Randomized Clinical Trial of New Intravenous Lipid (SMOFlipid 20%) Versus Medium‐Chain Triglycerides/Long‐Chain Triglycerides in Adult Patients Undergoing Gastrointestinal Surgery

Background: SMOFlipid 20% is intravenous lipid emulsion (ILE) containing long‐chain triglycerides (LCT), medium‐chain triglycerides (MCT), olive oil, and fish oil as a mixed emulsion containing α‐tocopherol. The aim was to assess the efficacy of this new ILE in gastrointestinal surgery compared with MCT/LCT. Methods: In this prospective study, 40 patients were randomized to SMOFlipid 20% or MCT/LCT (Lipovenoes 20%) group. Clinical and biochemistry data were collected. Inflammatory markers (CRP, IL‐6, IL‐10, TNF‐α, TGF‐β1) and oxidative stress (ROS and superoxide) were measured. Results: Thirty‐five patients (17 males and 18 females) with a mean age of 57 years completed the study. The patients’ demographic characteristics (age, gender, height, body weight, and BMI) were similar without significant differences between groups. The increment of triglyceride on day 6 from baseline was significantly lower in SMOFlipid group than in Lipovenoes MCT/LCT group. Inflammatory markers, as well as superoxide radical and total oxygen radical were not different between groups. Conclusions: Despite the comparable effect on inflammatory response, because of its well‐balanced fatty acid pattern, relatively low n‐6:n‐3 ratio, and high vitamin E content, SMOFlipid had a better triglyceride‐lowering effect as compared with MCT/LCT in adult patients undergoing gastrointestinal surgery.     

Effects on Varying Intravenous Lipid Emulsions on the Small Bowel Epithelium in a Mouse Model of Parenteral Nutrition

Background: Injectable fat emulsions (FEs) are a clinically dependable source of essential fatty acids (FA). ω‐6 FA is associated with an inflammatory response. Medium‐chain triglycerides (MCT, ω‐3 FA), fish oil, and olive oil are reported to decrease the inflammatory response. However, the effect of these lipids on the gastrointestinal tract has not been well studied. To address this, we used a mouse model of parenteral nutrition (PN) and hypothesized that a decrease in intestinal inflammation would be seen when either fish oil and MCT or olive oil were added. Methods: Three FEs were studied in adult C57BL/6 mice via intravenous cannulation: standard soybean‐based FE (SBFE), 80% olive oil ‐supplemented FE (OOFE), or a combination of a soybean oil, MCT, olive oil, and fish oil emulsion (SMOF). PN was given for 7 days, small bowel mucosa‐derived cytokines, animal survival rate, epithelial cell (EC) proliferation and apoptosis rates, intestinal barrier function and mucosal FA composition were analyzed. Results: Compared to the SBFE and SMOF groups, the best survival, highest EC proliferation and lowest EC apoptosis rates were observed in the OOFE group; and associated with the lowest levels of tumor necrosis factor‐α, interleukin‐6, and interleukin‐1β expression. Jejunal FA content showed higher levels of eicosapentaenoic and docosapentaenoic acid in the SMOF group and the highest arachidonic acid in the OOFE group. Conclusion: The study showed that PN containing OOFE had beneficial effects to small bowel health and animal survival. Further investigation may help to enhance bowel integrity in patients restricted to PN.     

脂肪乳在肠外营养中的应用进展

脂肪乳作为肠外营养支持中主要的能量来源,数十年来,已发展出多种不同配方的制剂.LCT脂肪乳由于代谢方面的缺陷,目前在临床上已被MCT/LCT脂肪乳逐步取代.较新的配方是由结构三酰甘油或橄榄油构成,此种新型脂肪乳更为安全,耐受性更好.含鱼油 ( n-3脂肪酸)的脂肪乳,可改善不同病人危重情况下的组织灌注.最新的脂肪乳SMOF,由添加维生素E的大豆长链脂肪酸、中链脂肪酸、橄榄油和鱼油混合配制而成,已在一项双盲试验中获得良好的应用,其效能尚有待进一步的临床验证.     

