kg) or SOLE (1.9 g/kg) over a time horizon of 6 years. Model inputs for clinical outcomes were derived from the integrated analysis of two US Phase 3 trials (NCT00910104 and NCT00738101). Cost estimates were estimated from the perspective of the US payer including the cost of PN, transplantation, and adverse events. The total cost associated with FOLE was $69,847 USD vs $141,605 USD for SOLE. The cost reduction of $71,757 USD was attributable to the avoidance of liver transplantation (-15.7%) and reduction in adverse events (-4.8%). Life-years and the quality-adjusted life-years were increased with FOLE compared with SOLE (by 0.248 and 0.295, respectively). By reducing the need for liver transplant and providing time to transition to full enteral nutrition, FOLE leads to cost-savings, compared with SOLE, in pediatric patients with PNAC in the perspective of the US payer. These findings support the use of FOLE in pediatric patients with PNAC who require PN.

Can Intravenous Lipid Emulsion Reduce Mortality Rate in Cases of Acute Aluminium Phosphide Poisoning? A Systematic Review

Background: Acute pesticide poisoning has remained a significant public health concern for decades. Supportive care has been the mainstay of treatment. Intravenous lipid emulsion (ILE) therapy offers a potential new strategy. Objectives: This systematic review aimed to evaluate the current research on the efficacy of ILE in treating aluminum phosphide (AlP) poisoning. Methods: A comprehensive electronic search was conducted across various databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Campbell Systematic Reviews, Scopus, Web of Science, Springer Nature, Elsevier, Google Scholar, and regional databases encompassing Mansoura, Zagazig, Ain Shams universities, and Indian publications. Studies published in English language were considered for inclusion (from 2015 to 2023). Inclusion criteria focused on human studies evaluating the use of ILE for AlP intoxication. Results: Five studies met the inclusion criteria, three studies were randomized controlled trials, one was observational cross sectional study, and one was case report encompassing a total of 224 patients. Of these, 102 patients received ILE, with all studies utilizing 20% ILE. Three studies administered ILE as a continuous intravenous infusion at a rate of 10 mL/h. Two other studies employed a bolus dose regimen, ranging from 1-3 mL/kg delivered over one minute, followed by continuous infusion. The overall mortality rate was 68.6% in the ILE group compared to 76.2% in the control group and the need for mechanical ventilation was lower in the ILE group with clinical improvement in the ILE group. Conclusion: Intravenous lipid emulsion represents a novel therapeutic approach in toxicology with the potential to improve patient outcomes. This review suggests ILE may reduce mortality associated with AlP poisoning. Additionally, ILE use might be associated with decreased, need for mechanical ventilation, hospital stay and discharge time among survivors.

Intensification of Invasive Fungal Infections and Exploration of Effective Antifungal Drug Delivery Formulations: A Detailed Review.

Invasive fungal infections (IFIs) pose a significant global health threat, particularly among immunocompromised individuals. These infections can lead to severe illness and death, placing a significant financial burden on healthcare systems. Fungi were not previously considered a substantial risk to human health, but this perception changed with the rise of the HIV epidemic. The emergence of drug-resistant fungal strains further complicates the man-agement of these infections, highlighting the urgent need for effective antifungal therapies. Addressing this challenge requires innovative approaches and antifungal drug delivery for-mulations as promising strategies. This article explores the role of effective antifungal drug delivery formulations in combating the rise of IFIs. These formulations, ranging from lipid-based systems like liposomes and lipid emulsions to polymeric nanoparticles and micropar-ticles, offer several advantages over conventional drug delivery methods. Optimizing these formulations may improve drug efficacy, reduce the risk of drug resistance, and enhance pa-tient outcomes. Furthermore, advancements in nanotechnology and targeted drug delivery systems hold promise in overcoming existing limitations and expanding the scope of antifun-gal therapies.

Interstitial lipoid pneumonia-A complication of intravenous administration of lipid emulsions in critically ill patients.

