Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
JPEN J Parenter Enteral Nutr. 2023 Nov;47(8):1038-1046. doi: 10.1002/jpen.2547. Epub 2023 Jul 26.
Children with intestinal failure without liver disease may be given soy-based lipid emulsion (SLE) or mixed lipid emulsion (MLE; containing soy, medium-chain triglyceride, olive, and/or fish oils). Both differ in essential fatty acid content: MLE has added arachidonic acid (AA) and docosahexaenoic acid (DHA). The aim of this study, in neonatal piglets, was to compare serum and tissue fatty acid composition when the emulsions were given at unrestricted doses.
We compared SLE (n = 15) and MLE (n = 15) at doses of 10-15 g/kg/day in parenteral nutrition (PN). On day 14 we collected serum and tissues. Using gas-liquid chromatography, percentage fatty acids were measured in serum, brain, and liver phospholipid. Comparisons were made to reference values from litter-matched controls (n = 8).
Comparing median values, linoleic acid (LA) was lower for MLE vs SLE in serum (-27%), liver (-45%), and brain (-33%) (P < 0.001). AA was lower for MLE in serum (-25%), liver (-40%), and brain (-10%). DHA was higher for MLE in serum (+50%), liver (+200%), and brain (+10%). AA levels were lower for MLE vs control piglets in serum (-81%), liver (-63%), and brain (-9%). DHA levels were higher in serum (+41%), liver (+38%), and brain (+19%).
This study in piglets has shown that, at unrestricted doses, MLE treatment is associated with low serum and tissue AA compared with SLE and healthy litter-matched controls. Although not yet proven, low tissue AA levels may have functional consequences, and these data support current practice avoiding MLE dose restriction.
无肝病的肠衰竭儿童可给予大豆基脂肪乳（SLE）或混合脂肪乳（MLE；含大豆、中链甘油三酯、橄榄油和/或鱼油）。两者在必需脂肪酸含量上有所不同：MLE 中添加了花生四烯酸（AA）和二十二碳六烯酸（DHA）。本研究旨在比较新生仔猪在给予无限制剂量的两种乳剂时血清和组织中的脂肪酸组成。
我们在肠外营养（PN）中比较了 10-15g/kg/天剂量的 SLE（n=15）和 MLE（n=15）。在第 14 天，我们采集了血清和组织。采用气相色谱法，测量血清、脑和肝磷脂中的脂肪酸百分比。并与同窝对照（n=8）的参考值进行了比较。
中位数比较显示，MLE 中的亚油酸（LA）在血清（-27%）、肝脏（-45%）和大脑（-33%）中均低于 SLE（P<0.001）。AA 在 MLE 中的血清（-25%）、肝脏（-40%）和大脑（-10%）中均低于 SLE。DHA 在 MLE 中的血清（+50%）、肝脏（+200%）和大脑（+10%）中均高于 SLE。MLE 中的 AA 水平在血清（-81%）、肝脏（-63%）和大脑（-9%）中均低于对照仔猪。DHA 水平在血清（+41%）、肝脏（+38%）和大脑（+19%）中均高于对照仔猪。
本研究表明，在给予无限制剂量时，与 SLE 和健康同窝对照相比，MLE 治疗与低血清和组织 AA 相关。虽然尚未得到证实，但组织中 AA 水平低可能具有功能后果，这些数据支持目前避免 MLE 剂量限制的做法。
