Oil-based Fat Emulsion Research Articles

The Effect of Fish Oil-Based Versus Soybean Oil-Based Fat Emulsion in the Occurrence of Parenteral Nutrition-Associated Liver Disease in Premature Infants

The Effect of Fish Oil-Based Versus Soybean Oil-Based Fat Emulsion in the Occurrence of Parenteral Nutrition-Associated Liver Disease in Premature Infants

Fish Oil-Based Fat Emulsion Reduces Acute Kidney Injury and Inflammatory Response in Antibiotic-Treated Polymicrobial Septic Mice.

Acute kidney injury (AKI) is a common complication in sepsis. This study compared the effects of a fish oil-based with a mixed oil fat emulsion on remote renal injury in an antibiotic-treated septic murine model. Mice were randomly assigned to a normal control (NC) group and three septic groups. Sepsis was induced by cecal ligation and puncture (CLP). The antibiotic was injected intraperitoneally (IP) after CLP and then daily till the time of sacrifice. Three hours after antibiotic treatment, one of the septic groups was injected IP with a fish oil-based emulsion (FO), while the other two groups were given either a mixed oil emulsion (MO) or saline (SC). The septic groups were further divided into two separate time groups, with blood and kidneys samples collected at 24 h or 72 h post-CLP. The results showed that sepsis leads to the activation of neutrophils, T helper (Th)1/Th-2/Th-17 and Treg cells (p < 0.05). Plasma NGAL and mRNA expressions of renal MyD88 and TLR4 were also enhanced (p < 0.05). Compared to the SC group, the group given the fish oil-based emulsion had decreased plasma NGAL by 22% and Treg by 33%. Furthermore, renal gene expressions of MyD88 and TLR4 reduced by 46% and 62%, respectively, whereas heat shock protein 70 and peroxisome proliferator-activated receptor-γ increased by 158% and 69%, respectively (p < 0.05), at Day 3 after CLP. These results suggest that administration of a fish oil-based emulsion has favorable effects, maintaining blood T cell percentage, downregulating Treg expression, attenuating systemic and local inflammation and offering renal protection under conditions of antibiotic-treated polymicrobial sepsis.

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

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

New Strategy to Reduce Hypertriglyceridemia During Parenteral Nutrition While Maintaining Energy Intake.

Hypertriglyceridemia is a frequent metabolic complication associated with fat administration in parenteral nutrition (PN). No clear guidelines have been published on how to proceed once hypertriglyceridemia has been detected. A new strategy could be to substitute the initial fat emulsion with another emulsion with faster clearance. Our objective was to determine the effectiveness in reducing triglyceridemia values, maintaining the caloric intake, and improving nutrition parameters in patients who had moderate hypertriglyceridemia during PN when an olive oil-based fat emulsion (OOFE) was substituted with a multiple-source oil fat emulsion (MOFE). We also assessed the safety of this substitution in hepatic and glycemic profiles. We performed a retrospective, observational study that included 38 adult patients to whom OOFE in PN was substituted with MOFE when moderate hypertriglyceridemia (≥250-400 mg/dL) was detected. Triglyceridemia values decreased in 36 (94.7%) patients. The mean reduction was 71 (88-22) mg/dL. Fat load was slightly reduced after substitution (-0.14 [-0.23 to 0] g/kg/d; P < .001), but total caloric intake increased from 22.5 (19.7-25.1) to 23.1 (19.8-26.8) kcal/kg/d (P = .053). After substitution, nutrition parameters improved, liver parameters remained unchanged, and insulin requirements increased. The substitution of OOFE with MOFE in patients with moderate hypertriglyceridemia during PN resulted in a reduction in triglyceridemia values of about 70 mg/dL. That allowed maintaining the caloric intake and improved nutrition parameters without affecting the hepatic profile. For some patients, insulin requirements increased moderately.