Lipoid pneumonia is a rare entity most often associated with inhalation of foreign material (i.e. "fire-eater's lung"), silicone injection, and severe trauma. We present the case of a 61-year old man who developed acute respiratory distress syndrome following endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis. Intensive care supportive therapy included mechanical ventilation, dialysis, and total parenteral nutrition. Unresolved pneumothorax necessitated lobectomy. Histology of the lobectomy specimen demonstrated massive intra-alveolar haemorrhage and numerous alveolar septal macrophages with clear cytoplasmic vacuoles. These findings were diagnostic of interstitial lipoid pneumonia due to intravenous administration of lipid emulsions. The differential diagnosis is also discussed. Although rare, interstitial lipoid pneumonia should be considered in critically ill patients presenting with an interstitial pattern of lung disease after intravenous administration of lipid emulsions.

Dexamethasone palmitate for children with Epstein-Barr virus associated hemophagocytic lymphohistiocytosis.

Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) has a wide range of clinical presentations and is sometimes life-threatening. It is often treated with systemic corticosteroids and etoposide, but no optimal treatment has been identified. Dexamethasone palmitate (DP) contains a combination of dexamethasone and a lipid emulsion and is selectively taken up by activated macrophages. Recently, a small case series reported the efficacy of dexamethasone palmitate (DP) in HLH. Here, we present the results of a nationwide survey in Japan detailing 14 cases of EBV-HLH treated with DP in children. One week after DP initiation, fever, cytopenia, and splenomegaly resolved in 77%, 38%, and 77% of patients (10, 5, and 10 of 13 patients, 1 missing). A 50% or greater reduction in ferritin levels was observed in 62% of patients (8 of 13 patients, 1 missing). In addition, the attending physician judged DP to be effective or partially effective in 12/14 (86%) patients. DP-related adverse events were uncommon, with only two infectious events reported. Thus, DP can be a therapeutic option for EBV-HLH.

Emulsification of milk fat and skimmed milk curds – Effect of temperature on rheological properties and structure of emulsion gels at different length scales

There is a need to develop innovative cheese processes to meet consumer demands and improve production efficiency. In this study, rennet skimmed milk curds (SMC), and butter were emulsified using a thermo-mechanical process at temperatures between 70 and 90 °C. The composition, rheological properties, and microstructure of the emulsion gels were analysed up to 2 weeks of storage. Confocal laser scanning microscopy (CLSM), Small angle X-Ray Scattering (SAXS) and Low-Field Nuclear Magnetic Resonance (LF-NMR) were used to understand the gel structure. The results demonstrated that the thermo-mechanical process developed was successful in creating stable emulsion gel at 85 °C. Temperatures exceeding 85 °C led to water and fat loss, reduced fat droplet size, leading to a more compact protein network. Emulsion gels behaved as weak solid viscoelastic materials and tan δ decreased at temperature >85 °C. Lower temperatures (70 °C) lead to oiling off and incomplete gel network formation.

Intestinal failure-associated liver disease model: a reduced phytosterol intravenous lipid emulsion prevents liver injury.

