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Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: a systematic review

Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: a systematic review
Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: a systematic review
Background & aims: Patients who have chronic intestinal failure require home parenteral nutrition (HPN) support. Intravenous lipid emulsions (IVLEs) are a vital part of HPN. The conventional IVLE is based on pure soybean oil, which contains a high concentration of omega-6 fatty acids. Alternative IVLEs are commercially available. These contain various oil blends and have different fatty acid compositions from soybean oil that could provide benefit to patients on HPN. The aim of this systematic review is to assess the effects of different IVLEs in adult patients requiring HPN. Methods: A systematic literature search was conducted up to October 2019 using relevant search terms in the Medline, EMBASE and CINAHL databases. Only randomised controlled trials (RCTs) in adults on HPN that compared two or more IVLEs were included. Data were extracted and the Cochrane Collaboration's tool for assessing risk of bias was used. Results: Six articles were identified for inclusion in this systematic review. Studies differed according to sample size, duration and the IVLEs compared. Four studies found no increased risk of adverse effects related to the different IVLEs, whilst one study found a higher frequency of serious adverse events with soybean oil. One study found higher serum α-tocopherol with the blend of soybean oil, medium chain triglycerides, olive oil and fish oil. Inflammatory markers were not affected by different IVLEs in three studies. Differences in liver function tests were minimal, but one study found slight abnormalities in patients receiving soybean oil. IVLEs containing olive oil or fish oil modified the blood fatty acid profile. No studies reported essential fatty acid deficiency. Conclusions: There may be benefits of using alternative IVLEs to soybean oil-based emulsions in adults requiring HPN, although there is currently insufficient evidence to determine superiority of one formulation over another. More and larger RCTs are required in this area.
Fish oil, Home parenteral nutrition, Intravenous lipid emulsion, Medium chain triglyceride, Olive oil, Soybean oil
0261-5614
1115-1122
Ahmed, Samir
6a532d2a-6472-4a3a-869c-89e1577bb303
Innes, Jacqueline K.
4423c9f2-75f4-4265-b550-aaec6f490c26
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6
Ahmed, Samir
6a532d2a-6472-4a3a-869c-89e1577bb303
Innes, Jacqueline K.
4423c9f2-75f4-4265-b550-aaec6f490c26
Calder, Philip
1797e54f-378e-4dcb-80a4-3e30018f07a6

Ahmed, Samir, Innes, Jacqueline K. and Calder, Philip (2021) Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: a systematic review. Clinical Nutrition, 40 (3), 1115-1122. (doi:10.1016/j.clnu.2020.07.014).

Record type: Article

Abstract

Background & aims: Patients who have chronic intestinal failure require home parenteral nutrition (HPN) support. Intravenous lipid emulsions (IVLEs) are a vital part of HPN. The conventional IVLE is based on pure soybean oil, which contains a high concentration of omega-6 fatty acids. Alternative IVLEs are commercially available. These contain various oil blends and have different fatty acid compositions from soybean oil that could provide benefit to patients on HPN. The aim of this systematic review is to assess the effects of different IVLEs in adult patients requiring HPN. Methods: A systematic literature search was conducted up to October 2019 using relevant search terms in the Medline, EMBASE and CINAHL databases. Only randomised controlled trials (RCTs) in adults on HPN that compared two or more IVLEs were included. Data were extracted and the Cochrane Collaboration's tool for assessing risk of bias was used. Results: Six articles were identified for inclusion in this systematic review. Studies differed according to sample size, duration and the IVLEs compared. Four studies found no increased risk of adverse effects related to the different IVLEs, whilst one study found a higher frequency of serious adverse events with soybean oil. One study found higher serum α-tocopherol with the blend of soybean oil, medium chain triglycerides, olive oil and fish oil. Inflammatory markers were not affected by different IVLEs in three studies. Differences in liver function tests were minimal, but one study found slight abnormalities in patients receiving soybean oil. IVLEs containing olive oil or fish oil modified the blood fatty acid profile. No studies reported essential fatty acid deficiency. Conclusions: There may be benefits of using alternative IVLEs to soybean oil-based emulsions in adults requiring HPN, although there is currently insufficient evidence to determine superiority of one formulation over another. More and larger RCTs are required in this area.

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More information

Accepted/In Press date: 15 July 2020
e-pub ahead of print date: 23 July 2020
Published date: 1 March 2021
Keywords: Fish oil, Home parenteral nutrition, Intravenous lipid emulsion, Medium chain triglyceride, Olive oil, Soybean oil

Identifiers

Local EPrints ID: 442535
URI: http://eprints.soton.ac.uk/id/eprint/442535
ISSN: 0261-5614
PURE UUID: 4533feec-43eb-4e53-84ee-97cd9d790cad
ORCID for Philip Calder: ORCID iD orcid.org/0000-0002-6038-710X

Catalogue record

Date deposited: 17 Jul 2020 16:31
Last modified: 09 Oct 2021 04:01

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Contributors

Author: Samir Ahmed
Author: Jacqueline K. Innes
Author: Philip Calder ORCID iD

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