Intradialytic parenteral nutrition: comparison of olive oil versus soybean oilbasedlipid emulsions

Abstract

Lipid, oxidative and inflammatory parameters are frequently altered in dialysis patients and may be worsened by intravenous lipid emulsions (ILE). We assessed the efficacy and tolerance of olive as compared with standard soybean oil-based ILE during intradialytic parenteral nutrition (IDPN). IDPN mixtures containing amino acids, glucose, and either olive oil (OO group, n 17) or soybean oil-based ILE (SO group, n 18) were administered in a 5-week randomized, double-blind study. On days 0 and 35, patients' nutritional status was assessed by BMI, normalized protein catabolic rate, predialytic creatinine, serum albumin and transthyretin; lipid metabolism by plasma LDL-and HDL-cholesterol, triacylglycerols, phospholipids, apo A-I, A-II, B, C-II, C-III, E and lipoprotein (a); oxidative status by a-tocopherol, retinol, selenium, glutathione peroxidase, malondialdehyde and advanced oxidized protein products; inflammatory status by serum C-reactive protein, orosomucoid, IL-2 and IL-6. No serious adverse event was observed. Significant changes were observed from day 0 to day 35 (P,0·05): nutritional criteria improved (albumin in OO; albumin, transthyretin and creatinine in SO); LDL-cholesterol, apo B, C-II, C-III and apo A-I/A-II ratio increased in both groups. HDL-cholesterol decreased in OO; apo E increased and lipoprotein (a) decreased in SO; a-tocopherol/cholesterol ratio increased in OO; malondialdehyde decreased in both groups; IL-2 increased in both groups. The between-group comparison only showed the following differences: a-tocopherol/cholesterol increased in OO; lipoprotein (a) decreased in SO. From these data, it was concluded that OO-and SO-based IDPNs similarly improved nutritional status and influenced plasma lipid, oxidative, inflammatory and immune parameters.

HDL-Related Mechanisms of Olive Oil Protection in Cardiovascular Disease

“…Another proposed mechanism comes from postprandial experiments which have suggested that OO chylomicron remnants compete for hepatic lipase and prevent the decrease in HDL-C observed after consuming OO in comparison with soybean oil [136]. The latter mechanism has also found involved in intravenous administration of mixtures of 17% (wt:v) OO plus 3% soybean oil emulsion compared to that containing only 20% soybean oil, since the former one showed a slower elimination which was inversely related to the hepatic lipase activity [137] that would selectively decrease HDL-C while increase APOA1 [138]. A decrease in CETP that could increase HDL levels was observed by isoenergetic substitution of a saturated fatty acid diet with NCEP Step I or virgin olive oil diets [139].…”

Olive oil in parenteral nutrition

“…Verdier et al [49] demonstrated that hemofilter duration was significantly longer (by almost one day) if ClinOleic was used as the infused emulsion and this effect was seen irrespective of anticoagulant used. A more recent study by Cano et al [55 ] was conducted in intradialitic parenteral nutrition in malnourished haemodialysis patients. They assessed the efficacy and safety of ClinOleic, compared with Ivelip, in 41 patients after 5 weeks corresponding to 15 dialysis sessions.…”

Intradialytic Parenteral Nutrition Does Not Improve Survival in Malnourished Hemodialysis Patients

“…Conversely, protein energy supplementation by IDPN was demonstrated to enhance albumin synthesis 8 and to increase serum albumin as well as prealbumin. 9,11 The effect of inflammation on the response to nutritional therapy is poorly documented. In a pilot study, Leon et al 28 reported that serum CRP did not alter the response to nutritional intervention, as assessed by serum albumin.…”

“…The interest of IDPN has been assessed in terms of metabolic effect and nutritional benefit 6 : IDPN has been shown to improve energy and protein balance, albumin synthesis rate, and, in randomized trials, nutritional parameters. [7][8][9][10][11] Retrospective studies have suggested that IDPN may improve survival in hypoalbuminemic hemodialysis patients. 4,5,12 However, to date, the effects of IDPN on patient morbidity and mortality have not been assessed in a prospective, randomized manner.…”