Long-term parenteral nutrition in children often results in intestinal failure-associated liver disease (IFALD). Phytosterols are plant steroids in vegetable oil-based intravenous lipid emulsions (ILEs) that are associated with IFALD. We investigated whether a phytosterol-depleted soybean oil ILE, compared to standard soybean oil ILE, prevented hepatotoxicity in a murine IFALD model. Eight-week-old male C57BL/6 J mice were provided a fat-free high carbohydrate liquid dietfor 19 days. Mice were intravenously administered ILEs as the sole fat source: Intralipid® (commercially available soybean oil ILE), Omegaven® (commercially available fish oil ILE), a low phytosterol soybean oil ILE (L-SOLE) or a high phytosterol soybean oil ILE (H-SOLE) with matched alpha tocopherol content. On days 6, 12, and 18 mice were administered escalating intraperitoneal doses of lipopolysaccharide. Compared to chow controls, mice that received Intralipid® demonstrated elevated plasma biomarkers of liver injury and histologic liver disease (hepatosteatosis, histologic inflammation, F4/80 staining). L-SOLE prevented both biochemical and histologic liver injury. Administration of H-SOLE also prevented biochemical liver injury, but not steatosis. The combination of phytosterol removal and alpha tocopherol supplementation may reduce the toxicity associated with parenteral use of soybean oil-based ILE. Low phytosterol soybean oil may be a valuable component in safer next generation ILEs. Half of children receiving long-term parenteral nutrition develop intestinal failure-associated liver disease (IFALD). Standard intravenous lipid emulsions (ILEs) in parenteral nutrition are vegetable oil based and high in phytosterols (plant steroids); no low phytosterol vegetable oil-based ILE is available. Phytosterols in ILEs are associated with IFALD. In this study, a new phytosterol-depleted soybean oil was utilized in a laboratory-generated ILE. Use of the phytosterol-depleted soybean oil ILE prevented liver injury in a murine model of IFALD. Phytosterol-depleted soybean oil may be utilized as a component of less toxic next-generation ILEs.

Can commercial aquafeeds improve the nutritional value of brine shrimp? Proximal composition and lipid profile of alternative enhancers

Artemia, commonly known as brine shrimp, holds a significant role as live prey in ornamental and commercial fish aquaculture. This study addressed the nutritional deficiency in adult Artemia biomass, exploring alternative enrichers available in Brazil. Evaluating a commercial aquafeed (Polinutre Poli Camarão 400PL) and a lipid emulsion (BioViv HUFA Continum), adult Artemia were subjected to different enrichment protocols, including periods of 1, 12, and 24 hours with each enricher, as well as a test group raised 100% on the commercial feed. Protein content for Artemia exclusively fed the commercial aquafeed (CF100) reached values very similar to those provided by the main commercial products available worldwide and other commonly used live prey. Enrichment time effects were observed from 12 h onwards, showing positive impacts on protein accumulation. Lipid content peaked at 12 h, followed by a decrease at 24 h. Further studies are needed to assess whether the combination of feed-based protocols followed by 12-h lipid emulsion enrichment can surpass the current results, providing high levels of protein content while maintaining a complete lipid profile.

Safe and well-tolerated long-term parenteral nutrition regimen: Omega-3-fatty-acid-enriched medium chained/ long chained triglycerides emulsion

Background and AimsA limited number of randomized controlled trials (RCTs) have examined the use of lipid emulsions (LEs) of different compositions in home parenteral nutrition (HPN), and there are very few data on the long-term use of omega-3 (n-3) polyunsaturated fatty acids (PUFAs). The study´s objective was to assess safety and tolerability of an n-3 PUFA-enriched LE in adult patients suffering from chronic intestinal failure (CIF) requiring long-term HPN. MethodsIn this prospective, randomized, controlled, double-blind, multicentre, international clinical trial, which was conducted at eleven sites, adult patients in need of HPN including lipids received either the investigational product, an n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) LE, or the reference product, a standard MCT/LCT LE, for an average duration of eight weeks. The primary outcome was the sum of changes of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives included fatty acid pattern in plasma and red blood cells (RBCs) and triene:tetraene ratio in plasma. Results74 patients were enrolled up to premature study termination. Liver function parameters showed no clinically relevant differences between study groups and remained within normal ranges. The n-3 PUFAs EPA and DHA increased in plasma and RBCs in the Lipidem group and were higher in the Lipidem group than the reference group at the end of the study resulting in an increased n-3-index in RBCs with Lipidem. Average n-3-index was >8. The plasma triene:tetraene ratio decreased in both groups. ConclusionThis study is one of the largest comparing two LEs in the complex setting of HPN treatment of adult patients. Although it has been early terminated its results considerably contribute to the evidence on safety and efficacy of longer-term use of LEs in HPN treatment. The n-3 PUFA-enriched LE Lipidem was safe and well-tolerated, particularly in terms of liver function. Lipidem provided an additional supply of n-3 PUFAs and led to positive changes in fatty acid profiles of plasma and RBCs. The n-3-index was in the desirable range at the end of the study in patients receiving Lipidem. There was no evidence of essential fatty acid deficiency with Lipidem. ClinicalTrials.gov IdentifierNCT03282955 Trial RegistrationEudraCT Number: 2015-000849-23