Effect of an Olive Oil–Based Lipid Emulsion Compared With a Soybean Oil–Based Lipid Emulsion on Liver Chemistry and Bile Acid Composition in Preterm Infants Receiving Parenteral Nutrition

Background: The pathogenesis of parenteral nutrition (PN)–associated liver dysfunction is multifactorial. Lipid emulsions may be one of the putative mechanisms. Our aim was to comparatively assess the effect of parenteral olive oil– and soybean oil–based lipid emulsions on liver chemistry and bile acid composition in preterm infants. Methods: We performed a double‐blind, randomized clinical study in which 103 preterm infants were randomly assigned to PN using either soybean oil–based lipid emulsion (SO; n = 51) or olive oil (OO)–based lipid emulsion (OO; n = 52). The primary end point was liver chemistry. The secondary end point was the plasma bile acid composition. Results: One hundred infants completed this study. In the SO group, the serum direct bilirubin was significantly higher after PN for 7 days compared with the OO group. Bile acids increased over time in both treatment groups. However, specific differences in the change in bile acid composition over time were noted between groups. Conclusions: Differences in direct bilirubin and bile acid composition were observed over time between the 2 groups. Considering the long‐term use of lipid emulsions in higher risk babies, these findings might be useful for understanding the pathogenesis of PN‐associated liver dysfunction.     

Phytonadione Content in Branded Intravenous Fat Emulsions

Background: Intravenous fat emulsions (IVFE) with different fatty acid compositions contain vitamin E as a by‐product of vegetable and animal oil during the refining processes. Likewise, other lipid‐soluble vitamins may be present in IVFE. No data, however, exist about phytonadione (vitamin K1) concentration in IVFE information leaflets. Therefore, our aim was to evaluate the phytonadione content in different IVFE. Materials and Methods: Analyses were carried out in triplicate on 6 branded IVFE as follows: 30% soybean oil (100%), 20% olive‐soybean oil (80%–20%), 20% soybean–medium‐chain triglycerides (MCT) coconut oil (50%–50%), 20% soybean‐olive‐MCT‐fish oil (30%‐25%‐30%‐15%), 20% soybean‐MCT‐fish oil (40%‐50%‐10%), and 10% pure fish oil (100%). Phytonadione was analyzed and quantified by a quali‐quantitative liquid chromatography–mass spectrometry (LC‐MS) method after its extraction from the IVFE by an isopropyl alcohol–hexane mixture, reverse phase–liquid chromatography, and specific multiple‐reaction monitoring for phytonadione and vitamin d3 (as internal standard). This method was validated through specificity, linearity, and accuracy. Results: Average vitamin K1 content was 500, 100, 90, 100, 95, and 70 µg/L in soybean oil, olive‐soybean oil, soybean‐MCT coconut oil, soybean‐olive‐MCT‐fish oil, soybean‐MCT‐fish oil, and pure fish oil intravenous lipid emulsions (ILEs), respectively. The analytical LC‐MS method was extremely effective in terms of specificity, linearity (r = 0.99), and accuracy (coefficient of variation <5%). Conclusions: Phytonadione is present in IVFE, and its intake varies according to IVFE type and the volume administered. It can contribute to daily requirements and become clinically relevant when simultaneously infused with multivitamins during long‐term parenteral nutrition. LC‐MS seems adequate in assessing vitamin K1 intake in IVFE.     

Effects of medium-chain triglycerides, long-chain triglycerides, or 2-monododecanoin on fatty acid composition in the portal vein, intestinal lymph, and systemic circulation in rats.

BACKGROUND: Fatty acid absorption patterns can have a major impact on the fatty acid composition in the portal, intestinal lymph, and systemic circulation. This study sought to determine the effects of long-chain triglycerides (LCT), medium-chain triglycerides (MCT), and 2-monododecanoin (2mono) on intestinal fatty acid composition during continuous feeding over a brief period. METHODS: The lipid sources were 100% LCT, 100% MCT, a 50:50 mixture of LCT and MCT (LCT/MCT), and a 50:50 mixture of LCT and 2mono (LCT/2mono). A total of 27 rats were randomly given 1 of the 4 diets at 200 kcal/kg/d, with 30% of total calories from lipids over 3 hours. RESULTS: MCT significantly increased each of the medium-chain fatty acids (C6:0, C8:0, and C10:0) as free fatty acids in the portal vein and about 10%/mol of C10:0 as triglycerides in the lymph compared with the other groups. There was significantly less C10:0 in lymphatic triglycerides with LCT/MCT than with MCT, but more than in the LCT and LCT/2mono diets. MCT also significantly increased the contents of C16:0, C18:0, C18:1, and C20:4 in the lymphatic triglycerides compared with all other groups including LCT/MCT. The amount of linoleic acid (C18:2) in lymphatic triglycerides followed the relative amounts of this fatty acid in the diet, with the greatest in LCT followed by LCT/MCT and LCT/2mono and least in MCT. A so-called structured lipid composed of the medium-chain fatty acid dodecanoic acid on the 2 position and long-chain fatty acids on the 1 and 3 positions appeared to be endogenously synthesized in response to the LCT/2mono diet. CONCLUSIONS: The original differences in MCT and LCT content in the diets were preserved in the fatty acid composition in the intestinal free fatty acids and triglycerides during feeding. In addition, the duration of lipid administration can play a role in altering fatty acid composition in the intestine.     

