Calder PC, Jensen GL, Koletzko BV, Singer P, Wanten GJA. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med 36, 735-749

Institute of Human Nutrition, University of Southampton, Southampton, UK.
Intensive Care Medicine (Impact Factor: 7.21). 05/2010; 36(5):735-49. DOI: 10.1007/s00134-009-1744-5
Source: PubMed


Energy 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.
In 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, omega-9 monounsaturated fatty acids or omega-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.
Ongoing 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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Available from: Pierre Singer, Jan 07, 2015
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    • "One of the omega-3 fatty acids, EPA, which is precursor of synthesis of biologically highly active eicosanoids influences inflammatory reactions.5,20 In many studies, omega-3 fatty acids supplementation to diet was shown to reduce the release of PGE2, TXB2, LTB4, LTE4 from inflammatory cells.8,11 "
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    ABSTRACT: Objective: Lipid emulsions containing omega-3 are known to have positive effects on patient's prognosis due to anti-inflammatory properties. The aim of this study was to investigate the effects of omega-3 enriched total parenteral nutrition (TPN) emulsion containing omega-9 on biochemical parameters, inflammatory mediators in septic patients. Methods: Thirty-two participants who were not fed orally for over five days and needing TPN support were included in this prospective, randomized and double-blind clinical study. Patients were randomly divided into control (n=16), treatment (n=16) groups. The treatment group received TPN containing 80% olive oil+20% soy oil additionally 10 g fish oil enriched TPN. Control group received only olive oil containing standard lipid emulsion (1.3±0.1 g/kg/day). Blood samples were collected for biochemical analysis on the 1st and 6th days of study. Results: The serum albumin levels significantly increased (p<0.05) in both groups whereas total protein and prealbumin levels did not show any significant changes. In treatment group, significant decreases were determined in LTB4 and CRP levels (p<0.05) while decreases in IL-6, TNF-α and leukocyte levels were not significant. No statistically significant changes were found in LTB4, CRP, IL-6, TNF-α and leukocyte levels of controls. Conclusion: Results of the study have shown that omega-3 enriched TPN solution containing omega-9 contributes to decrease in the levels of inflammatory mediators and to improvement in the biochemical parameters in septic patients.
    Full-text · Article · Mar 2014 · Pakistan Journal of Medical Sciences Online
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    • "This theoretical benefit is the rationale for the use of FO supplements in chronic inflammatory disease such as asthma [23] and rheumatoid arthritis [22]. It is also why there is significant interest in the use of n-3 PUFA supplementation in critically ill patients and in patients undergoing major surgery [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] "
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    ABSTRACT: Omega-3 polyunsaturated fatty acids, in particular eicosapentaenoic acid, and docosahexaenoic acid have been shown to have multiple beneficial antitumour actions that affect the essential alterations that dictate malignant growth. In this review we explore the putative mechanisms of action of omega-3 polyunsaturated fatty acid in cancer protection in relation to self-sufficiency in growth signals, insensitivity to growth-inhibitory signals, apoptosis, limitless replicative potential, sustained angiogenesis, and tissue invasion, and how these will hopefully translate from bench to bedside.
    Full-text · Article · May 2013
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    • "The control group received a mixture of soybean oil and medium-chain triglycerides. This mix is fairly rich in linoleic acid, although less so than traditional soybean oil lipid emulsions [35]. One interesting observation is that plasma PC EPA decreased slightly but significantly in the control group. "
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    ABSTRACT: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are functionally the most important omega-3 polyunsaturated fatty acids (PUFAs). Oral supply of these fatty acids increases their levels in plasma and cell membranes, often at the expense of the omega-6 PUFAs arachidonic acid (ARA) and linoleic acid. This results in an altered pattern of lipid mediator production to one which is less pro-inflammatory. We investigated whether short term intravenous supply of omega-3 PUFAs could change the levels of EPA, DHA, ARA and linoleic acid in plasma and erythrocytes in patients with hepatic colorectal metastases. Twenty patients were randomised to receive a 72 hour infusion of total parenteral nutrition with (treatment group) or without (control group) omega-3 PUFAs. EPA, DHA, ARA and linoleic acid were measured in plasma phosphatidylcholine (PC) and erythrocytes at several times points up to the end of infusion and 5 to 12 days (mean 9 days) after stopping the infusion. The treatment group showed increases in plasma PC EPA and DHA and erythrocyte EPA and decreases in plasma PC and erythrocyte linoleic acid, with effects most evident late in the infusion period. Plasma PC and erythrocyte EPA and linoleic acid all returned to baseline levels after the 5–12 day washout. Plasma PC DHA remained elevated above baseline after washout. Intravenous supply of omega-3 PUFAs results in a rapid increase of EPA and DHA in plasma PC and of EPA in erythrocytes. These findings suggest that infusion of omega-3 PUFAs could be used to induce a rapid effect especially in targeting inflammation. Trial registration identifier NCT00942292
    Full-text · Article · May 2013 · Lipids in Health and Disease
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