Parenteral lipid nutrition in congenital gastrointestinal malformation operated cases

Background: Congenital gastrointestinal malformation (CGIM) cases require immediate surgical correction after birth and proper nutrition to meet energy demands. Among the macronutrients, lipids are considered the major energy source, playing a vital role in parenteral nutrition. However, the time of their initiation remains unclear. We compared the data of CGIM cases where lipids were given from the first post-surgical day to those where parenteral lipids were initiated on the second or third day of surgery and then reevaluated them on the seventh day of parenteral nutrition.Methods: We collected the data of patients who had undergone surgical correction for CGIM and were kept on parenteral nutrition including lipids from day 1 of surgery labeling them as group 1. Group 2 comprised of neonates having lipid parenteral nutrition started from day 2 or 3 of surgery. Both groups were reevaluated on the 7th day of parenteral nutrition. Statistical analysis was performed.Results: Group 1 had higher total bilirubin (TB) statistically significant (p-value=0.0299), as well as lower lipase (p-value=0.0286), and lower total lipids (p-value=0.0365). The values were lower of triglycerides (p-value=0.0365), and total lipids (p-value=0.0365), on day 1. Comparing both groups, all biochemical parameters were found to be statistically significant.Conclusion: Lipid deficiency and overload should be carefully evaluated, especially in neonates having undergone recent surgical interventions, which increase their nutritional demands. No adverse effects were seen in our study related to parenteral lipid emulsion administration in post-surgical congenital gastrointestinal malformation cases. Early initiation of parenteral lipid regimens can provide better outcomes.Keywords: Congenital gastrointestinal malformations; Intravenous lipid emulsions; Parenteral nutrition; Gestational age; Milk formula

Substrate specificity and kinetic mechanism of 3β-hydroxy-[formula omitted]5-C27-steroid oxidoreductase

Cholesterol is a key sterol whose homeostasis is primarily maintained through bile acid metabolism. Proper bile acid formation is vital for nutrient and fat-soluble vitamin absorption and emulsification of lipids. Synthesis of bile acids occurs through two main pathways, both of which rely on 3-hydroxy-5-C27 steroid oxidoreductase (HSD3B7) to begin epimerization of the 3β hydroxyl of cholesterol into its active 3α conformation. In this sequence HSD3B7 catalyzes the dehydrogenation of the 3β-hydroxy group followed by isomerization of the Δ5-cholestene-3-one. These reactions are some of the many steps that transform cholesterol for either storage or secretion. HSD3B7 has distinct activity from other 3β-HSD family members leaving significant gaps in our understanding of its mode of catalysis and substrate specificity. Additionally, the role of HSD3B7 in health and disease positions it as a metabolic vulnerability that could be harnessed as a therapeutic target. To this end, we evaluated the mechanism of HSD3B7 catalysis and reveal that HSD3B7 displays activity towards diverse 7α-hydroxylated oxysterols. HSD3B7 retains its catalytic efficiency towards these substrates, suggesting that its substrate binding pocket can withstand changes in polarity upon alterations to this hydrocarbon tail. Experiments aimed at determining substrate order are consistent with HSD3B7 catalyzing a sequential ordered bi bi reaction mechanism with the binding of NAD+ followed by 7α-hydroxycholesterol to form a central complex. HSD3B7 bifunctional activity is dependent on membrane localization through a putative membrane-associated helix giving insight into potential regulation of enzyme activity. We found strong binding of the NADH product thought to activate the isomerization reaction. Homology models of HSD3B7 reveal a potential substrate pocket that allows for oxysterol binding and mutagenesis was utilized to support this model. Together these studies offer an understanding of substrate specificity and kinetic mechanism of HSD3B7 which can be exploited for future drug development.

