Department of General Surgery and Clinical Nutrition, Warsaw Medical University, Warsaw, Poland.
Centre of Clinical Nutrition, Pirogow Hospital, Lodz, Poland.
Clin Nutr. 2019 Jun;38(3):1355-1361. doi: 10.1016/j.clnu.2018.05.028. Epub 2018 Jun 6.
The effect of different lipid emulsions (LEs) within the parenteral nutrition (PN) regimen of adult home PN (HPN) patients is not clear. This study investigated the effect of changing adult HPN patients from a soybean oil based LE (Intralipid) to either a fish oil containing LE (providing n-3 fatty acids) (SMOFLipid) or an olive oil based LE (ClinOleic).
Thirty two adults receiving long-term HPN with Intralipid as the LE were transferred to receive either SMOFLipid (n = 13) or ClinOleic (n = 19) for 60 days. Liver function markers, cholesterol, triglycerides, a full profile of fatty acids, and several cytokines were measured at study entry and after 60 days.
SMOFLipid did not affect liver function markers, blood lipids or plasma cytokines. ClinOleic lowered both gamma-glutamyltranspeptidase (P = 0.044) and interleukin-8 (P = 0.030) concentrations. Both LEs induced marked changes in the fatty acid profile of plasma. SMOFLipid resulted in significant decreases in the proportions of linoleic acid, several other n-6 fatty acids and the essential fatty acid (EFA) deficiency indicator mead acid and significant increases in the proportions of the n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. ClinOleic resulted in significant decreases in the proportions of some saturated fatty acids, linoleic acid, several n-6 fatty acids, all n-3 fatty acids and mead acid and a significant increase in the proportion of oleic acid. The ratio of mead to arachidonic acid in plasma was not altered by either SMOFLipid or ClinOleic. No patient had a mead acid to arachidonic acid ratio of >0.2, the cut-off used to indicate EFA deficiency.
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.
不同的脂肪乳（LE）在成人家庭肠外营养（HPN）患者的肠外营养方案中的作用尚不清楚。本研究调查了将接受大豆油基 LE（Intralipid）的成人 HPN 患者转换为含鱼油的 LE（提供 n-3 脂肪酸）（SMOFLipid）或橄榄油基 LE（ClinOleic）的效果。
32 名长期接受 HPN 治疗且以 Intralipid 为 LE 的成年人，转换为接受 SMOFLipid（n=13）或 ClinOleic（n=19）治疗 60 天。在研究开始时和 60 天后测量肝功能标志物、胆固醇、甘油三酯、脂肪酸全谱和几种细胞因子。
SMOFLipid 未影响肝功能标志物、血脂或血浆细胞因子。ClinOleic 降低了谷氨酰转肽酶（P=0.044）和白细胞介素-8（P=0.030）的浓度。两种 LE 均使血浆脂肪酸谱发生明显变化。SMOFLipid 导致亚油酸、几种其他 n-6 脂肪酸和必需脂肪酸（EFA）缺乏指标甲羟戊酸的比例显著降低，而 n-3 脂肪酸二十碳五烯酸和二十二碳六烯酸的比例显著增加。ClinOleic 导致一些饱和脂肪酸、亚油酸、几种 n-6 脂肪酸、所有 n-3 脂肪酸和甲羟戊酸的比例降低，油酸的比例显著增加。血浆中甲羟戊酸与花生四烯酸的比值不受 SMOFLipid 或 ClinOleic 的影响。没有患者的甲羟戊酸与花生四烯酸的比值大于 0.2，这是指示 EFA 缺乏的截止值。
SMOFLipid 和 ClinOleic 均显著改变了先前使用 Intralipid 的成人 HPN 患者的血浆脂肪酸谱。两种 LE 均未在这些患者中引起 EFA 缺乏。SMOFLipid 未改变肝功能标志物或炎症。相反，ClinOleic 降低了一些但不是所有的肝功能和炎症标志物。SMOFLipid 和 ClinOleic 均可考虑用于成人 HPN 患者。
