Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

Abstract

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.

Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition

“…The risk for developing sepsis was also significantly diminished by 56% (nine studies: RR 0.44, 95%CI 0.28 to 0.70, p = 0.0004). Mortality was lower with 16%, but the difference did not reach significance (20 studies: RR 0.84, 95% CI 0.65 to 1.07; p = 0.15) [216]. Moreover, fish oil was found to be more cost-effective than parenteral nutrition with a standard intravenous lipid emulsion [220].…”

“…For critically ill surgical patients who require parenteral nutrition, intravenous lipid emulsions containing omega-3 LCPUFAs are considered safe, but parenteral nutrition should only be considered in patients who cannot be adequately enterally fed [171]. International consensus exists that a dose of 0.1 to 0.2 g/kg/d of fish oil would be appropriate for patients who require parenteral nutrition [215][216][217][218]. A recent meta-analysis of 49 prospective randomized trials showed significant benefits for the fish oil containing parenteral nutrition compared to a standard lipid emulsion [219].…”

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

“…There is a growing body of evidence suggesting that differences in the fatty‐acid composition of lipid emulsions can influence clinical outcomes in hospitalized adults who require PN . The article by Mayer et al in the current supplement reviews the evidence from clinical studies evaluating lipid emulsions in adult critically ill and surgical patients and presents consensus statements related to the use of lipid emulsions in hospitalized adults. Consensus statements related to the provision of lipid emulsions to adult critically ill (consensus statements 5–13) and surgical patients (consensus statements 14–25) are presented in Table .…”

Pharmacoeconomics of Parenteral Nutrition with ω‐3 Fatty Acids in Hospitalized Adults

“…[11][12][13][14][15][16][17][18][19] Results from these meta-analyses have been discussed in more detail in another review in this supplement. 20 The 2012 meta-analysis by Pradelli et al 13 has formed the basis for clinical outcomes data for all published ω-3 parenteral nutrition pharmacoeconomic studies, [21][22][23] as it formed the largest and most comprehensive dataset until being updated in 2019. 19 Pradelli et al, 2012, included 23 randomized controlled trials and 1502 patients, covering intensive care unit (ICU) populations (13 studies, 762 patients) as well as non-ICU/major abdominal surgery patients (10 studies, 740 patients).…”