Therapeutic utility of Perfluorocarbon Oxygent in limiting the severity of subarachnoid hemorrhage in mice

Subarachnoid hemorrhage (SAH) is the deadliest form of hemorrhagic stroke; however, effective therapies are still lacking. Perfluorocarbons (PFCs) are lipid emulsion particles with great flexibility and their much smaller size as compared to red blood cells (RBCs) allows them to flow more efficiently within the blood circulation. Due to their ability to carry oxygen, a specific PFC-based emulsion, PFC-Oxygent, has been used as a blood substitute; however, its role in cerebral blood flow regulation is unknown. Adult C57BL/6 wildtype male mice were subjected to an endovascular perforation model of SAH followed by an intravenous (i.v.) injection of 9 ml/kg PFC-Oxygent or no treatment at 5 h after SAH. At 48 h after SAH, functional and anatomical outcomes were assessed. We found that SAH resulted in significant neurologic and motor deficits which were prevented by PFC-Oxygent treatment. We found that SAH-induced vasospasm, reduced RBC deformability, and augmented endothelial dysfunction were also restricted by PFC-Oxygent treatment. Moreover, mitochondrial activity and fusion proteins were also markedly decreased as assessed by oxidative phosphorylation (OXPHOS) after SAH. Interestingly, PFC-Oxygent treatment brought the mitochondrial activity close to the basal level. Moreover, SAH attenuated the level of phosphorylated AMP-activated protein kinase (pAMPK), whereas PFC treatment improved pAMPK levels. These data show the beneficial effects of PFC-Oxygent in limiting the severity of SAH. Further studies are needed to fully understand the mechanism through which PFC-Oxygent exerts its beneficial effects in limiting SAH severity.

Clinical efficacy and safety of parenteral nutrition in hematopoietic stem cell transplantation: results of a single-center randomized controlled study

BACKGROUND: Hematopoietic stem cell transplantation frequently necessitates nutritional support. However, the safety and tolerance of parenteral nutrition have not been adequately examined, except for its association with infectious complications. AIM: To evaluate the impact of parenteral nutrition on nutritional status and its correlation with complications during the early period following hematopoietic stem cell transplantation. MATERIALS AND METHODS: From 2019–2020, 125 recipients of autologous (n=38) and allogeneic (n=87) hematopoietic stem cell transplantation were included in the study with a median age of 20 years (2–65). The chosen cohort included patients with leukemia (n=67), solid tumors (n=32), dysplasia (n=15) and lymphoproliferation (n=11). The control group (n=55) was composed of patients who did not depend on nutritional support. Parenteral nutrition was administered to the primary group (n=70) using second-generation (n=22) and third-generation (n=24) fat emulsions. In the event of contraindications, parenteral nutrition was administered without fat emulsions (n=24). To mitigate the risk of side effects, the initial dose of parenteral nutrition was 50%, with the achievement of the complete dose by the third day of therapy. RESULTS: In 95.7% of cases, mucositis was the indication for parenteral nutrition. The duration of parenteral nutrition was 2–31 days (median, 11 days). In 58.6% of cases, parenteral nutrition was initiated against the background of nausea and vomiting. During the escalation of the parenteral nutrition dose, increased nausea was observed in 7.1% of patients. Side effects were noted in 22.9% of cases: hyperglycemia (n=7), vomiting (n=6) and hypertriglyceridemia (n=3). Four patients developed complications associated with parenteral nutrition, and nutritional therapy was discontinued in 20% of cases (n=14). After hematopoietic stem cell transplantation, the primary clinical efficacy criterion, body mass index, was observed to decline in each observation group. However, it recovered by day 28 and did not differ between the comparison groups as follows: the control group — from 22.7±6.4 to 21.7±6.1 kg/m2, (p=0.42); group “2 in 1” — from 23.4±6.1 to 21.6±4 kg/m2, (p=0.56); group provided with parenteral nutrition employing second-generation fat emulsions — from 18,8±4,9 to 18.7±4.4 kg/m2, (p=0.72); group administered parenteral nutrition with third-generation fat emulsions — from 18.6±4.2 to 18.3±3.5 kg/m2, (p=0.84). The febrile neutropenia rate was 75.2% and did not vary in the control and comparison groups (p=0.54). The incidence of sepsis was 24.8% and was not influenced by the use of parenteral nutrition (p=0.07). Furthermore, sepsis risk was higher when administering parenteral nutrition “2 in 1” compared to fat emulsions-containing parenteral nutrition (p=0.002). The overall frequency of acute graft versus host disease was 16.1% and was similar in the comparison groups (p=0.65). CONCLUSION: In the cohort of patients treated with hematopoietic stem cell transplantation, parenteral nutrition regimens supplemented with second- and third-generation fat emulsions with a stepwise dose increase varied in acceptable tolerance, infection-related complications, and immunological safety, as well as effectively maintained nutritional status parameters.

