Intravenous Lipid Emulsions in Parenteral Nutrition

Fell, Gillian L.; Nandivada, Prathima; Gura, Kathleen M.; Puder, Mark

doi:10.3945/an.115.009084

Cited by 72 publications

(120 citation statements)

References 104 publications

(106 reference statements)

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“…Traditionally, soy bean oil has been the major component of parenteral lipid solution as it contained sufficient amounts of essential fatty acids, linoleic acid and α-linolenic acid to prevent deficiency. The predominant fatty acid in soybean oil is however linoleic acid, resulting in a high and unfavourable LCn6 to LCn3 ratio of 5:1 [149]. Furthermore there is emerging evidence that intravenous lipid emulsions that include mixed oil sources such as an olive oil/ soy oil blend supplementing PN with fish oil may have a positive impact on PN related liver disease [150] and may have favourable outcomes such as reduced length of stay [23,151,152].…”

Section: (Iv) Lcn3s In Parental Nutrition and Liver Diseasementioning

confidence: 97%

Controversies in omega-3 efficacy and novel concepts for application

Radcliffe

Thomas

Bramley

et al. 2016

Journal of Nutrition & Intermediary Metabolism

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The interest in the cardioprotective effects of long chain omega-3 polyunsaturated fatty acids (LCn3) was largely influenced by the low rates of cardiovascular disease (CVD) amongst the Inuits of Greenland who consumed a high marine fat diet rich in LCn3s. This finding stimulated years of epidemiological and clinical studies investigating the cardioprotective effects of LCn3s, thought to be primarily mediated through anti-inflammatory (and antiaggregatory) prostaglandins that protect the vascular wall from pro-inflammatory effects of metabolic stress precipitated by poor diet and lifestyle. Although the original hypothesis of the link between LCn3s and CVD protection was based on a high LCn3 containing diet (namely a high marine fat diet) the majority of clinical trials since have focussed on EPA and DHA supplementation, and results of repeated meta-analyses have not shown conclusive evidence in support of their beneficial health effects. In this review we focus on the controversies that surround the efficacy of LCn3s in cardiovascular and other chronic diseases and present emerging areas of research for novel applications. We will examine factors that can impact on the efficacy of LCn3s such as source (plant vs marine vs supplements (algal vs marine)), stability of product, dose, trial duration, ratio of EPA:DHA, and ratio of LCn6:LCn3 fatty acids in the diet.

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Section: (Iv) Lcn3s In Parental Nutrition and Liver Diseasementioning

confidence: 97%

Controversies in omega-3 efficacy and novel concepts for application

Radcliffe

Thomas

Bramley

et al. 2016

Journal of Nutrition & Intermediary Metabolism

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“…The biological effects of lipid emulsions are strongly influenced by their fatty‐acid composition . Pure soybean‐oil emulsions contain high concentrations of the ω‐6 polyunsaturated fatty acid (PUFA) linoleic acid, which is converted to arachidonic acid, a precursor to eicosanoids that promote inflammation and suppress cell‐mediated immunity .…”

Section: Biological Aspects Of Lipid Administrationmentioning

confidence: 99%

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Martindale

Berlana

Boullata

et al. 2020

J Parenter Enteral Nutr

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Background The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). Methods The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. Results The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence‐based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω‐3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. Conclusions This article provides a set of expert consensus statements to complement formal PN guideline recommendations.

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“…Lipid oil sources can also be characterized by their relative range of inflammatory effects: soybean oil, which contains a high concentration of linoleic acid, is more inflammatory than either medium‐chain triglycerides (MCTs) or olive oil, while fish oil is even less inflammatory and possibly even anti‐inflammatory . Access to lipid emulsions is variable: ranging from a full spectrum of lipid emulsions available in parts of Europe, to the situation in the United States where pure soybean oil lipid emulsions were the only lipid emulsions available until August 2016 . The wide range of lipid emulsions obtainable is reviewed elsewhere .…”

Section: Introductionmentioning

confidence: 99%

“…In this article, we discuss the use of lipid emulsions as part of parenteral nutrition in adult hospitalized patients, with a particular emphasis on comparisons between lipid emulsions containing ω‐3 fatty acids and other standard lipid emulsions without fish oil, to reflect recent clinical research in this field. While all commercially available lipid emulsions suffice as an energy supply and contain enough essential fatty acids to prevent EFAD, those containing only soybean oil as a lipid source have a high ω‐6:ω‐3 fatty‐acid ratio and abundance of phytosterols, raising concerns about their inflammatory and hepatotoxic potential in some patients . Conversely, there is a growing body of evidence that ω‐3 fatty acids can exert beneficial immunomodulatory, anti‐inflammatory, and resolution of inflammation effects across a wide range of patient groups including surgical, cancer, and critically ill patients .…”

Section: Introductionmentioning

confidence: 99%

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

Mayer

Kłęk²,

Garcı́a-de-Lorenzo

et al. 2020

J Parenter Enteral Nutr

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In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty‐acid deficiency. However, mixtures of different lipid emulsions have now become widely available, including mixtures of soybean oil, medium‐chain triglycerides, olive oil, and fish oil. Fish oil is high in the ω‐3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω‐3 fatty acids can exert beneficial immunomodulatory, anti‐inflammatory, and inflammation‐resolution effects across a wide range of patient groups including surgical, cancer, and critically ill patients. At least in part, these effects are realized via potent specialized pro‐resolution mediators (SPMs). Moreover, parenteral nutrition including ω‐3 fatty acids can result in additional clinical benefits over the use of standard lipid emulsions, such as reductions in infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding lipid emulsion use in a variety of hospitalized patient groups, including surgical, critically ill, sepsis, trauma, and acute pancreatitis patients. Practical aspects of lipid emulsion use in critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider parenteral nutrition, duration of infusion, and safety monitoring.

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Intravenous Lipid Emulsions in Parenteral Nutrition

Cited by 72 publications

References 104 publications

Controversies in omega-3 efficacy and novel concepts for application

Controversies in omega-3 efficacy and novel concepts for application

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

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