Lipids for intravenous nutrition in hospitalised adult patients: a multiple choice of options

• Published in: Proceedings of the Nutrition Society Vol. 72; no. 3; pp. 263 - 276
• Main Author: Calder, Philip C.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.08.2013
• Subjects: adults; adverse effects; BAPEN and Nutrition Society Symposium: Immuno nutrition & novel substrates; Carbon; Clinical trials; Clinical Trials as Topic; Critical Illness - therapy; Digestive Disorders Federation Conference; Emulsions; energy; Energy resources; Fat Emulsions, Intravenous - administration & dosage; Fat Emulsions, Intravenous - chemistry; Fatty acids; Fish; Fish oils; Fish Oils - administration & dosage; Fish Oils - chemistry; Gas exchange; Gastrointestinal surgery; gastrointestinal system; Hospitalization; hospitals; Human subjects; Humans; Hydrocarbons; Immune response; inflammation; intravenous injection; linoleic acid; Lipids; Lipids - administration & dosage; meta-analysis; Nutrition; Olive Oil; parenteral feeding; Parenteral nutrition; Parenteral Nutrition - methods; Patients; Plant Oils - administration & dosage; Plant Oils - chemistry; soybean oil; Soybeans; vegetable oil; Vegetable oils; Critical illness; Inflammation; Olive oil; Fish oil; Surgery
• ISSN: 0029-6651; 1475-2719; 1475-2719
• DOI: 10.1017/S0029665113001250

Lipids used in parenteral nutrition provide energy, building blocks and essential fatty acids. Traditionally, these lipids have been based on n-6 PUFA-rich vegetable oils particularly soyabean oil. This may not be optimal because soyabean oil may present an excessive supply of linoleic acid. Alternatives to use of soyabean oil include its partial replacement by medium-chain TAG, olive oil or fish oil, either alone or in combination. Lipid emulsions containing these alternatives are well tolerated without adverse effects in a wide range of hospitalised adult patients. Lipid emulsions that include fish oil have been used in parenteral nutrition in adult patients' post-surgery (mainly gastrointestinal). This has been associated with alterations in patterns of inflammatory mediators and in immune function and, in some studies, a reduction in length of intensive care unit and hospital stay. These benefits are emphasised through recent meta-analyses. Perioperative administration of fish oil may be superior to post-operative administration. Parenteral fish oil has been used in critically ill adults. Here, the influence on inflammatory processes, immune function and clinical endpoints is not clear, since there are too few studies and those that are available report contradictory findings. However, some studies found reduced inflammation, improved gas exchange and shorter length of hospital stay in critically ill patients if they receive fish oil. More and better trials are needed in patient groups in which parenteral nutrition is used and where fish oil may offer benefits.