The Novel Lipid Emulsion Vegaven Is Well Tolerated and Elicits Distinct Biological Actions Compared With a Mixed-Oil Lipid Emulsion Containing Fish Oil: A Parenteral Nutrition Trial in Piglets

BackgroundVegaven is a novel lipid emulsion for parenteral nutrition (PN) based on 18-carbon n–3 (ω-3) fatty acids, which elicits liver protection via interleukin (IL) 10 in the murine model of PN. ObjectivesIn a preclinical model of PN in neonatal piglets, Vegaven was tested for efficacy and safety and compared with a mixed-oil lipid emulsion containing fish oil (SMOFlipid). MethodsMale piglets 4–5 d old were randomly allocated to isocaloric isonitrogenous PN for 14 d, which varied only by the type of lipid emulsion (Vegaven, n = 8; SMOFlipid, n = 8). Hepatic IL-10 tissue concentration served as primary outcome. Secondary outcomes were organ weights, bile flow, blood analyses, plasma insulin and glucagon concentrations, insulin signaling, proinflammatory cytokines, tissue lipopolysaccharide concentrations, and fatty acid composition of phospholipid fractions in plasma, liver, and brain. ResultsTotal weight gain on trial, organ weights, and bile flow were similar between the Vegaven and the SMOFlipid group. Vegaven elicited higher hepatic IL10 (Δ = 148 pg/mg protein; P < 0.001) and insulin receptor substrate-2 amounts (Δ = 0.08 OD; P = 0.012). Plasma insulin concentrations (Δ = 1.46 mU/L; P = 0.003) and fructosamine (glycated albumin, Δ = 12.4 μmol/g protein; P = 0.003) were increased in SMOFlipid as compared with those of Vegaven group, indicating insulin resistance. Higher hepatic injury markers were observed more frequently in the SMOFlipid group than those in the Vegaven group. Lipopolysaccharide, tumor necrosis factor-α, and IL-6 concentrations increased in pancreatic and brain tissues of SMOFlipid-treated compared with those in the Vegaven-treated piglets. Insulin signaling reduced in the brains of SMOFlipid-treated piglets. Vegaven and SMOFlipid elicited distinct fatty acid profiles in the phospholipid fractions of the rapidly growing brains but showed similar accretion of docosahexaenoic acid and arachidonic acid after 2 wk of PN. ConclusionsVegaven is well tolerated in this piglet model of PN, demonstrating distinct biological actions compared with SMOFlipid, namely lower liver, pancreas, and brain inflammation, enhanced insulin signaling, and improved whole body glucose control.

Comparison of n-3 PUFA-Enriched vs. Olive-Oil-Based Lipid Emulsion on Oxidative Stress and Inflammatory Response in Critically Ill Post-Surgery Adults: Secondary Analysis of a Randomized Controlled Trial.

