Division of Pharmacy, American Family Children's Hospital, Madison, Wisconsin, USA.
Division of Pharmacy, The Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
JPEN J Parenter Enteral Nutr. 2024 Oct;48(7):793-801. doi: 10.1002/jpen.2678. Epub 2024 Aug 8.
Pediatric patients with intestinal failure require long-term parenteral nutrition owing to impaired enteral nutrition absorption. A potential complication is essential fatty acid deficiency (EFAD), resulting from decreased linoleic and α-linolenic acid concentrations and defined by an increased triene:tetraene ratio (TTR; Mead acid:arachidonic acid). Historically, soybean oil lipid emulsion (SOLE) was the only commercially available parenteral lipid in the United States. Recently, a composite lipid emulsion (CLE) and fish oil lipid emulsion (FOLE) received US Food and Drug Administration approval. This study investigated whether lipid emulsion regimen impacts EFAD incidence in pediatric patients with intestinal failure.
This study was a 10-year retrospective cohort study of pediatric patients with intestinal failure who received parenteral SOLE, CLE, or FOLE. The primary outcome was EFAD incidence, defined as a TTR ≥ 0.2. Secondary outcomes included TTR ≥ 0.05, cholestasis incidence, lipid dose effect on EFAD incidence, and fatty acid parameter differences.
A total of 144 fatty acid profiles from 47 patients were reviewed. EFAD did not occur in any lipid emulsion group. There were no differences in the incidence of TTR ≥ 0.05 or cholestasis. The effect of dose could not be evaluated because of no EFAD incidence. Lastly, although each group had varied fatty acid parameters, none saw decreased essential fatty acid levels.
This study found that, with close monitoring, the lipid emulsion regimen did not impact EFAD incidence. This suggests that FOLE and CLE do not increase EFAD risk compared with SOLE in pediatric patients with intestinal failure.
由于肠内营养吸收受损，儿科肠衰竭患者需要长期接受肠外营养。一个潜在的并发症是必需脂肪酸缺乏症（EFAD），这是由于亚油酸和α-亚麻酸浓度降低以及三烯：四烯比值（TTR；Mead 酸：花生四烯酸）增加而导致的。历史上，大豆油脂肪乳剂（SOLE）是美国唯一可获得的商业肠外脂质。最近，复合脂质乳剂（CLE）和鱼油脂肪乳剂（FOLE）获得了美国食品和药物管理局的批准。本研究探讨了脂质乳剂方案是否会影响肠衰竭儿科患者 EFAD 的发生率。
这是一项对接受肠外 SOLE、CLE 或 FOLE 的肠衰竭儿科患者进行的 10 年回顾性队列研究。主要结局是 EFAD 的发生率，定义为 TTR≥0.2。次要结局包括 TTR≥0.05、胆汁淤积发生率、脂质剂量对 EFAD 发生率的影响以及脂肪酸参数差异。
共回顾了 47 名患者的 144 份脂肪酸谱。没有任何脂质乳剂组发生 EFAD。TTR≥0.05 或胆汁淤积的发生率没有差异。由于 EFAD 发生率为零，无法评估剂量的影响。最后，尽管每个组的脂肪酸参数都有所不同，但没有一个组的必需脂肪酸水平降低。
本研究发现，在密切监测的情况下，脂质乳剂方案并未影响 EFAD 的发生率。这表明在肠衰竭的儿科患者中，与 SOLE 相比，FOLE 和 CLE 不会增加 EFAD 的风险。
