Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-01-24T11:13:45.215Z Has data issue: false hasContentIssue false
  • English
  • Français

Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long-chain triacylglycerols

Published online by Cambridge University Press:  08 March 2007

A. García-de-Lorenzo ,
R. Denia ,
P. Atlan ,
S. Martinez-Ratero ,
A. Le Brun ,
D. Evard  and
G. Bereziat
A. García-de-Lorenzo*
Affiliation:
Hospital Universitario La Paz, Intensive Care Unit, Paseo de la Castellana, 261, 28046 Madrid, Spain
R. Denia
Affiliation:
Hospital Universitario La Paz, Intensive Care Unit, Paseo de la Castellana, 261, 28046 Madrid, Spain
P. Atlan
Affiliation:
Baxter SAS, R&D Nutrition, 6 avenue Louis-Pasteur, B.P. 56, 78311 Maurepas, Cedex, France
S. Martinez-Ratero
Affiliation:
Hospital Universitario La Paz, Intensive Care Unit, Paseo de la Castellana, 261, 28046 Madrid, Spain
A. Le Brun
Affiliation:
Baxter SAS, R&D Nutrition, 6 avenue Louis-Pasteur, B.P. 56, 78311 Maurepas, Cedex, France
D. Evard
Affiliation:
Baxter SAS, R&D Nutrition, 6 avenue Louis-Pasteur, B.P. 56, 78311 Maurepas, Cedex, France
G. Bereziat
Affiliation:
Laboratory of Biochemistry, Saint-Antoine Hospital, 75012 Paris, France
*
*Corresponding author: Dr A. Garcia-de-Lorenzo, fax +34 91 372 10 30, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

It has been claimed that lipid emulsions with a restricted linoleic acid content can improve the safety of total parenteral nutrition (TPN). The tolerability of TPN and its effects on the metabolism of fatty acids were assessed in this prospective, double-blind, randomised study comparing an olive/soyabean oil long-chain triacylglycerol (LCT) with a medium-chain triacylglycerol (MCT)/LCT; 50:50 (w) based lipid emulsion in two groups (O and M, respectively; eleven per group) of severely burned patients. After resuscitation (48–72 h), patients received TPN providing 147 kJ/kg per d (35 kcal/kg per d) with fat (1·3 g/kg per d) for 6 d Plasma fatty acids, laboratory parameters including liver function tests, and plasma cytokines were assessed before and after TPN. Adverse events encountered during TPN and the clinical outcomes of patients within the subsequent 6 months were recorded. With both lipid emulsions, the conversion of linoleic acid in its higher derivatives (di-homo-γ-linolenic acid) improved and essential fatty acid deficiency did not appear. Abnormalities of liver function tests occurred more frequently in the M (nine) than in the O (three) group (P=0·04, Suissa–Shuster test). Seven patients (four from group O and three from group M) died as a consequence of severe sepsis 3–37 d after completion of the 6 d TPN period. When compared with the surviving patients, those who died were older (P=0·01) and hyperglycaemic at baseline (P<0·001), and their plasma IL-6 levels continued to increase (P<0·04). Although fatty acid metabolism and TPN tolerability were similar with both lipid emulsions, the preservation of liver function noted with the use of the olive oil-based lipid emulsions deserves confirmation.

Keywords

BurnsParenteral nutritionLipid emulsionOlive oilLiver function tests
Type
Research Article
Information
British Journal of Nutrition , Volume 94 , Issue 2 , August 2005 , pp. 221 - 230
Copyright
Copyright © The Nutrition Society 2005

