Effect of changing the lipid component of home parenteral nutrition in adults

Osowska, S.; Kunecki, Marek; Sobocki, Jacek; Tokarczyk, J.; Majewska, K.; Omidi, M.; Radkowski, Marek; Fisk, Helena L.; Calder, Philip C.

doi:10.1016/j.clnu.2018.05.028

Cited by 22 publications

(41 citation statements)

References 25 publications

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“…More recently, Osowska et al, evaluated the effect of switching adult home PN patients from soybean lipid emulsion to SMOF ©Lipid or an olive oil lipid emulsion for 60 days and found that, while both lipid emulsions were effective in reducing the ratio of omega‐6:omega‐3 fatty acids. The olive oil‐based emulsion was also effective in lowering interleukin‐8 concentrations . A long‐term randomised study, assessing PN use over 12 months was reported in 2018.…”

Section: Managementmentioning

confidence: 99%

Review article: diagnosis and management of intestinal failure‐associated liver disease in adults

Bond

Huijbers

Pironi

et al. 2019

Aliment Pharmacol Ther

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Summary Background Hepatic disturbances in the context of intestinal failure and parenteral nutrition (PN) are frequently encountered and carry a significant burden of morbidity and sometimes mortality. The term intestinal failure‐associated liver disease (IFALD) refers to liver injury due to intestinal failure and associated PN, in the absence of another evident cause of liver disease, encompassing a spectrum of conditions from deranged liver enzymes, steatosis/ steatohepatitis, cholestasis as well as progressive fibrosis, cirrhosis and end‐stage liver disease. Aims To present an up to date perspective on the diagnosis/definition, aetiologies and subsequent management of IFALD and to explore future consideration for the condition, including pharmacological therapies Results In adults using long‐term PN for benign chronic intestinal failure, 1%‐4% of all deaths are attributed to IFALD. The aetiology of IFALD is multifactorial and can be broadly divided into nutritional factors (eg lipid emulsion type) and patient‐related factors (eg remaining bowel anatomy). Given its multifaceted aetiology, the management of IFALD requires clinicians to investigate a number of factors simultaneously. Patients with progressive liver disease should be considered for combined liver‐intestine transplantation, although multivisceral grafts have a worse prognosis. However, there is no established non‐invasive method to identify progressive IFALD such that liver biopsy, where appropriate, remains the gold standard. Conclusion A widely accepted definition of IFALD would aid in diagnosis, monitoring and subsequent management. Management can be complex with a number of factors to consider. In the future, dedicated pharmacological interventions may become more prominent in the management of IFALD.

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Section: Managementmentioning

confidence: 99%

Review article: diagnosis and management of intestinal failure‐associated liver disease in adults

Bond

Huijbers

Pironi

et al. 2019

Aliment Pharmacol Ther

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“…Should parenteral nutrition be used, it appears that lipid emulsions are safe. Newer lipid preparations such as SMOF lipid (SMOF) containing ω‐3 and medium‐chain triglycerides have theoretical benefit over standard soy‐based lipid (Intralipid) . Fat metabolism requires active mitochondrial function, without which fats may accumulate and lead to further liver injury .…”

Section: Nutrition Complications In Acute Liver Failurementioning

confidence: 99%

Acute Hepatic Failure and Nutrition

Kappus

2019

Nut in Clin Prac

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Malnutrition is prevalent in patients with hepatic failure and remains an independent risk factor for morbidity and mortality in these patients. Factors that contribute to malnutrition in this patient population include altered metabolic rate, fat malabsorption, and impaired gastric emptying, all in the setting of an acute and potentially prolonged hospitalization. Acute liver failure (ALF), different from cirrhosis or chronic liver disease, is an uncommon but dramatic clinical syndrome that demonstrates severe and rapid decline in hepatic metabolic function. ALF has a significant risk of mortality. There are >10 cases per million persons per year in developed countries, but ALF presents with unique challenges in clinical management related to heterogeneity in severity and etiology. Patients with ALF by definition should not have a prior history of liver disease, and liver disease is subsequently defined by the onset of liver injury, the presence of hepatic encephalopathy (HE), and coagulopathy as defined by an international normalized ratio > 1.5. HE usually develops within 1-4 weeks of the onset of liver injury but may occur within 26 weeks of the initial presentation. Rates of survival from ALF have improved over recent years, but the rarity and severity of presentation have resulted in traditionally limited evidence to guide basic supportive care. Over time, advances in critical care management and the use of emergency liver transplantation have improved. In this article, we will review current nutrition considerations for patients with ALF. (Nutr Clin Pract. 2020;35:30-35)

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“…However, since it is lower in soybean oil than IL, SMOF has a reduced content of the essential fatty acid linoleic acid . Osowska et al have posited concerns regarding risk of essential fatty acid deficiency (EFAD) in patients using alternative forms of ILE, although the benefit of lower linoleic intake is a reduction in proinflammatory compounds. The presence of EFAD is assessed through clinical examination as well as biochemistry, typically by evaluating for an increase in mead acid .…”

Section: Case Reportmentioning

confidence: 99%

“…Osowska et al have posited concerns regarding risk of essential fatty acid deficiency (EFAD) in patients using alternative forms of ILE, although the benefit of lower linoleic intake is a reduction in proinflammatory compounds. The presence of EFAD is assessed through clinical examination as well as biochemistry, typically by evaluating for an increase in mead acid . A fatty acid profile completed 5 months after the patient's change to SMOF indicated low linoleic and high mead acid values (Table ), so her prescription was adjusted to increase the ILE to an average of 0.7 g/kg/d with a corresponding decrease in dextrose to keep the energy consistent.…”

Section: Case Reportmentioning

confidence: 99%

“…Since 2016, ILEs with alternative formulations, including fish oil, mixed soy and olive oil (OO) and a blend including soy, medium‐chain triglycerides, OO, and fish oils, have become available in the United States . Although still in its nascent stage, research on these novel oils has demonstrated that they are safe, well tolerated, and may offer benefits over IL relative to progression of liver disease …”

Section: Introductionmentioning

confidence: 99%

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Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

et al. 2019

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A potential risk of long‐term parenteral nutrition (PN) is intestinal failure–associated liver disease (IFALD). One recommendation for mitigating risk is limiting the fat dose to reduce the harmful effects of the ω‐6 fatty acids, which are the main ingredient in traditional fats. SMOFlipid (SMOF) (Kabi‐Fresenius, Bad Homburg, Germany) is a combination of soybean oil, medium‐chain triglycerides, olive oil, and fish oil emulsion. This fat source may alleviate the risk of IFALD and improve liver function tests. A patient with a long history of PN reliance and IFALD is presented in this case report. After 4 months on SMOF, total and direct bilirubin levels improved.

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Effect of changing the lipid component of home parenteral nutrition in adults

Cited by 22 publications

References 25 publications

Review article: diagnosis and management of intestinal failure‐associated liver disease in adults

Review article: diagnosis and management of intestinal failure‐associated liver disease in adults

Acute Hepatic Failure and Nutrition

Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

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