Serum phospholipid fatty acids in severely injured patients on total parenteral nutrition with medium chain/long chain triglyceride emulsions

Abstract

The final goals of parenteral nutrition of severely injured patients is to satisfy energy and nitrogen requirements and simultaneously to prevent deficiency of essential nutrients as well as to reduce trauma-related metabolic disturbances. To evaluate clinical benefits either by a combination of carbohydrates and a medium-chain/long-chain triglyceride (MCT/LCT) lipid emulsion versus carbohydrates as the sole energy donor, 24 ventilated patients with multiple injuries and major head trauma were investigated. All patients received an isocaloric, isonitrogenous total parenteral nutrition (TPN) regimen consisting of either a no-lipids carbohydrate regimen (CH regimen) or a combined regimen of carbohydrates plus MCT/LCT emulsion (CH + MCT/LCT regimen), for 8 days in equal groups in the format of a prospective randomized study. After 5 days on the CH regimen, serum phospholipid measurements suggested linoleic acid deficiency and after 7 days alpha-linolenic acid deficiency. As a consequence significant decreases in the concentrations of both the n-6 and n-3 fatty acids along with a compensatory increase in nonessential n-9 fatty acids were observed. By contrast, the CH + MCT/LCT regimen maintained the concentrations of phospholipid linoleic acid and alpha-linolenic acid, thus preventing fatty acid pattern imbalances. The linoleic acid and alpha-linolenic acid metabolite balance was similarly maintained with the CH + MCT/LCT regimen.