Malnutrition in critically ill patients represents a major concern as it can lead to adverse outcomes including increased morbidity and mortality. These patients exhibit an impaired immune response accompanied by increased oxidative stress. Nutritional support, including parenteral nutrition (PN), is critical in these patients. Intravenous lipid emulsions (ILEs), a key component of PN, provide energy and intervene in the modulation of inflammation. This was a secondary study of a randomized clinical trial at the Reina Sofia University Hospital (Murcia, Spain) for critically ill patients following major abdominal surgery that were administered PN supplemented with olive-oil-based ILE (OO-ILE, n = 29) or a mixed-lipid ILE (soybean oil, medium chain triglycerides, OO and fish oil, SMOF-ILE, n = 25). The effects on clinical outcomes, metabolic markers, oxidative stress, and inflammation were evaluated. No significant differences were observed between groups in the clinical parameters and outcomes, oxidative stress, or inflammatory markers. The within-group evaluation demonstrated an increase in total antioxidant capacity in both groups, while OO-ILE increased the levels of 15-F2t-isoprostane. In addition, the results showed that both mixtures reduced the release of IL-1β and IL-6. These findings suggest that both treatments had similar effects on oxidative stress and inflammatory response in this type of patient.

Alteration in rheological and digestive properties of O/W emulsions using controlled aggregation of konjac glucomannan and xanthan gum in aqueous phases

The modulation of lipid digestion and emulsion stability remains a pivotal area of research, crucial for developing healthier food products with enhanced sensory and nutritional attributes. This study investigates the influence of konjac glucomannan (KGM) and xanthan gum (XG) on oil-in-water (O/W) emulsions throughout simulated gastrointestinal tract (GIT) digestion, focusing on rheological properties, microstructure evolution, and lipid release kinetics. Three distinct O/W emulsions were formulated with 20 wt% oil content, incorporating either 0.8 wt% XG, a 1:1 mixture of KGM and XG (KGM/XG), or a blend of KGM-XG. Rheological assessments revealed all emulsions exhibited shear-thinning behavior across applied shear rates (0.1–100 1/s). During gastric and small intestinal digestion phases, the KGM-XG emulsion exhibited significantly higher viscosity at higher shear rates (2.512–100 1/s), indicating robust molecular interactions between KGM and XG under digestive conditions. The analysis of microstructure, particle size, and flow behavior showed that the KGM-XG emulsion exhibited significantly (p < 0.05) higher viscosity and smaller particle sizes compared to other systems throughout the digestion process. This finding indicates that KGM-XG emulsion demonstrates a strong resistance to enzymes and digestive fluid during the transition from oral to small intestinal phases. Importantly, the extent of free fatty acid (FFA) release at the end of the small intestinal phase was highest for XG (34.4%), followed by KGM/XG (15.65%) and KGM-XG (13.23%). These findings highlight the potential of KGM-XG emulsions to modulate lipid digestion kinetics, offering applications in designing emulsion-based foods, such as sauces, beverages, and reduced-fat foods.

Association between SMOFlipid and impaired brain development on term-equivalent age brain magnetic resonance imaging in very preterm infants

Soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) is used without evidence of benefits. We investigated the relationship between lipid emulsions and brain injury in term-equivalent age magnetic resonance imaging (MRI) in 148 very preterm infants with a birth weight of < 1500 g at ≤ 32 gestational weeks in a neonatal intensive care unit. Infants who received soybean-based lipid emulsions between January 2015 and December 2018 were compared with those who received SMOFlipids between January 2019 and December 2022. A negative binomial generalized linear model was applied for bivariate analysis. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber–White) were applied to adjust for potential confounders. The Kidokoro score was used to determine if lipid emulsion type would affect brain morphology and growth at term-equivalent age. Eighty-six (58.9%) received SMOFlipid. SMOFlipid was associated with lower focal signal abnormality, myelination delay, increased extracerebral space, and cerebellar volume reduction (P = 0.02, P = 0.007, P = 0.01, P = 0.02, respectively). SMOFlipidis are associated with brain insult, especially in white matter, cortical gray matter, and the cerebellum. Well-designed studies are needed to investigate the effect of lipid emulsions on the central nervous system.