Partial replacement of ω-6 fatty acids with medium-chain triglycerides, but not olive oil, improves colon cytokine response and damage in experimental colitis

Background: Soybean oil is rich in ω‐6 fatty acids, which are associated with higher incidence and more severe cases of inflammatory bowel diseases. The authors evaluated whether partial replacement of soybean oil by medium‐chain triglycerides (MCTs) or olive oil influenced the incidence and severity of experimental ulcerative colitis by using different parenteral lipid emulsions (LEs). Methods: Wistar rats (n = 40) were randomized to receive parenteral infusion of the following LE: 100% soybean oil (SO), 50% MCT mixed with 50% soybean oil (MCT/SO), 80% olive oil mixed with 20% soybean oil (OO/SO), or saline (CC). After 72 hours of infusion, acetic acid experimental colitis was induced. After 24 hours, colon histology and cytokine expression were analyzed. Results: SO was not significantly associated with overall tissue damage. MCT/SO was not associated with necrosis (P < .005), whereas OO/SO had higher frequencies of ulcer and necrosis (P < .005). SO was associated with increased expression of interferon‐γ (P = .005) and OO/SO with increased interleukin (IL)–6 and decreased tumor necrosis factor–α expression (P < .05). MCT/SO appeared to decrease IL‐1 (P < .05) and increase IL‐4 (P < .001) expression. Conclusions: Parenteral SO with high concentration of ω‐6 fatty acids was not associated with greater tissue damage in experimental colitis. SO partial replacement with MCT/SO decreased the frequency of histological necrosis and favorably modulated cytokine expression in the colon; however, replacement with OO/SO had unfavorable effects.     

脂肪乳的特点及临床应用

脂肪乳剂是构成TPN中非蛋白质能量的来源之一。传统的以大豆油为基础的长链脂肪乳,由于长链脂肪乳存在导致脂质过氧化、免疫抑制、诱发炎症和损伤内皮系统作用的潜在风险,因此,研究出了中／长链脂肪乳剂、鱼油、橄榄油、结构脂肪乳剂、SMOF等。不同脂肪乳剂的差别主要在于甘油三酯的不同,即结合于甘油的脂肪酸的不同,而脂肪酸的不同代谢特点决定了各种脂肪乳剂在临床中的不同应用。     

Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition

Background: Soybean oil lipid emulsion may compromise immune function and promote hepatic damage due to its composition of long‐chain fatty acids, phytosterols, high proportion of ω‐6 fatty acids, and low α‐tocopherol levels. Combination lipid emulsions have been developed using medium‐chain triglyceride oil, fish oil, and/or olive oil, which provide adequate essential fatty acids, a smaller concentration of ω‐6 fatty acids, and lower levels of phytosterols. The purpose of this systematic review is to determine if combination lipid emulsions have a more favorable impact on bilirubin levels, triglyceride levels, and incidence of infection compared with soybean oil lipid emulsions in children receiving parenteral nutrition. Methods: This study comprises a systematic review of published studies. Data were sufficient and homogeneous to conduct a meta‐analysis for total bilirubin and infection. Results: Nine studies met the inclusion criteria. Meta‐analysis showed that combination lipid emulsion decreased total bilirubin by a mean difference of 2.09 mg/dL (95% confidence interval, –4.42 to 0.24) compared with soybean oil lipid emulsion, although the result was not statistically significant (P = .08). Meta‐analysis revealed no statistically significant difference in incidence of infection between the combination lipid emulsion and the soybean oil lipid emulsion groups (P = .846). None of the 4 studies that included triglyceride as an outcome detected a significant difference in triglyceride levels between the combination lipid emulsion and soybean oil lipid emulsion groups. Conclusion: There is inadequate evidence that combination lipid emulsions offer any benefit regarding bilirubin levels, triglyceride levels, or incidence of infection compared with soybean oil lipid emulsions.     

