Inflammatory Response Using Different Lipid Parenteral Nutrition Formulas in Children After Hematopoietic Stem Cell Transplantation

Abstract

Nutritional support is an integral part of the supportive care of hematopoietic stem cell transplantation (HSCT) patients. Omega-3 fatty acids (n-3 FA) emulsions in parenteral nutrition (PN) may modify the inflammatory response. The purpose of this study is to compare plasma cytokine levels in children after HSCT using an n-3 FA-containing lipid emulsion (LE) and a soybean oil-based formulation in PN. A randomized double-blind controlled trial was conducted on 14 children following HSCT. Children were randomized to receive either a fish oil or a soybean oil LE. Blood samples were drawn at baseline, on Day 10 and after completion of PN to analyze plasma interleukin 1 beta (IL-1β), 2 (IL-2), 6 (IL-6), 8 (IL-8), 10 (IL-10), and tumor necrosis factor alpha (TNF-α). After 10 days of PN, there were no significant changes in interleukins levels when comparing the two groups or time points (baseline vs. Day 10 of PN). In children requiring PN >21 days, IL-10 and TNF-α levels (P ≤ 0.05) were lower in the fish-oil-containing LE group. Fish oil- and soybean oil-supplemented PN administered for at least 10 days does not cause inflammatory changes. Prolonged PN based on fish oil LE may modulate the inflammatory response.

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids

“…In children after haematopoietic stem cell transplantation, composite ILEs with FO, compared to SO ILE, improve antioxidant profile but did not alter markers of inflammation at day 10 [75]. However, on prolonged PN for more than 21 days, IL-10 and TNF-a levels were reduced by the composite ILE with FO [76]. Finally, preterm infants receiving a composite ILE with FO compared to a SO ILE, had lower IL-6 and IL8 levels at day 30 of life or at the end of intervention [77].…”

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults

“…(254) On the other hand, with transplanted patients exposed to the lipid-increasing effects of immunosuppressants, the use of longchain triglycerides in the PNT composition must be restricted. (255) Still today, there are few studies on the use of omega-3 lipids during HSCT. (255) The literature recognizes that its parenteral use attenuates inflammatory activity in a short time (days); however, the ideal dose required, the time of administration, and safety-related issues due to changes in platelet function during critical levels of thrombocytopenia, result in the lack of recommendations for its use in the initial phase of the transplant.…”

Immunonutritional support as an important part of multidisciplinary anti-cancer therapy

“…In another study, which was randomized and double-blinded, it has been shown that in patients after HCT, long-term supplementation with omega-3 acids (> 21 days) is particularly preferred. Supplementation with these acids modulates the immune system by reducing the concentration of inflammatory cytokines, such as IL-10 and TNF-α (p ≤ 0.05) [39].…”