Clinical and metabolic effects of two lipid emulsions on the parenteral nutrition of septic patients

Garnacho‐Montero, José; Ortíz-Leyba, Carlos; Jiménez-Jiménez, F J; García-Garmendia, José Luis; Jiménez-Jiménez, Luis; Garnacho-Montero, M.C; Barrero-Almodóvar, A

doi:10.1016/s0899-9007(01)00716-x

Cited by 39 publications

(21 citation statements)

References 25 publications

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“…Of these, we excluded 40 trials due to the following reasons: 22 trials [14,15,16,17,18,19,20,21,22,23,24,25,26,27, 28,29,30,31,32,33,34,35] trials did not include ICU patients (mostly elective surgery and cancer patients), 12 trials [36,37,38,39,40,41,42,43,44,45,46,47] did not evaluate clinically important outcomes; 2 trials [48,49] did not include SO-based LE in the control group; 1 trial [50] compared LCT vs. another LCT emulsion without reduction in SO; 1 trial [51] was conducted in a pediatric population; 1 trial[52] had a short duration of intervention (12 hour of lipid emulsion infusion during the first day); 1 trial included patients with poisoning and not representative of ICU patients[53]. In the end, 12 RCTs [54,55,56,57,58,59,60,61,62,63,64,65] enrolling a total of 806 patients met the inclusion criteria and were included in this systematic review (see Table 1 and 2). The authors reached 100% agreement for inclusion of relevant trials in this review.…”

Section: Resultsmentioning

confidence: 99%

“…There was a trend towards a reduction in ICU LOS associated with the use of ω-6-sparing strategies when compared to LCT [54,56,58,59,60,61,62,64] (WMD −2.31, 95% CI −5.28, 0.66, P=0.13, I 2= 68%, P< 0.003) (Figure 3). When the data from 5 RCTs [58,60,62,63,65] that reported ICU-acquired infections were aggregated, ω-6-sparing strategy had no effect (RR= 1.13, 95% CI 0.87, 1.46, P=0.35, heterogeneity I 2 =0%).…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2013

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“…Soybean oil (SBO)-based lipid emulsions, which are rich in n-6 polyunsaturated longchain triglycerides, have been the standard for lipidbased parenteral nutrition for a long time. In spite of long-term experience using these lipids, which have a good safety profile, experimental and clinical investigations have reported less desirable results (compared with newer emulsions) in terms of pathophysiologic and immunologic profiles [3][4][5][6]. Fish oil-based lipid emulsions, which are rich in n-3 lipids, are now available for parenteral nutrition.…”

Section: Immunological Modulation By Lipidsmentioning

confidence: 99%

Fish oil in critical illness

Mayer¹,

Seeger²

2008

Current Opinion in Clinical Nutrition and Metabolic Care

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Inclusion of fish oil in nutrition may influence the immune response and clinical outcomes by balancing the negative effects of n-6 fatty acids. Application as a part of enteral immunonutrition in surgical or acute respiratory distress syndrome patients and in lipid emulsions in surgical patients has beneficial effects. In septic patients, data on enteral use are highly controversial. Prospective data from randomized trials, however, are lacking.

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“…However, high dose of MCT may lead to metabolic acidosis and gastrointestinal symptoms. Recent findings had shown that the use of lipid emulsion containing medium-chain triglycerides/long-chain triglycerides (MCT/ LCT) showed a greater recovery of their nutrition status than the traditional MCT or LCT formula in the total parenteral nutrition study (Lai and Chen 2000;Garnacho-Montero et al 2002;Lin et al 2002;Socha et al 2007). MLCT that contained medium-chain fatty acids (MCFA, C6-C10) and long-chain fatty acids (LCFA, C12-C24) in the same triacylglycerol (TAG) are the latest structured lipids being focused nowadays.…”

Section: Introductionmentioning

confidence: 99%

Enzymatic Synthesis of Medium- and Long-Chain Triacylglycerols (MLCT): Optimization of Process Parameters Using Response Surface Methodology

Koh

Tan

Lai

et al. 2008

Food Bioprocess Technol

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The main objective of this study was to understand the effects and relationship amongst four factors, which are reaction temperature, reaction time, enzyme load, and substrate mole ratio with the purpose of producing healthy functional cooking oil for long-term dietary treatment. Lipozyme RM IM lipase-catalyzed esterification of medium-and long-chain triacylglycerols (MLCT) from glycerol and mixtures of capric and oleic acid was optimized using response surface methodology (RSM) with a fivelevel, four-factorial design. Reaction temperature, reaction time, and substrate mole ratio strongly affected MLCT synthesis (P<0.01). However, enzyme load did not have a significant (P>0.01) effect on MLCT yield. Comparison between predicted and experimental value from central composite rotatable design optimization procedures revealed good correlation, implying that the reduced cubic polynomial model with backward elimination statistically expressed the percent MLCT yield obtained. The optimum MLCT yield was 59.76% by using 10 wt% enzyme load, reaction temperature of 70°C, reaction time of 14 h, and substrate mole ratio of 3.5:1. Experiments to confirm the predicted results using the optimal parameters showed an MLCT yield of 56.35% (n=2). The choice on the types of fatty acids used in MLCT optimization work greatly influenced the physical and chemical properties of MLCT oil produced. The refined MLCT oil characteristics study showed this oil is suitable to be used for cooking/frying purposes as a high-value added product.

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Clinical and metabolic effects of two lipid emulsions on the parenteral nutrition of septic patients

Cited by 39 publications

References 25 publications

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

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

Fish oil in critical illness

Enzymatic Synthesis of Medium- and Long-Chain Triacylglycerols (MLCT): Optimization of Process Parameters Using Response Surface Methodology

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