Long‐Term Use of Mixed‐Oil Lipid Emulsion in Adult Home Parenteral Nutrition Patients: A Case Series

Mundi, Manpreet S.; McMahon, Megan T.; Carnell, Jennifer; Hurt, Ryan T.

doi:10.1002/ncp.10014

Cited by 14 publications

(27 citation statements)

References 27 publications

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“…11,21 Amino acids range between 0.8 and 1.0 g/kg for unstressed patients to as high as 1.5-2.0 g/kg for patients with significant fistulae, wounds, or renal dialysis dependence. 22 With this approach, the typical macronutrient composition consists of 15%-20% amino acids, 20%-25% ILE, and 50%-60% of energy from dextrose. Laboratory tests, including LFTs, are routinely monitored initially on a weekly basis followed by transition to biweekly, monthly, and then quarterly, based on stability.…”

Section: Methodsmentioning

confidence: 99%

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Long‐Term Use of Mixed‐Oil Lipid Emulsion in Soybean Oil–Intolerant Home Parenteral Nutrition Patients

Mundi

Kuchkuntla

Salonen

et al. 2019

J Parenter Enteral Nutr

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Background: Although home parenteral nutrition (HPN) is lifesaving for patients with chronic intestinal failure (IF), long‐term use can be associated with complications such as infections, metabolic abnormalities, and IF–associated liver disease (IFALD). The key to treatment of many of these complications is prevention. Guidelines recommend avoidance of overfeeding, use of oral/enteral nutrition if possible, cyclic PN, and maintaining dose of soybean oil (SO) intravenous lipid emulsion (ILE) <1 g/kg/day as preventive strategies for IFALD. Additionally, with development of IFALD, ω‐6/ω‐3 polyunsaturated fatty acid ratio should be decreased in ILE. The newly available mixed‐oil (MO) ILE offers such an opportunity; however, there is a paucity of long‐term data available. Methods: The current study reports our long‐term experience with MO ILE use in HPN patients. Results: Seventeen patients (8 female and 9 male) with an average age of 47 ± 12 years and median HPN duration of 4.6 years (1.1–32.1 years) have utilized MO ILE for >12 months after being transitioned from SO ILE because of intolerance. Use of MO ILE allowed an increase in ILE energy from 8% ± 8% to 22% ± 8% while reducing dextrose energy from 66% ± 8% to 54% ± 5%, maintaining stability in alkaline phosphatase and triglyceride levels, and achieving improvement in aspartate aminotransferase, alanine aminotransferase, total bilirubin, and α‐tocopherol levels. Conclusion: In this HPN cohort with SO ILE intolerance, MO ILE was well tolerated and allowed an improvement in macronutrient composition while improving some liver parameters over a 12‐month period.

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Section: Methodsmentioning

confidence: 99%

“…Short-term data for this cohort have been published previously. 22 The current manuscript focuses on the longterm (>12 months) impact of MO ILE in SO ILEintolerant patients. All normally distributed data are presented as the mean ± standard deviation, whereas skewed data are reported as median and range.…”

Section: Methodsmentioning

confidence: 99%

Long‐Term Use of Mixed‐Oil Lipid Emulsion in Soybean Oil–Intolerant Home Parenteral Nutrition Patients

Mundi

Kuchkuntla

Salonen

et al. 2019

J Parenter Enteral Nutr

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Section: Clinical Datamentioning

confidence: 99%

“…Instead of starting with adult patients who are newer to HPN, another beneficial approach has been to use MO ILE in patients who may have developed intolerance to SO ILE, such as those with liver abnormalities. 35,39,40 This was the approach taken in the case study of a patient with IFALD, as discussed previously. 35 After development of IFALD, reduction in ILE dose and corresponding increase in dextrose dose was complicated by development of pancreatitis.…”

Section: Clinical Datamentioning

confidence: 99%

Use of Lipids in Adult Patients Requiring Parenteral Nutrition in the Home Setting