Short-Term Intravenous Fish-Oil Emulsions in Pediatric Oncologic Patients—Effect on Liver Parameters

Pediatric oncologic patients often need parenteral nutrition (PN) during chemotherapy. Long-term use of soybean-based lipid emulsions is associated with progressive liver disease and cholestasis, whereas fish-oil based emulsions have anticholestatic effects. We studied the potentially hepato-protective effects of short-term use of SMOF lipids in children undergoing chemotherapy. Fifteen pediatric oncologic patients treated with SMOF lipids were retrospectively analyzed in respect to bilirubin and liver parameters and compared to matched-controls who had received soybean-based fat emulsions. For statistics the time-points baseline, Day 14 of PN (PN14), and post (Day+7) were chosen. None of the study patients developed cholestasis. Within the SMOF-lipid group there were no differences in the laboratory parameters between baseline, PN14, and post. In the control group, gamma glutamyltransferase (γGT) levels increased during PN (baseline vs. PN14, 26.43 vs. 63.00 U/l, P < 0.05). Lactate dehydrogenase (LDH) levels showed a significantly different behavior in the 2 groups: In the SMOF lipids group, LDH decreased whereas it increased in the controls (−32.75 U/l vs. + 29.57 U/l, P < 0.05). An advantage of fish oil-based fat emulsions can be shown even after short-term PN. In children undergoing chemotherapy the use of soybean-based fat emulsions but not SMOF lipids led to increased γGT levels.

Agglutination of Intravenously Administered Phosphatidylcholine‐Containing Lipid Emulsions With Serum C‐reactive Protein

C-reactive protein (CRP) is able to bind phospholipids in the presence of calcium. We wanted to investigate the reaction of CRP with various commercial fat emulsions and to explore the impact of CRP agglutination on serum CRP levels. Serum specimens were mixed with Intralipid 20% (soybean oil-based fat emulsion), Structolipid (structured oil-based fat emulsion), Omegaven (fish oil-based fat emulsion), or SMOFlipid (mixed soybean oil-, olive oil-, and fish oil-based emulsion) in Tris-calcium buffer (pH 7.5). After 30 minutes of incubation at 37°C, CRP-phospholipid complexes were turbidimetrically quantified and flow cytometric analysis was performed. Similarly, CRP complexes were monitored in vivo, following administration of fat emulsion. CRP was able to agglutinate phospholipid-containing lipid droplets present in the soybean oil-based fat emulsion and the structured oil-based fat emulsion. To a lesser extent, agglutination was observed for fish oil-containing fat emulsions, whereas no agglutination was noticed for the mixed soybean oil-, olive oil-, and fish oil-based emulsion. Results for propofol-containing emulsions were comparable. Agglutination correlated with phospholipid content of the emulsions. When in vivo agglutination occurred, plasma CRP values dropped due to consumption of CRP by phospholipid-induced agglutination. In this in vitro experiment, we demonstrated agglutination of CRP with phospholipids in various fat emulsions. Research studies are required in patients to determine which effects occur with various intravenous fat emulsions.

A.S.P.E.N. Position Paper

The currently available, standard soybean oil (SO)-based intravenous fat emulsions (IVFEs) meet the needs of most parenteral nutrition (PN) patients. There are alternative oil-based fat emulsions, such as medium-chain triglycerides (MCTs), olive oils (OOs), and fish oils (FOs), that, based on extensive usage in Europe, have an equivalent safety profile to SO. These alternative IVFEs are metabolized via different pathways, which may lead to less proinflammatory effects and less immune suppression. These alternative oil-based IVFEs are not currently available in the United States. Many patients who require IVFEs are already in a compromised state. Such patients could potentially have better clinical outcomes when receiving one of the alternative IVFEs to diminish the intake of the potentially proinflammatory ω-6 fatty acid-linoleic acid-which comprises more than 50% of the fatty acid profile in SO. Further research is needed on these alternative oil-based IVFEs to identify which IVFE oils or which combination of oils may be most clinically useful for specific patient populations.

Comparison of the Effects of Different Intravenous Fat Emulsions in Patients With Systemic Inflammatory Response Syndrome and Sepsis

