Effect of total parenteral nutrition with different lipid emulsions on human monocyte and neutrophil functions

Waitzberg, Dan Linetzky; Bellinati-Pires, Raquel; Salgado, Maristela Marques; Hypolito, Iara P.; Colleto, Gloria M.D.D.; Yagi, Osmar Kenji; Yamamuro, Elisa Miki; Gama-Rodrigues, Joaquim; Pinotti, H W

doi:10.1016/s0899-9007(96)00386-3

Cited by 72 publications

(55 citation statements)

References 17 publications

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“…The lipid emulsion in the TPN solution used in this experiment was based on soybean oil, containing a high content of n-6 polyunsaturated fatty acids. Soybean oil intravenous emulsions have been suggested to exhibit immunosuppressive effects resulting in impairment of chemotaxis, phagocytosis, antigenpresenting cell function, and cytokine production in vitro (26,37), although the evidence is less clear from in vivo studies (44). Soybean-based intravenous emulsions have also been shown to cause increased pulmonary vasoconstriction in piglets (3), possibly through thromboxane production.…”

Section: Discussionmentioning

confidence: 99%

Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

Bjørnvad

Thymann

Deutz

et al. 2008

American Journal of Physiology-Gastrointestinal and Liver Physi

132

193

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Preterm neonates have an immature gut and metabolism and may benefit from total parenteral nutrition (TPN) before enteral food is introduced. Conversely, delayed enteral feeding may inhibit gut maturation and sensitize to necrotizing enterocolitis (NEC). Intestinal mass and NEC lesions were first recorded in preterm pigs fed enterally (porcine colostrum, bovine colostrum, or formula for 20–40 h), with or without a preceding 2- to 3-day TPN period ( n = 435). Mucosal mass increased during TPN and further after enteral feeding to reach an intestinal mass similar to that in enterally fed pigs without TPN (+60–80% relative to birth). NEC developed only after enteral feeding but more often after a preceding TPN period for both sow's colostrum (26 vs. 5%) and formula (62 vs. 39%, both P < 0.001, n = 43–170). Further studies in 3-day-old TPN pigs fed enterally showed that formula feeding decreased villus height and nutrient digestive capacity and increased luminal lactic acid and NEC lesions, compared with colostrum (bovine or porcine, P < 0.05). Mucosal microbial diversity increased with enteral feeding, and Clostridium perfringens density was related to NEC severity. Formula feeding decreased plasma arginine, citrulline, ornithine, and tissue antioxidants, whereas tissue nitric oxide synthetase and gut permeability increased, relative to colostrum (all P < 0.05). In conclusion, enteral feeding is associated with gut dysfunction, microbial imbalance, and NEC in preterm pigs, especially in pigs fed formula after TPN. Conversely, colostrum milk diets improve gut maturation and NEC resistance in preterm pigs subjected to a few days of TPN after birth.

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Section: Discussionmentioning

confidence: 99%

Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

Bjørnvad

Thymann

Deutz

et al. 2008

American Journal of Physiology-Gastrointestinal and Liver Physi

132

193

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“…The lipid solvent of LCT/MCT has been used widely for parenteral nutrition and is recognized as a safe caloric substrate, showing rapid lipometabolism, no adverse effect on liver function and a lower adverse effect on the immune and reticuloendothelial systems compared to LCT. [25][26][27][28] The lipid solvents generate bradykinin probably because of their negative charge, 3 which may explain the similar physiological properties observed with both LCT and LCT/MCT.…”

Section: Bradykinin Generation and Complement Activationmentioning

confidence: 95%

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Ohmizo

Obara

Iwama

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not been examined. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared.M Me et th ho od ds s: : Two hundred adult patients randomly allocated to two groups were given 1.5 mg·kg -1 iv of either LCT propofol or LCT/MCT propofol at a rate of 200 mg·min -1 in a double-blind manner and were asked to grade pain scores. In another study, bradykinin and activated complement 3 (C3a) concentrations were measured using blood obtained from 13 healthy volunteers mixed with saline, LCT propofol or LCT/MCT propofol.R Re es su ul lt ts s: : There was a significant difference in pain scores between groups, showing a lower incidence of injection pain in the LCT/MCT propofol group. The bradykinin concentrations in blood mixed with LCT and LCT/MCT propofol were significantly higher than in blood mixed with saline. The C3a concentrations showed similar results.C Co on nc cl lu us si io on ns s: : LCT/MCT propofol causes less pain on injection compared with LCT propofol. Bradykinin generation and complement activation are similar with both LCT and LCT/MCT propofol. Thus, the reason for less pain on injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase. Objectif : On a pensé qu'une émulsion de propofol avec une chaîne mi-longue de triglycéride (CLT/CMT) cause moins de douleur à l'injection qu'une émulsion à chaîne longue (CLT) parce que la concentration de propofol diminue pendant la phase aqueuse. Aussi, le propofol avec CLT génère de la bradykinine, causant de la douleur à l'injection, et active le complément, mais ces effets n'ont pas été étudiés avec le propofol CLT/CMT. Pour définir le mécanisme qui réduit la douleur avec le propofol CLT/CMT, nous avons comparé la douleur à l'injection, la génération de bradykinine et l'activation du complément avec l'usage des deux produits de propofol. Méthode : Deux cents patients adultes ont été répartis au hasard en deux groupes et ont reçu 1,5 mg·kg -1 iv de propofol CLT ou CLT/CMT

