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

Vanek, Vincent W.; Seidner, Douglas L.; Allen, Penny; Bistrian, Bruce R.; Collier, Sharon; Gura, Kathleen M.; Miles, John M.; Valentine, Christina J.; Kochevar, Marty

doi:10.1177/0884533612439896

Cited by 145 publications

(60 citation statements)

References 153 publications

(81 reference statements)

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“…In 2012, the American Society of Parenteral and Enteral Nutrition identified MCT oil as a potentially beneficial additive to lipid emulsions containing soybean and/or fish oil and recommended further research in identifying an optimal ratio of n-3 fatty acids, n-6 fatty acids, and MCT. 21 …”

Section: Introductionmentioning

confidence: 99%

The addition of medium-chain triglycerides to a purified fish oil-based diet alters inflammatory profiles in mice

et al. 2015

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Objective Parenteral nutrition associated liver disease (PNALD) is a deadly complication of long term parenteral nutrition (PN) use in infants. Fish oil-based lipid emulsion has been shown in recent years to effectively treat PNALD. Alternative fat sources free of essential fatty acids have recently been investigated for health benefits related to decreased inflammatory response. We hypothesized that the addition of medium-chain triglycerides (MCT) to a purified fish oil-based diet would decrease the response to inflammatory challenge in mice, while allowing for sufficient growth and development. Materials/Methods Six groups of ten adult male C57/Bl6 mice were pair-fed different dietary treatments for a period of twelve weeks, varying only in fat source (percent calories by weight): 10.84% soybean oil (SOY), 10% coconut oil (HCO), 10% medium-chain triglycerides (MCT), 3% purified fish oil (PFO), 3% purified fish oil with 3% medium-chain triglycerides (50:50 MCT:PFO) and 3% purified fish oil with 7.59% medium-chain triglycerides (70:30 MCT:PFO). An endotoxin challenge was administered to half of the animals in each group at the completion of dietary treatment. Results All groups demonstrated normal growth throughout the study period. Groups fed MCT and HCO diets demonstrated biochemical essential fatty acid deficiency and decreased IL-6 and TNF-α response to endotoxin challenge. Groups containing PFO had increased inflammatory response to endotoxin challenge, and the addition of MCT to PFO mitigated this inflammatory response. Conclusion These results suggest that the addition of MCT to PFO formulations may decrease the host response to inflammatory challenge, which may pose potential for optimized PN formulations. Inclusion of MCT in lipid emulsions given with PN formulations may be of use in therapeutic interventions for disease states resulting from chronic inflammation.

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Section: Introductionmentioning

confidence: 99%

The addition of medium-chain triglycerides to a purified fish oil-based diet alters inflammatory profiles in mice

et al. 2015

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“…Lipid emulsions (LEs) are an essential constituent of parenteral nutrition (PN) [1] and are considered an important source of energy, essential fatty acids (FA) and vitamins E and K [2,3,4]. However, the current literature suggests that soy-bean oil (SO) and safflower-based LEs which are rich in the ω−6 fatty acid linoleic acid, might promote production of pro-inflammatory prostanoids and leukotrienes resulting in increased oxidative stress and systemic inflammation[5,6] and may be associated with worse clinical outcomes [7].…”

Section: Introductionmentioning

confidence: 99%

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

et al. 2013

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Introduction Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides (LCT) derived from soybean oil (SO). SO containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to SO emulsion only products. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients. Methods We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition (PN). Results A total of 12 RCTs met inclusion criteria. When the results of these RCTs that were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio RR= 0.83, 95% confidence intervals CI 0.62, 1.11, P = 0.20), in duration of ventilation (weighted mean difference, WMD −2.57, 95% CI −5.51, 0.37, P= 0.09), and in ICU length of stay (WMD −2.31, 95% CI −5.28, 0.66, P= 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR=1.13, 95% CI 0.87, 1.46, P=0.35). Conclusion Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

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“…Intravenous fat emulsion (IVFE) is a mixture of long-chain fatty acids originally formulated to provide essential fatty acids for patients on parenteral nutrition (PN) and a dense source of calories to help reduce the volume required for PN 1,2. Before the development of IVFE, patients would develop essential fatty acid deficiencies.…”

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confidence: 99%

“…The emulsion is a mixture of 3 fatty acids: omega-6, -3, and -9. In addition, alpha linolenic acid (ALA), which is used as a stabilizing agent for the emulsion, makes up a small percentage of the emulsion 1. Vitamin E is also added to help reduce the oxidative stress of the emulsion components, as well as the oxidative stress on patients 1–3…”

mentioning

confidence: 99%

Review of Intravenous Lipid Emulsion Therapy

Spray

2016

Journal of Infusion Nursing

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Intravenous fat emulsion (IVFE) is an important source of calories and essential fatty acids for patients receiving parenteral nutrition (PN). Administered as an individual infusion or combined with PN, the fats provided by IVFE are vital for cellular structural function and metabolism. The affinity of some medications to lipids has led to the use of IVFE as a treatment for any lipophilic drug overdose. This article will explain the available formulations of IVFE, administration, and maintenance issues, as well as the risks and benefits for various applications.

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

Cited by 145 publications

References 153 publications

The addition of medium-chain triglycerides to a purified fish oil-based diet alters inflammatory profiles in mice

The addition of medium-chain triglycerides to a purified fish oil-based diet alters inflammatory profiles in mice

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

Review of Intravenous Lipid Emulsion Therapy

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