Reduced Metabolic Complications in Total Parenteral Nutrition: Pilot Study Using Fat to Replace One‐third of Glucose Calories

Meguid, Michael M.; Schimmel, Elihu M.; Johnson, Willard C.; Meguid, Victoria; Lowell, Barbara; Bourinski, James; Nabseth, Donald C.

doi:10.1177/0148607182006004304

Cited by 58 publications

(16 citation statements)

References 9 publications

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“…In Europe in 1984, a second generation IVLE was introduced consisting of 50:50 physical mixtures of SOY and medium chain triglycerides (MCT) that was derived from the assumption that the newly recognized SOY-related complications (i.e., reticulo-endothelial system dysfunction exaggerated systemic inflammatory response in the critically ill, and liver dysfunction in acutely ill infants and in patients of any age requiring long-term PN) [16,17,18,19,20] were possibly attributed to its high ω-6 FA content [2]. A third generation IVLE was introduced in 1990 that consisted of 20% SOY and 80% olive oil.…”

Section: History Of Ivle In Parenteral Nutritionmentioning

confidence: 99%

Parenteral Nutrition and Lipids

et al. 2017

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Lipids have multiple physiological roles that are biologically vital. Soybean oil lipid emulsions have been the mainstay of parenteral nutrition lipid formulations for decades in North America. Utilizing intravenous lipid emulsions in parenteral nutrition has minimized the dependence on dextrose as a major source of nonprotein calories and prevents the clinical consequences of essential fatty acid deficiency. Emerging literature has indicated that there are benefits to utilizing alternative lipids such as olive/soy-based formulations, and combination lipids such as soy/MCT/olive/fish oil, compared with soybean based lipids, as they have less inflammatory properties, are immune modulating, have higher antioxidant content, decrease risk of cholestasis, and improve clinical outcomes in certain subgroups of patients. The objective of this article is to review the history of IVLE, their composition, the different generations of widely available IVLE, the variables to consider when selecting lipids, and the complications of IVLE and how to minimize them.

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Section: History Of Ivle In Parenteral Nutritionmentioning

confidence: 99%

Parenteral Nutrition and Lipids

et al. 2017

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“…Perhaps most importantly, the use of LEs in PN is associated with a reduction in the metabolic complications related to excessive hypertonic glucose infusion because the dextrose load is correspondingly reduced. Results of a study involving critically ill patients with gastric carcinoma, sepsis, colitis or pancreatitis demonstrated that replacement of one-third of the total calories contained in a conventional glucose-amino acid PN formulation with a LE maintained or increased patients’ body weight [26]. Plasma glucose concentrations were maintained or reduced, and no cases of hyperglycemia, hyperosmolar nonketotic coma or hypertriglyceridemia were observed [26].…”

Section: The Role Of Lipid Emulsions In Parenteral Nutritionmentioning

confidence: 99%

“…Results of a study involving critically ill patients with gastric carcinoma, sepsis, colitis or pancreatitis demonstrated that replacement of one-third of the total calories contained in a conventional glucose-amino acid PN formulation with a LE maintained or increased patients’ body weight [26]. Plasma glucose concentrations were maintained or reduced, and no cases of hyperglycemia, hyperosmolar nonketotic coma or hypertriglyceridemia were observed [26]. Another study found that ICU patients receiving parenteral fluids unintentionally received 150–600 kcal/day dextrose as a constituent of various fluids and drugs [1].…”

Section: The Role Of Lipid Emulsions In Parenteral Nutritionmentioning

confidence: 99%

Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions

Calder

Jensen

Koletzko³

et al. 2010

Intensive Care Med

185

152

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BackgroundEnergy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill patients. Lipids provide a key source of calories within PN formulations, preventing or correcting energy deficits and improving outcomes.DiscussionIn this article, we review the role of parenteral lipid emulsions (LEs) in the management of critically ill patients and highlight important biologic activities associated with lipids. Soybean-oil-based LEs with high contents of polyunsaturated fatty acids (PUFA) were the first widely used formulations in the intensive care setting. However, they may be associated with increased rates of infection and lipid peroxidation, which can exacerbate oxidative stress. More recently developed parenteral LEs employ partial substitution of soybean oil with oils providing medium-chain triglycerides, ω-9 monounsaturated fatty acids or ω-3 PUFA. Many of these LEs have demonstrated reduced effects on oxidative stress, immune responses, and inflammation. However, the effects of these LEs on clinical outcomes have not been extensively evaluated.ConclusionsOngoing research using adequately designed and well-controlled studies that characterize the biologic properties of LEs should assist clinicians in selecting LEs within the critical care setting. Prescription of PN containing LEs should be based on available clinical data, while considering the individual patient’s physiologic profile and therapeutic requirements.

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“…Once IFALD develops, PN formula should be evaluated to ensure avoidance of overfeeding, reduction of SO ILE to <1 g/kg/day, and reduction of the ω‐6/ω‐3 PUFA ratio. Unfortunately, as the SO ILE component of PN is reduced, a higher percentage of nonprotein energy is derived from dextrose, which can have its own detrimental effects …”

Section: Introductionmentioning

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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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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Reduced Metabolic Complications in Total Parenteral Nutrition: Pilot Study Using Fat to Replace One‐third of Glucose Calories

Cited by 58 publications

References 9 publications

Parenteral Nutrition and Lipids

Parenteral Nutrition and Lipids

Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions

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

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