Mundi

Kłęk²,

Martindale

2020

J Parenter Enteral Nutr

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It is estimated that over 25,000 Americans receive home parenteral nutrition (HPN), mostly because of intestinal failure (IF). Although there is significant variability in the fluid and energy needs of patients receiving HPN, intravenous lipid emulsions (ILEs) are an essential part of the macronutrient composition, serving as an excellent source of non‐protein energy, as well as supplying essential fatty acids. However, the long‐term use of ILEs in particular may be associated with some detrimental health effects, such as intestinal failure associated liver disease (IFALD). Although there is lack of unifying diagnosis, IFALD can present as cholestasis, steatosis, or fibrosis, with a prevalence that ranges between 5% and 43%. The development of IFALD tends to be multifactorial. Risk factors of IFALD can include those related to IF, inflammation/infection, and long‐term parenteral nutrition. Some studies have shown a link between development of IFALD and ILE dose, especially if the dose is >1 g/kg/d, with high ω‐6:ω‐3 polyunsaturated fatty acid (PUFA) ratio and phytosterol content being theorized as some contributing factors. Thus, efforts have been made to use alternative oils (olive oil, medium‐chain triglycerides, and fish oil) to reduce the soybean‐oil content of ILE, which tends to be high in ω‐6 PUFA and phytosterols. Although additional long‐term clinical data are emerging, this strategy, as reviewed in the current manuscript, has shown to provide some benefit in both prevention and treatment of IFALD and other sequelae of HPN.

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“…For adult patients, data on the use of n-3 PUFA ILEs in HPN are still very limited [2,19]. Some case reports showing beneficial effects from FO/n-3 enriched ILEs in the prevention or treatment of IFALD [20,21,22] and case series [23,24] investigating the effects of ILE in adult patients, altogether covering 110 patients [25]. Just one of them studied an n-3 PUFA-containing ILE [26].…”

Section: Intravenous Lipid Emulsions and Liver Functionmentioning

confidence: 99%

Home parenteral nutrition with an omega-3 fatty acid enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study): Study protocol for a randomized, controlled, multicenter, international clinical trial

Kłęk¹,

Chambrier

Cooper

et al. 2019

Preprint

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Background Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenous lipid emulsions (ILEs) are an essential component of HPN providing energy and essential fatty acids, but can become a risk factor for intestinal failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited.Methods The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem / Lipoplus ® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin ® MCT/LCT / Medialipide ® 20%, B. Braun Melsungen AG) for a projected period of eight weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of safety and tolerability as well as the efficacy of the ILEs.Discussion Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The aim of the HOME study is to demonstrate that the n-3 PUFA enriched ILE is safe and well tolerated especially with regard to liver function in patients requiring HPN. The study will provide data from a considerable number of CIF patients and thus contribute to broaden the present evidence on the use of ILEs in HPN.Trial registrationClinicalTrials.gov, NCT03282955, registered on September 14, 2017

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Long‐Term Use of Mixed‐Oil Lipid Emulsion in Adult Home Parenteral Nutrition Patients: A Case Series

Abstract: MO ILE was well tolerated in this small cohort and led to improvement in the macronutrient composition of HPN while providing a trend toward improvement in liver studies. These results are promising; however, additional randomized control trials are needed to delineate the true benefit.

Cited by 14 publications

References 27 publications

Long‐Term Use of Mixed‐Oil Lipid Emulsion in Soybean Oil–Intolerant Home Parenteral Nutrition Patients

Long‐Term Use of Mixed‐Oil Lipid Emulsion in Soybean Oil–Intolerant Home Parenteral Nutrition Patients

Use of Lipids in Adult Patients Requiring Parenteral Nutrition in the Home Setting

Home parenteral nutrition with an omega-3 fatty acid enriched MCT/LCT lipid emulsion in patients with chronic intestinal failure (the HOME study): Study protocol for a randomized, controlled, multicenter, international clinical trial

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