In this study, the authors aimed to compare the effects that a medium- and long-chain triglyceride (MCT/LCT) fat infusion and a fish oil-based (ω-3) fat infusion for parenteral nutrition (PN) had on systemic inflammation, cytokine response, and hepatic steatosis in mixed intensive care unit (ICU) patients. This was a single-center, placebo-controlled, randomized clinical trial in a university hospital. Four patient groups, including systemic inflammatory response syndrome (SIRS) and sepsis patients, were assigned to receive PN employing the MCT/LCT fat infusion or the fish oil-based fat infusion over 7 days. Blood biochemistry and liver steatosis were evaluated. Twenty sepsis and 20 SIRS patients were included in this study. There was no statistically significant difference in terms of biochemical values and Acute Physiology and Chronic Health Evaluation II scores between the different feeding groups. Sepsis groups who received MCT/LCT revealed higher grades of liver steatosis by ultrasound on days 7 and 10 (P < .05). Tumor necrosis factor (TNF)-α and interleukin (IL)-6 values in sepsis group 1 (S1) were higher than in sepsis group (S2) on day 7, whereas IL-1 values were higher on days 3, 7, and 10 in group S1 than in group S2. Conversely, IL-10 values on days 3 and 7 were significantly higher in group S2. Fish oil-based fat emulsions might have anti-inflammatory and hepatoprotective effects in hyperinflammatory disease such as sepsis.

Olive Oil‐Based Fat Emulsion Versus Soy Oil‐Based Fat Emulsion in Abdominal Oncologic Surgery

In parenteral nutrition (PN), essential fatty acids are provided by soy oil-based fat emulsions, which may exert adverse effects on the immune system and lipid peroxidation. Olive oil -based fat emulsions have been said to prevent these undesired effects. This study compares effects of olive oil - and soy oil -based fat emulsions in 22 patients who underwent abdominal surgery for cancer. The first group (n = 10) received soy oil -based fat emulsion; the second group (n = 10) received olive oil -based fat emulsion. Body temperature, body mass index, (BMI) and biochemical variables were measured on days 0 and 7. There were no differences between the groups with regard to BMI or temperature. On day 7, the first group (compared with day 0) had significant increases in plasma alkaline phosphatase (81.70 ± 16.03 vs 117.60 ± 11.1), γ-glutamyl transferase (39.90 ± 15.40 vs 137.70 ± 24.09), and mean body temperature (36.72°C ± 0.14°C vs 37.20°C ± 0.17°C) (P < .01). Second group had increases in alkaline phosphatase (85.80 ± 13.46 vs 147.20 ± 34.17), γ-glutamyl transferase (48.40 ± 12.86 vs 129.40 ± 42.03), total protein (5.14 ± 0.19 vs 6.06 ± 0.49), and albumin (2.62 ± 0.14 vs 3.00 ± 0.18) (P < .05). Changes in thiobutyric acid levels were not statistically significant in either group. In postoperative cancer patients, olive oil-based fat emulsion had similar effects on BMI, body temperature, biochemical values, and thiobutyric acid levels as soy oil-based fat emulsions.

Fat emulsions based on structured lipids (1,3-specific triglycerides): an investigation of the in vitro interaction with plasma proteins

Structured lipids (1,3-specific triglycerides) are new chemical entities made by enzymatictransesterification of the fatty acids in the 1,3-positions of the triglyceride. The purpose of this study was to investigate the in vitro interaction of fat emulsions based on either structured lipids or vegetable oils with human plasma proteins employing two-dimensional polyacrylamide gel electrophoresis (2-D PAGE). The structured lipids are triglycerides of the SLS and MLM types, where S is short-chain fatty acids (C 4), M is medium-chain fatty acids (C 8–10) and L is long-chain fatty acids (C 16−18). The vegetable oil-based fat emulsions were the commercially available product, Intralipid, and a soybean oil (LLL) emulsion made de novo identically as the emulsions containing structured lipids. The SLS emulsion was found to adsorb a different protein pattern than the MLM and LLL emulsions. The protein pattern of the SLS emulsion was similar to the protein pattern of Intralipid. These findings might explain the in vivo difference in elimination found in another study, where the emulsion based on structured lipids with short-chain fatty acids in the 1,3-positions was removed more slowly from the general blood circulation compared to emulsions based on lipids with long-chain fatty acids in the 1,3-positions (LLL) (1).

Hypertriglyceridemia during the intravenous infusion of a safflower oil-based fat emulsion

Comparaison prospective en double aveugle croise chez 18 prematures se servant a eux-memes de temoins, places sous alimentation parenterale et recevant comme emulsion lipidique soit de l'intralipid (huile de soja) soit du liposyn. L'hypertriglyceridemie apparait plus frequente et plus importante apres administration du liposyn qui doit etre utilise avec reserve chez les enfants les plus prematures