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Review
. 2015 Sep 15;6(5):600-10.
doi: 10.3945/an.115.009084. Print 2015 Sep.

Intravenous Lipid Emulsions in Parenteral Nutrition

Gillian L Fell  1 , Prathima Nandivada  1 , Kathleen M Gura  2 , Mark Puder  3
Affiliations
Review

Intravenous Lipid Emulsions in Parenteral Nutrition

Gillian L Fell et al. Adv Nutr. .

Abstract

Fat is an important macronutrient in the human diet. For patients with intestinal failure who are unable to absorb nutrients via the enteral route, intravenous lipid emulsions play a critical role in providing an energy-dense source of calories and supplying the essential fatty acids that cannot be endogenously synthesized. Over the last 50 y, lipid emulsions have been an important component of parenteral nutrition (PN), and over the last 10-15 y many new lipid emulsions have been manufactured with the goal of improving safety and efficacy profiles and achieving physiologically optimal formulations. The purpose of this review is to provide a background on the components of lipid emulsions, their role in PN, and to discuss the lipid emulsions available for intravenous use. Finally, the role of parenteral fat emulsions in the pathogenesis and management of PN-associated liver disease in PN-dependent pediatric patients is reviewed.

Keywords: fatty acids; lipid metabolism; parenteral nutrition; parenteral nutrition-associated liver disease; ω-3 fatty acids.

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Conflict of interest statement

Author disclosures: GL Fell and P Nandivada, no conflicts of interest. A license agreement for the use of Omegaven has been signed by Boston Children’s Hospital and Fresenius Kabi, and a patent has been submitted by Boston Children’s Hospital on behalf of KM Gura and M Puder.

Figures

FIGURE 1
FIGURE 1
Acetyl-CoA is a common intermediate of protein, carbohydrate, and fat metabolism, facilitating the conversion of excess protein and carbohydrate calories to fat, which is the densest form of energy storage. Nonbold black text indicates the important macronutrient metabolites. Red text indicates the cellular processes mediating each conversion.
FIGURE 2
FIGURE 2
Structure of the EFAs. (A) The parent n–3 FA ALA. All n–3 PUFAs contain more than one double bond, one of which is always at the n–3 carbon position. (B) The parent n–6 FA LA. All n–6 PUFAs contain more than one double bond, one of which is at the n–6 carbon position. ALA, α-linolenic acid; LA, linoleic acid.
FIGURE 3
FIGURE 3
Metabolic processing of n–3, n–6, and n–6 PUFAs by shared elongases and desaturases. These enzymes have the highest affinity for the n–6 FAs and the lowest affinity for the n–9 FAs. FAs in red are key intermediates for generating modulators of inflammation, coagulation, and cell signaling.
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