A Comparison of Fish Oil Sources for Parenteral Lipid Emulsions in a Murine Model

Background: Fat emulsions are important components of parenteral nutrition (PN). Fish oil (FO) emulsions reverse cholestasis in PN‐associated liver disease. There are 2 FO monographs. One is “FO; rich in omega‐3 fatty acids” (NFO). The other, “omega‐3 acids,” (PFO), is enriched in omega‐3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The purpose of this study is to compare the effects of 20% NFO and PFO emulsions produced in the laboratory in a murine model. Methods: Emulsions were compounded containing different oils: soybean oil (SO), NFO, and two PFOs differing in percentage of fatty acids as triglycerides (PFO66 and PFO90). Chow‐fed mice received saline, one of the above emulsions, or a commercial FO (OM) intravenously (2.4 g/kg/day) for 19 days. On day 19, animals were euthanized. Livers, spleens, and lungs were procured for histologic analysis. Results: OM, SO, NFO, and PFO90 were well‐tolerated clinically. PFO66 resulted in tachypnea and lethargy for ~1 minute following injections. At euthanasia, PFO66 and PFO90 groups had organomegaly. Histologically, these groups had splenic and hepatic fat‐laden macrophages, and lungs had scattered fat deposits. Other groups had normal organs. Conclusions: PFO emulsions present an attractive possibility for improving inflammation in PN‐dependent patients by concentrating anti‐inflammatory EPA and DHA. However, 20% PFO emulsions were poorly tolerated and precipitated adverse end organ sequelae, suggesting that they may not be safe. Development of novel manufacturing methods may achieve safe 20% PFO parenteral emulsions, but by established formulation methods, these emulsions were clinically suboptimal despite meeting pharmacopeial standards.     

Medium-chain fatty acids: evidence for incorporation into chylomicron triglycerides in humans

The purpose of this study was to evaluate the fatty acid composition of chylomicron triglycerides isolated from subjects fed liquid-formula diets containing 40% of total energy as medium- (C8:0 and C10:0) or long-chain (C16-C18) triglycerides (MCT, LCT) for 6 d. Medium-chain fatty acids (MCFA) comprised 8% of total chylomicron triglyceride fatty acids after the first MCT meal. After 6 d of continued MCT feeding, chylomicron triglyceride MCFA content increased to 13%. When subjects were fed the LCT (soybean oil) diet, C16:0, C18:1, and C18:2 comprised nearly 90% of the chylomicron triglyceride fatty acids. The mass of triglyceride transported in chylomicrons isolated from subjects fed the MCT diet was approximately 20% of that found when subjects consumed the LCT diet. We conclude that although total triglyceride production during MCT ingestion is low, the chylomicron triglycerides that are synthesized contain significant amounts of MCFA.     

Effects of fat emulsions with different fatty acid composition on plasma and hepatic lipids in rats receiving total parenteral nutrition

Effects of different fatty acids on the development of hepatic steatosis were studied in rats receiving total parenteral nutrition (TPN). 65 rats, with internal jugular catheters, were divided into one control group (n = 8), and four experimental groups (n = 13-15 each). The control group was fed a chow diet and all experimental groups received TPN. TPN provided 300 kcal/kg/day with 40% of the non-protein energy provided as fat. All TPN solutions were isonitrogenous and identical in nutrient composition except for the fatty acid composition of the fat emulsion. Four kinds of fat emulsions rich in: 1) medium chain fatty acids (C8:0,C10:0), 2) oleic acid (C18:1 n-9), 3) linoleic acid (C18:2 n-6), 4) eicosapentaenoic acid (C20:5 n-3)/docosahexaenoic acid (C22:6 n-3), were used. These fat emulsions were prepared with: 1) a mixture of medium chain triglycerides (MCT) and soybean oil (9:1), 2) olive oil, 3) safflower oil, 4) fish oil, respectively. The results of the study demonstrated a higher hepatic lipid content in the olive oil and safflower oil groups than in the control group, whereas no significant difference was seen between the MCT and control groups. Also, no difference was observed between the fish oil and control groups. With regard to the plasma lipids, the MCT group and olive oil group produced hyperlipidaemia. The plasma of the safflower oil and fish oil groups, however, had a low lipid concentration comparable to the control group. These results suggest that TPN with a fat emulsion prepared with fish oil does not cause hyperlipidaemia nor induce hepatic steatosis in normal rats.     

