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

Abstract

Background & aims: Intravenous lipid emulsions (IVLEs) are a key component in long-term home parenteral nutrition (HPN), providing energy and essential fatty acids (EFAs). Modification of the fatty acid (FA) composition of IVLEs may lead to changes in metabolic responses and cell and tissue function, providing opportunity for clinical improvements. Studies have suggested that, in place of conventional pure soybean oil (SO)-based IVLEs, which have a high omega-6 FA content, alternative IVLEs with different FA profiles may have beneficial effects. Our aim is to assess the effects of different IVLEs in adults dependent on HPN.

Methods: A systematic literature search using specific terms was performed up to December 2015. Randomised controlled trials (RCTs) comparing two or more IVLEs in adult patients receiving HPN were included. The Cochrane Collaboration's tool for assessing risk of bias was employed and data for outcomes of interest were extracted and collated for interpretation.

Results: Three RCTs met the eligibility criteria to be included in this review. Sample sizes ranged from 13 to 75, giving a total of 110 patients. All three RCTs reported similar clinical safety for alternative IVLEs compared to SO. Antioxidant status improved with SO-medium-chain triglyceride-olive oil-fish oil (SMOF) but not with olive oil-SO (OO-SO). There was no effect on inflammatory markers according to IVLE used. Phospholipid FA profile was modified by SMOF and OO-SO, with SMOF resulting in a more preferable omega-6/omega-3 FA ratio than SO. There was no evidence of essential fatty acid deficiency with any IVLE. Liver function was improved with SMOF.

Conclusions: There may be benefits in using alternative IVLEs rather than pure SO in adults on HPN, but there are currently too few RCTs to reach a firm conclusion.

Keywords: Fish oil; Home parenteral nutrition; Intravenous lipid emulsion; Medium-chain triglyceride; Olive oil; Soybean oil.