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“…28 A soybean oil-based lipid emulsion and a lipid emulsion containing 50% MCTs and 50% soybean oil were evaluated for their ex vivo effects on the chemotaxis, phagocytosis, and bacterial killing of human neutrophils and monocytes. Bacterial killing was the only function that was significantly reduced in neutrophils following infusion of the soybean oil emulsion, while chemotaxis of both cell populations from 80% of the patients remained within a normal range.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…2,25 In an attempt to further increase awareness of such an important therapy, the SBNPE, together with the Brazilian Medical Association, has worked to establish guidelines that address recommended nutrition practices for several disease conditions. long-chain triglycerides derived from soybean oil-based emulsions 27,28 ; leukocyte functions, as well as local and systemic inflammatory mediators, are sensitive to infusions of lipids, and a better outcome is achieved with fish oil lipid emulsions, a source of ω-3 fatty acids, especially in association with MCTenriched lipid emulsions. [29][30][31][32] When the influence of fish oil parenteral lipid emulsions was evaluated on human monocyte/macrophage (Mphi)-expressing HLA-DR without activation (control group) vs HLA-DR in distinct activation states, the emulsions did not affect the expression of these molecules on the former.…”

Section: Nutrition Care Per Sementioning

confidence: 99%

Strategies for High‐Quality Nutrition Therapy in Brazil

Waitzberg

Correia

2015

J Parenter Enteral Nutr

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It is a great honor to present the 2015 Rhoads Lecture and to discuss strategies for high-quality nutrition therapy (NT), as well as to address the problem of malnutrition in Brazilian hospitals.Dr Rhoads is known for his outstanding achievements in nutrition care, and his unquestionable legacy is demonstrated by the translation of his many scientific papers and books into several languages. The importance of artificial nutrition in the overall care of a patient is reflected in Dr Rhoads's own words: "intravenous feeding is one of the rare things in Medicine that has turned out to be better than its sponsors anticipated." Moreover, when Dr Rhoads was awarded for his contributions and leadership in the field of nutrition, in his speech, he referred to a quote by Nobel laureate economist Milton Friedman: "success lies on the degree to which one's ideas and contributions become embedded in the body of knowledge that comprised one's discipline."1 Indeed, we are here to confirm the veracity of this statement regarding Dr Rhoads's scientific contributions.Accumulating evidence supports the utmost relevancy of artificial nutrition, including oral nutrition, enteral nutrition (EN), and parenteral nutrition (PN), as one of the cornerstones of patient care. Nonetheless, for the full success of NT to be achieved, it is imperative that standardized procedures be followed to prevent life-threatening associated complications and, above all, to avoid the "one-size-fits-all" practice of nutrition, which should be condemned by those following the evidence behind science. History of NT in BrazilHere, the steps that have helped Brazil implement an NT practice are presented and discussed. The statements herein are based on the experience and data of the authors, although we also acknowledge and cite the work of other professionals who have contributed to the development of NT practice in Brazil. In combination, these scientific data highlight the importance of applying advances in laboratory research to the clinical setting to improve patient care. First, we review the history of clinical nutrition in Brazil, with a particular emphasis on the role of nutrition screening and nutrition assessment as demonstrated by a malnutrition prevalence study that encompassed 4000 patients.2 Next follows a discussion of to whom, when, and what NT should be administered, particularly regarding immunonutrition and parenteral lipid emulsions. Finally, strategies that have been used to implement hospital clinical nutrition are presented, with a focus on patients with short bowel syndrome (SBS) and obesity. The outcomes, costs, quality control, and education in clinical practice that are currently involved with these strategies are also presented, as well as how these strategies have the potential to affect perspectives.Very briefly, Brazil is a country that has approximately 200 million inhabitants, 10% of whom are elderly. Life expectancy AbstractStrategies for improving nutrition therapy (NT) are of utmost importance in any healthcare system. The ...

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Effect of total parenteral nutrition with different lipid emulsions on human monocyte and neutrophil functions

Cited by 72 publications

References 17 publications

Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Strategies for High‐Quality Nutrition Therapy in Brazil

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