No Clinical or Biochemical Evidence for Essential Fatty Acid Deficiency in Home Patients Who Depend on Long‐Term Mixed Olive Oil– and Soybean Oil–Based Parenteral Nutrition

Olthof, E.D.; Roelofs, Hennie M.J.; Fisk, Helena L.; Calder, Philip C.; Wanten, Geert

doi:10.1177/0148607115581375

Cited by 20 publications

(28 citation statements)

References 20 publications

(49 reference statements)

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“…The latter observation suggests that neither SMOFLipid nor ClinOleic will induce EFA deficiency in adults on HPN. Again, this is consistent with the limited data on use of ClinOleic in adult HPN patients [17,18,20]. These findings indicate that the amount of linoleic and -linolenic acids provided in both ClinOleic and SMOFLipid is sufficient to meet the requirement for EFAs in this patient group.…”

Section: Effect Of Changing Lipid Emulsion On Plasma Cytokine Concentsupporting

confidence: 86%

Effect of changing the lipid component of home parenteral nutrition in adults

Osowska

Kunecki²,

Sobocki

et al. 2019

Clinical Nutrition

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Both SMOFLipid and ClinOleic significantly alter the fatty acid profile of plasma in adult HPN patients previously using Intralipid. Neither LE induces EFA deficiency in these patients. SMOFLipid did not alter liver function markers or inflammation. In contrast, ClinOleic decreased some, though not all, markers of liver function and inflammation. SMOFLipid and ClinOleic may both be considered for use in adult HPN patients.

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Section: Effect Of Changing Lipid Emulsion On Plasma Cytokine Concentsupporting

confidence: 86%

Effect of changing the lipid component of home parenteral nutrition in adults

Osowska

Kunecki²,

Sobocki

et al. 2019

Clinical Nutrition

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“…The development of ILEs containing lower levels of LA and ALA raised concerns about their ability to prevent EFAD . However, although the LA content of OO‐based ILE is lower than that of SO‐based ILE, studies have shown that this does not reduce the potential of OO‐based ILE to prevent EFAD . Vahedi et al found no biochemical evidence (based on T:T ratio >0.2) of EFAD in 13 patients with intestinal failure receiving OO‐based ILE or SO‐based ILE in a 3‐month, double‐blind, randomized study.…”

Section: Iles and Efadmentioning

confidence: 99%

Essential Fatty Acid Requirements and Intravenous Lipid Emulsions

Gramlich

Ireton‐Jones²,

Miles

et al. 2019

J Parenter Enteral Nutr

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Linoleic acid (LA) and α‐linolenic acid (ALA) must be supplied to the human body and are therefore considered essential fatty acids. This narrative review discusses the signs, symptoms, diagnosis, prevention, and treatment of essential fatty acid deficiency (EFAD). EFAD may occur in patients with conditions that severely limit the intake, digestion, absorption, and/or metabolism of fat. EFAD may be prevented in patients requiring parenteral nutrition by inclusion of an intravenous lipid emulsion (ILE) as a source of LA and ALA. Early ILEs consisted solely of soybean oil (SO), a good source of LA and ALA, but being rich in LA may promote the production of proinflammatory fatty acids. Subsequent ILE formulations replaced part of the SO with other fat sources to decrease the amount of proinflammatory fatty acids. Although rare, EFAD is diagnosed by an elevated triene:tetraene (T:T) ratio, which reflects increased metabolism of oleic acid to Mead acid in the absence of adequate LA and ALA. Assays for measuring fatty acids have improved over the years, and therefore it is necessary to take into account the particular assay used and its reference range when determining if the T:T ratio indicates EFAD. In patients with a high degree of suspicion for EFAD, obtaining a fatty acid profile may provide additional useful information for making a diagnosis of EFAD. In patients receiving an ILE, the T:T ratio and fatty acid profile should be interpreted in light of the fatty acid composition of the ILE to ensure accurate diagnosis of EFAD.

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“…In patients who received FO‐LE as sole FA source at 1 g/kg/d, a normal Mead acid/arachidonic acid ratio was found despite lowered linoleic acid concentrations in 50% of patients 34 . A recent Dutch survey in 30 adult patients receiving long‐term HPN who depended on a mixed LE consisting of 20% SO and 80% OO for their FA intake for at least 3 months showed no clinical evidence of EFAD with a normal Holman index and normal innate immune functions compared with healthy controls 35 …”

Section: Efadmentioning

confidence: 93%

Parenteral Lipid Tolerance and Adverse Effects

Wanten

2015

J Parenter Enteral Nutr

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Lipid emulsions (LEs) are indispensable sources of fuel calories and (essential) fatty acids (FAs) in modern parenteral nutrition formulations. The use of LE, however, also remains associated with the development of adverse effects. Intolerance for LE mostly becomes apparent upon the development of patient complaints or disturbed blood function tests, mainly of the liver. These issues may be associated with the composition, stability, or the infusion rate of the emulsion. Also, altered balances of (anti)oxidants or the presence or absence of protective or toxic bioactive agents such as phytosterols and tocopherol in LE may lead to complications, especially in already vulnerable patients with an inflammatory condition. While the oldest available LEs are based on pure soybean oil (SO-LE), rich in the proinflammatory ω-6 polyunsaturated fatty acid linoleic acid, more recent next-generation LEs where alternative FA sources such as olive and fish oil (partially) replace soybean oil to lower the content of linoleic acid seem safe and effective. Especially LEs containing fish oil (FO-LE) have less proinflammatory characteristics that promise to convey beneficial effects on immune system and organ functions, although much of the available evidence awaits more robust clinical validation.

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No Clinical or Biochemical Evidence for Essential Fatty Acid Deficiency in Home Patients Who Depend on Long‐Term Mixed Olive Oil– and Soybean Oil–Based Parenteral Nutrition

Abstract: 25 26Background: Home parenteral nutrition (HPN) patients depend on lipid emulsions as part of their 27

Cited by 20 publications

References 20 publications

Effect of changing the lipid component of home parenteral nutrition in adults

Effect of changing the lipid component of home parenteral nutrition in adults

Essential Fatty Acid Requirements and Intravenous Lipid Emulsions

Parenteral Lipid Tolerance and Adverse Effects

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