Effect of various lipid emulsions on total parenteral nutrition-induced hepatosteatosis in rats

The effect of various lipid emulsions on the development of fatty liver during total parenteral nutrition (TPN) was investigated in rats given TPN for 7 days. Medium-chain triglycerides (MCT), long-chain triglycerides (LCT), chemically defined triglycerides (CDT; structured lipid with a high purity of 94.3%), and a mixture of MCT and LCT (MIX) were prepared as the lipid emulsions. TPN provided 350 kcal/kg/day, with a nonprotein calorie/nitrogen ratio of 160. The TPN-1 group received 10% nonprotein calories and the TPN-2 group received 30% nonprotein calories. MCT TPN was found to have some disadvantages, especially with regard to nitrogen balance and plasma albumin levels. Total cholesterol and phospholipids tended to be high in the MCT TPN group. The hepatic lipid content was higher in the lipid-free TPN and the MCT TPN groups, and lower in the CDT and LCT TPN groups. Histologically, the livers of the MIX, CDT, and LCT TPN groups showed less fatty change than those of the FREE and MCT groups.     

Tocopherol isoforms in parenteral lipid emulsions and neutrophil activation

BACKGROUND AND AIMS: Tocopherol is a lipid-soluble anti-oxidant that exists in several isoforms. Patients on total parenteral nutrition depend on lipid emulsions for their tocopherol intake. In the present study, we analysed the content of tocopherol isoforms in various lipid emulsions. We also tested the hypothesis that immune-modulating effects of lipid emulsions could be attributed to different concentrations of alpha-tocopherol (alpha-toc) or peroxidation products. METHOD: alpha-, beta-, gamma- and delta-toc were measured in emulsions containing long-chain triglycerides (LCT), mixed long- and medium-chain triglycerides (LCT/MCT), structured lipids (SL), olive oil (OO) or fish oil (FO). As a measure for cellular activation, neutrophil membrane adhesion markers were assessed after exposure to two LCT/MCT emulsions that differ only in alpha-toc content. RESULTS: Various emulsions differed widely in tocopherol contents, especially with respect to the alpha- isoform. The latter isomer also was subject to considerable degradation despite adequate storage conditions. The previously observed activation of neutrophils by LCT/MCT was not influenced by the increased concentration of alpha-toc or the decreased concentration of lipid peroxidation products in a new LCT/MCT emulsion. CONCLUSIONS: Tocopherol supplementation by parenteral lipid emulsions strongly depends on the lipid source and the storage lifetime of the emulsion. The effects of LCT/MCT on the immune system are not modulated by alpha-toc or by lipid peroxidation products.     

中链甘油三酯干预对2型糖尿病血脂和血浆游离脂肪酸的影响

目的探讨中链甘油三酯(MCT)干预对2型糖尿病(T2DM)患者体重、血脂和血浆游离脂肪酸的影响。方法以长链甘油三酯(LCT)为对照,将所有T2DM患者分为MCT组、MCT/LCT组和LCT组,在控制总能量和脂肪摄入量的基础上,3组分别连续食用100%MCT油、50%MCT油 50%LCT油和100%LCT油12周。在0、6和12周时检测血浆总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)和载脂蛋白B(ApoB)浓度以及血浆游离脂肪酸浓度。计算体质指数(BMI)、LDL/HDL、ApoA1/ApoB、总游离脂肪酸(TFFA)、长链饱和脂肪酸(LCSFA)和不饱和脂肪酸(USFA)浓度。结果在6和12周时,MCT和MCT/LCT组的体重和BMI均较LCT组低(P<0.05)。在12周时MCT/LCT组的TC水平较LCT组低(P<0.05)。与实验前相比,MCT/LCT组6和12周时的LDL-C水平均显著下降(P<0.05);与6周时相比,MCT组12周时的LDL-C水平显著下降(P<0.05)。12周时LCT组的HDL-C水平较MCT组高(P<0.05)。与MCT组相比,LCT组的LCSFA水平在6周时显著升高(P<0.05)。3组的TFFA和USFA水平差异无显著性。结论在控制总能量和脂肪摄入量的基础上,用MCT取代100%或50%的膳食油脂,患者的BMI和血脂谱得到改善,而血浆游离脂肪酸无明显变化。     

