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Lipids in parenteral nutrition: biological aspects

Lipids in parenteral nutrition: biological aspects
Lipids in parenteral nutrition: biological aspects

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.

fatty acids, fish oil, immunomodulation, inflammation, lipids, omega-3 fatty acids, parenteral nutrition, soybean oil, specialized pro-resolving mediator
0148-6071
S21-S27
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Waitzberg, Dan L
2247082d-1b02-4f5e-bcb6-87fdbd28fe41
Klek, Stanislaw
086b8bd4-60bc-44a2-b24e-e31fb0abaaa2
Martindale, Robert G
8c7d1366-0415-4508-af66-2d4a851be935
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Waitzberg, Dan L
2247082d-1b02-4f5e-bcb6-87fdbd28fe41
Klek, Stanislaw
086b8bd4-60bc-44a2-b24e-e31fb0abaaa2
Martindale, Robert G
8c7d1366-0415-4508-af66-2d4a851be935

Calder, Philip, Waitzberg, Dan L, Klek, Stanislaw and Martindale, Robert G (2020) Lipids in parenteral nutrition: biological aspects. Journal of Parenteral and Enteral Nutrition, 44 (S1), S21-S27. (doi:10.1002/jpen.1756).

Record type: Review

Abstract

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.

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Biological aspects ms 03Nov2019b - Accepted Manuscript
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More information

Accepted/In Press date: 11 November 2019
e-pub ahead of print date: 12 February 2020
Published date: February 2020
Additional Information: Funding Information: The authors are grateful to Fresenius Kabi for organizing the summit upon which the reviews in this supplement are based and for their support in the production of this review. The authors thank Dr Richard Clark (freelance medical writer, Dunchurch, Warwickshire, UK) for writing the first draft of this manuscript and collating the authors' comments, and Dr Martina Sintzel (mcs medical communication services, Erlenbach, Switzerland) for valuable consultation services. Publisher Copyright: © 2020 American Society for Parenteral and Enteral Nutrition
Keywords: fatty acids, fish oil, immunomodulation, inflammation, lipids, omega-3 fatty acids, parenteral nutrition, soybean oil, specialized pro-resolving mediator

Identifiers

Local EPrints ID: 435809
URI: http://eprints.soton.ac.uk/id/eprint/435809
ISSN: 0148-6071
PURE UUID: da04cae1-4ca0-44b0-8315-ef47da8cfe7d
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

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Date deposited: 21 Nov 2019 17:30
Last modified: 02 Aug 2022 04:01

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Contributors

Author: Philip Calder ORCID iD
Author: Dan L Waitzberg
Author: Stanislaw Klek
Author: Robert G Martindale

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