Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition

In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty‐acid deficiency. However, mixtures of diff...

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Published inJPEN. Journal of parenteral and enteral nutrition Vol. 44; pp. S28 - S38
Main Authors Mayer, Konstantin, Klek, Stanislaw, García‐de‐Lorenzo, Abelardo, Rosenthal, Martin D., Li, Ang, Evans, David C., Muscaritoli, Maurizio, Martindale, Robert G.
Format Journal Article
LanguageEnglish
Published United States 01.02.2020
Subjects
Acute Disease
Adult
Fat Emulsions, Intravenous
Fatty Acids, Omega-3
fish oil
Fish Oils
Humans
infections
inflammation
intensive care unit
lipids
meta‐analyses
Olive Oil
omega‐3
Pancreatitis
Parenteral Nutrition
Soybean Oil
specialized pro‐resolving mediator
surgery
Triglycerides
specialized pro-resolving mediator
lipids
meta-analyses
omega-3
parenteral nutrition
inflammation
fish oil
infections
intensive care unit
surgery
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Summary:In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty‐acid deficiency. However, mixtures of different lipid emulsions have now become widely available, including mixtures of soybean oil, medium‐chain triglycerides, olive oil, and fish oil. Fish oil is high in the ω‐3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω‐3 fatty acids can exert beneficial immunomodulatory, anti‐inflammatory, and inflammation‐resolution effects across a wide range of patient groups including surgical, cancer, and critically ill patients. At least in part, these effects are realized via potent specialized pro‐resolution mediators (SPMs). Moreover, parenteral nutrition including ω‐3 fatty acids can result in additional clinical benefits over the use of standard lipid emulsions, such as reductions in infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding lipid emulsion use in a variety of hospitalized patient groups, including surgical, critically ill, sepsis, trauma, and acute pancreatitis patients. Practical aspects of lipid emulsion use in critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider parenteral nutrition, duration of infusion, and safety monitoring.
Bibliography:Conflicts of interest: K. Mayer has received reimbursements for travel costs and honoraria from Abbot, AstraZeneca, Baxter, BBraun, Fresenius Kabi, MSD, Nestlé, Novartis, and Pfizer. R. G. Martindale has received honoraria from Abbott, Baxter, Fresenius Kabi, and Nestlé, and acted as an advisory board member for Nestlé. A. García‐de‐Lorenzo has received honoraria from Abbott, Baxter, Fresenius Kabi, and Vegenat. M. D. Rosenthal has received honoraria from Fresenius Kabi. A. Li has received speaker's fees from Fresenius Kabi. D. C. Evans has received honoraria from Abbott, Fresenius Kabi, Coram, and Alcresta, and acted as an advisory board member for Abbott and Coram. M. Muscaritoli has received speaker's fees from Fresenius Kabi. S. Klek has received speaker's honoraria from Baxter, Braun, Fresenius Kabi, Nestlé, Nutricia, Shire, and Vipharm, and acted as an advisory board member for Fresenius Kabi, Shire, and Tracheron.
Financial disclosure: Fresenius Kabi Deutschland GmbH provided financial support to organize and invite experts to participate as speakers and discussants, based on knowledge and international reputation in the areas of clinical nutrition and more specifically lipid metabolism, to the international summit “Lipids in Parenteral Nutrition” from November 2–4, 2018 (Miami, FL, USA), as well as financial support for the development of this review. Fresenius Kabi Deutschland GmbH had no involvement in the study design; collection, analysis, and interpretation of data; writing of the manuscript; nor any decision on whether to submit the manuscript for publication. Dr Richard Clark (freelance medical writer, Dunchurch, Warwickshire, UK) drafted the manuscript, and Dr Martina Sintzel (mcs medical communication services, Erlenbach, ZH, Switzerland) provided consultancy services, both funded by Fresenius Kabi Deutschland GmbH. These services complied with international guidelines for Good Publication Practice (GPP3).
ISSN:0148-6071
1941-2444
DOI:10.1002/jpen.1733