Liver Disease,Systemic Inflammation,and Growth Using a Mixed Parenteral Lipid Emulsion,Containing Soybean Oil,Fish Oil,and Medium Chain Triglycerides,Compared With Soybean Oil in Parenteral Nutrition–Fed Neonatal Piglets

Background: The optimal parenteral lipid emulsion for neonates should reduce the risk of intestinal failure–associated liver disease and inflammation, while supporting growth and development. This could be best achieved by balanced content of ω‐6 and ω‐3 polyunsaturated fatty acids (PUFAs). Using a neonatal piglet model of parenteral nutrition (PN), we compared a 100% soy oil–based emulsion (ω‐6:ω‐3 PUFA: 7:1) with a mixed lipid emulsion comprising 30% soy oil, 30% medium‐chain triglycerides, 25% olive oil, and 15% fish oil (ω‐6:ω‐3 PUFA: approximately 2.5:1) with regard to liver disease, inflammation, and fatty acid content in plasma and brain. Method: Neonatal piglets, 3–6 days old, underwent jugular catheter insertion for isonitrogenous, isocaloric PN delivery over 14 days. The IL group (n = 8) was treated with Intralipid; the ML group (n = 10) was treated with the mixed lipid (SMOFlipid). Bile flow, liver chemistry, C‐reactive protein (CRP), and PUFA content in plasma phospholipids and brain were compared. Results: Compared with the IL group, ML‐treated piglets had increased bile flow (P = .008) and lower total bilirubin (P = .001) and CRP (P = .023) concentrations. The ω‐6 long‐chain PUFA content was lower in plasma and brain for the ML group. The key ω‐3 long‐chain PUFA for neonatal development, docosahexaenoic acid (DHA), was not different between groups. Conclusion: The mixed lipid, having less ω‐6 PUFA and more ω‐3 PUFA, was able to prevent liver disease and reduce systemic inflammation in PN‐fed neonatal piglets. However, this lipid did not increase plasma or brain DHA status, which would be desirable for neonatal developmental outcomes.     

Comparison of Formulas Based on Lipid Emulsions of Olive Oil,Soybean Oil,or Several Oils for Parenteral Nutrition: A Systematic Review and Meta-Analysis

Many studies have reported that olive oil–based lipid emulsion (LE) formulas of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) may be a viable alternative for parenteral nutrition. However, some randomized controlled clinical trials (RCTs) have raised concerns regarding the nutritional benefits and safety of SMOFs. We searched principally the MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to March 2014 for the relevant literature and conducted a meta-analysis of 15 selected RCTs that 1) compared either olive oil– or SMOF-based LEs with soybean oil–based LEs and 2) reported plasma concentrations of α-tocopherol, oleic acid, and ω-6 (n–6) and ω-3 (n–3) long-chain polyunsaturated fatty acids (PUFAs) and liver concentrations of total bilirubin and the enzymes alanine transaminase, aspartate transaminase, alkaline phosphatase, and γ-glutamyl transferase. The meta-analysis suggested that SMOF-based LEs were associated with higher plasma concentrations of plasma α-tocopherol, oleic acid, and the ω-3 PUFAs eicosapentaenoic and docosahexaenoic acid. Olive oil– and SMOF-based LEs correlated with lower plasma concentrations of long-chain ω-6 PUFAs and were similar to soybean oil–based LEs with regard to their effects on liver function indicators. In summary, olive oil– and SMOF-based LEs have nutritional advantages over soybean oil–based LEs and are similarly safe. However, their performance in clinical settings requires further investigation.     

Pretreatment With an Intravenous Lipid Emulsion Increases Plasma Eicosapentanoic Acid and Downregulates Leukotriene B4, Procalcitonin,and Lymphocyte Concentrations After Open Heart Surgery in Infants

