Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, England, UK.
NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, England, UK.
JPEN J Parenter Enteral Nutr. 2020 Feb;44 Suppl 1:S21-S27. doi: 10.1002/jpen.1756.
Lipid emulsions are an integral part of parenteral nutrition, and traditionally have been regarded as an energy-dense source of calories and essential fatty acids. For many years, lipids used in parenteral nutrition have been based on vegetable oils (eg, soybean-oil emulsions). However, soybean-oil emulsions may not have an optimal fatty-acid composition under some circumstances when used as the only lipid source, as soybean oil is particularly abundant in the ω-6 polyunsaturated fatty acid (PUFA), linoleic acid. Hence, a progressive series of more complex lipid emulsions have been introduced, typically combining soybean oil with 1 or more alternative oils, such as medium-chain triglycerides (MCTs) and/or olive oil and/or fish oil. The wide range of lipid emulsions now available for parenteral nutrition offers opportunities to alter the supply of different fatty acids, which potentially modifies functional properties, with effects on inflammatory processes, immune response, and hepatic metabolism. Fish oil has become an important component of modern, composite lipid emulsions, in part owing to a growing evidence base concerning its biological effects in a variety of preclinical models. These biological activities of fish oil are mainly attributed to its ω-3 PUFA content, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA and EPA have known mechanisms of action, anti-inflammatory, immunomodulatory, and antioxidative properties. Specialized proresolving mediators, such as resolvins, protectins, and maresins, are synthesized directly from DHA and EPA, are key for the resolution of inflammation, and improve outcomes in many cell- and animal-based models and, recently, in some clinical settings.
脂肪乳剂是肠外营养的一个组成部分，传统上被认为是能量密集型卡路里和必需脂肪酸的来源。多年来，肠外营养中使用的脂肪一直基于植物油（例如，大豆油乳剂）。然而，在某些情况下，当大豆油作为唯一的脂肪来源时，其脂肪酸组成可能并不理想，因为大豆油特别富含 ω-6 多不饱和脂肪酸（PUFA）亚油酸。因此，已经引入了一系列越来越复杂的脂肪乳剂，通常将大豆油与 1 种或多种替代油（如中链甘油三酯（MCT）和/或橄榄油和/或鱼油）结合使用。现在可用于肠外营养的各种脂肪乳剂为改变不同脂肪酸的供应提供了机会，这可能会改变其功能特性，从而影响炎症过程、免疫反应和肝脏代谢。鱼油已成为现代复合脂肪乳剂的重要组成部分，部分原因是其在各种临床前模型中的生物学效应的证据基础不断增加。鱼油的这些生物学活性主要归因于其 ω-3 PUFA 含量，特别是二十二碳六烯酸（DHA）和二十碳五烯酸（EPA）。DHA 和 EPA 具有已知的作用机制，具有抗炎、免疫调节和抗氧化特性。专门的促解决介质，如 resolvins、保护素和maresins，直接从 DHA 和 EPA 合成，是炎症解决的关键，并改善许多基于细胞和动物的模型以及最近在一些临床环境中的结果。