Background: The effect of providing a lipid emulsion containing medium‐chain triglyceride (MCT), soybean oil, and fish oil in critically ill infants is not widely studied. This study investigated lipid emulsion effects on plasma phospholipids and immune biomarkers. Materials and Methods: Thirty‐two infants undergoing cardiopulmonary bypass (CPB) and dependent on parenteral nutrition (PN) were randomized to receive either soybean oil (control, n = 16) or a 50:40:10 mixture of MCT, soybean oil, and fish oil (treatment, n = 16). PN was administered for 3 days preoperatively and 10 days postoperatively. Fatty acids, procalcitonin (PCT), leukotriene B₄ (LTB₄), and lymphocytes were quantified at baseline, before surgery, and days 1, 7 and 10 after surgery. Results: PCT was significantly lower in the treatment vs control group 1 day postoperatively (P = .01). The treatment group exhibited a lower ω‐6 to ω‐3 ratio (P = .0001) and a higher ω‐3 concentration at all postoperative study periods (P = .001). Treatment resulted in higher (P < .05) plasma phospholipid eicosapentaenoic acid (EPA) on days 7 and 10, while α‐linolenic acid, arachidonic acid, and docosahexaenoic acid remained constant. An increase in plasma phospholipid EPA concentration was associated with a decrease in plasma phospholipid LTB₄ concentration (P < .05). On postoperative day 10, treatment infants with high Pediatric Risk of Mortality III scores exhibited a 45% lower lymphocyte concentration (P < .05). Conclusion: These findings suggest that treating infants undergoing CPB with a lipid emulsion containing ω‐3 improves fatty acid status and results in a lower inflammatory response after surgery. Overall, this alternative ω‐3–enriched lipid emulsion may benefit clinical outcomes of critically ill infants after cardiac surgery.     

Provision of a Soy‐Based Intravenous Lipid Emulsion at 1 g/kg/d Does Not Prevent Cholestasis in Neonates

Background: One of the most common and severe complications of long‐term parenteral nutrition (PN) is PN‐associated cholestasis. The soybean oil–based lipid emulsion administered with PN has been associated with cholestasis, leading to an interest in lipid reduction strategies. The purpose of this study was to determine whether the provision of a soybean oil–based lipid emulsion at 1 g/kg/d compared with 2–3 g/kg/d is associated with a reduced incidence of cholestasis. Methods: Retrospective review of neonates admitted between 2007 and 2011 with a gastrointestinal condition necessitating ≥21 days of PN support. Neonates were divided into 2 groups based on the intravenous lipid emulsion dose: 1‐g group (1 g/kg/d) and 2‐ to 3‐g group (2–3 g/kg/d). The primary outcome measure was the incidence of cholestasis. Results: Sixty‐one patients met inclusion criteria (n = 29, 1‐g group; n = 32, 2‐ to 3‐g group). The 2 groups did not differ in any baseline characteristics other than associated comorbidities that were more common in the 2‐ to 3‐g group. The duration of PN, the number of operative procedures and bloodstream infections, and enteral nutrition (EN) were similar between groups. The incidence of cholestasis was not different between groups (51.7%, 1‐g group; 43.8%, 2‐ to 3‐g group; P = .61), and there was no difference between groups in the time to cholestasis (32.6 ± 24.1 days, 1‐g group; 27.7 ± 10.6 days, 2‐ to 3‐g group; P = .48). Overall, 44.8% of patients with cholestasis were transitioned to full EN, and 55.2% were transitioned to a fish oil–based lipid emulsion after which the direct bilirubin normalized in all patients. Conclusion: Lipid reduction to 1 g/kg/d does not prevent or delay the onset of cholestasis in neonates.     

Effect of dietary olive oil, corn oil and medium-chain triglycerides on the lipid composition of rat red blood cell membranes

The effects of dietary olive oil, corn oil and medium-chain triglycerides (MCT) on factors that characterized erythrocyte membrane lipid fluidity were studied. Weanling rats were fed for 3 or 5 wk high fat diets (10%) containing olive oil, corn oil or a mixture of MCT with olive oil or corn oil. Total phospholipids and phosphatidylcholine of erythrocyte ghosts obtained from olive oil-fed animals, as compared to those fed corn oil, showed an increase in long-chain polyunsaturated fatty acids (PUFA) of the (n-6) and (n-3) series and a decrease in saturated fatty acids. The addition of MCT to the olive oil diet induced an increase in palmitic, palmitoleic and delta-5,8,11-eicosatrienoic acids and a decrease in long-chain PUFA of the (n-6) series in erythrocyte membrane phospholipids. Conversely, rats fed a mixture of MCT and corn oil, as compared to those fed exclusively corn oil, showed increase in long-chain PUFA of the (n-6) and (n-3) series, with no changes in saturated fatty acid levels. The cholesterol/phosphorus molar ratio showed only a slight increase with MCT supplementation. Olive oil feeding induced important changes in fatty acid composition of erythrocyte membrane phospholipids as compared to corn oil feeding without modifying the cholesterol/phosphorus ratio and MCT feeding slightly affected red blood cell membrane lipid composition.