References

Alexander, JW (1990) Mechanism of immunologic suppression in burn injury. J Trauma 30, 70S–75S.CrossRefGoogle ScholarPubMed
Alpers, DH (2001) Liver complications and failure in patients on home parenteral nutrition. Curr Opin Gastroenterol 17, 147–149.CrossRefGoogle ScholarPubMed
Barlow, Y (1994) T lymphocytes and immunosuppression in the burned patient: a review. Burns 20, 487–490.CrossRefGoogle ScholarPubMed
Battistella, FD, Widergren, JT, Anderson, JT, Siepler, JK, Weber, JC & MacColl, K (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 43, 52–60.CrossRefGoogle ScholarPubMed
Beau, P, Barrioz, T & Ingrand, P (1994) Is parenteral nutrition-related cholestatic liver disease an infectious disease? Gastroenterol Clin Biol 18, 63–67.Google ScholarPubMed
Beau, P, de Lédinghen, V & Ingrand, P (1995) Total parenteral nutrition-related liver disease and medium chain triglycerides lipid emulsions. Nutr Clin Metabol 9, 117–122.CrossRefGoogle Scholar
Bellinati-Pires, R, Waitzberg, DL, Salgado, MM & Carneiro-Sampaio, MM (1993) Functional alterations of human neutrophils by medium-chain triglyceride emulsion: evaluation of phagocytosis, bacterial killing, and oxidative activity. J Leukoc Biol 53, 404–410.CrossRefGoogle ScholarPubMed
Bone, RC (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101, 1644–1655.CrossRefGoogle ScholarPubMed
Bouletreau, P, Berrada, K & Chambrier, C (1996) Tolérance hépatique de l'émulsion lipidique ClinOleic ®. Nutr Clin Métabol 10, 335–365.CrossRefGoogle Scholar
Calder, PC & Newsholme, EA (1992) PUFAs suppress human peripheral blood lymphocytes proliferation and interleukin-2 production. Clin Sci 75, 695–700.CrossRefGoogle Scholar
Capron, JP, Gineston, JL, Hervé, MA & Braillon, A (1983) Metronidazole in prevention of cholestasis associated with total parenteral nutrition. Lancet 1, 446–447.CrossRefGoogle ScholarPubMed
Carsin, H, Assicot, M, Feger, F, Roy, O, Pennacino, I, Le Bever, H, Ainaud, P & Bohuon, C (1997) Evolution and significance of circulating procalcitonin levels compared with IL-6, TNF alpha and endotoxin levels early after thermal injury. Burns 23, 218–224.CrossRefGoogle ScholarPubMed
Cavicchi, M, Bean, P, Crenn, P, Degott, C & Messing, B (2000) Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 132, 525–532.CrossRefGoogle ScholarPubMed
Cetinkale, O & Yazici, Z (1997) Early postburn fatty acid profile in burn patients. Burns 23, 392–399.CrossRefGoogle ScholarPubMed
Chambrier, C, Guiraud, M, Gibault, JP, Labrosse, H & Bouletreau, P (1999) Medium- and long-chain triacylglycerols in postoperative patients: structured lipids versus a physical mixture. Nutrition 15, 274–277.CrossRefGoogle ScholarPubMed
Charcon Castro, MP, Jimenez Sesé, B, Salvado Salvat, J, Sabin Urquia, P, Pascual Mostaza, C & Planas Vila, M (2000) Influence of two fatty emulsions with a different triglyceride composition on the lipid metabolism of the septicemic patient. Nutr Hosp 15, 13–17.Google Scholar
De Francesco, A, Balzola, FA, Come, A, Le Brun, A, Evard, D, Atlan, P, Dutot, G & Balzola, F (1999) Long-term safety of home parenteral nutrition (HPN) with a new olive oil-based lipid emulsion (LE): a randomised, double-blind, comparative trial. Clinical Nutrition 18, Suppl. 1, 46.Google Scholar
Deitch, EA (1995) Nutrition support of the burn patient. In Nutrition in the Critically Ill Patient, pp. 735–750 [Lang, CH, editor]. Philadelphia: WB Saunders.Google Scholar
Driss, F, Darcet, P, Delhaye, N & Mendy, F (1988) Effect of eicosapentanoic acid on RBC filterability and fatty acid composition. Clin Hemorrheol 8, 679–685.Google Scholar
Drost, AC, Burleson, DG, Cioffi, WG Jr, Jordan, BS, Mason, AD Jr & Pruitt, BA Jr (1993) Plasma cytokines following thermal injury and their relationship with patient mortality, burn size, and time postburn. J Trauma 35, 335–339.CrossRefGoogle ScholarPubMed
Endo, S, Inada, K, Yamada, Y, et al. (1996) Plasma levels of interleukin-1 receptor antagonist (IL-1ra) and severity of illness in patients with burns. J Med 27, 57–71.Google ScholarPubMed
Eritsland, J (2000) Safety considerations of polyunsaturated fatty acids. Am J Clin Nutr 71, 197S–201S.CrossRefGoogle ScholarPubMed
Freeman, J, Goldmann, DA, Smith, NE, Sidebottom, DG, Epstein, ME & Platt, R (1990) Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 323, 301–308.CrossRefGoogle ScholarPubMed
Friedman, B & Deppe, SA (2002) Nutritional considerations in the severely burned patient. In Nutritional Considerations in the Intensive Care Unit, pp. 245–258 [Shirota, SA, Martindale, RG and Scwaitzberg, SD, editors]. Silver Spring, CO: Kendall/Hunt Publishing Company & ASPEN.Google Scholar
García-de-Lorenzo, A (1983) Metronidazole, cholestasis and total parenteral nutrition. Lancet 21, 1161.Google Scholar
Garcia-de-Lorenzo, A & Culebras, JM (1992) Linoleic acid and the immune system. Controversies about lipid emulsions. Nutr Hosp 7, 377–387.Google ScholarPubMed
Garnacho-Montero, J, Ortiz-Leyba, C, Garnacho-Montero, MC, Garcia-Garmendia, JL, Perez-Paredes, C, Moyano-Del Estad, MR, Barrero-Almodovar, A & Jimenez-Jimenez, FJ (2002) Effects of three intravenous lipid emulsions on the survival and mononuclear phagocyte function of septic rats. Nutrition 18, 751–754.CrossRefGoogle ScholarPubMed
Garrel, DR, Razi, M, Lariviere, F, Jobin, N, Naman, N, Emptoz-Bonneton, A & Pugeat, MM (1995) Improved clinical status and length of care with low-fat nutrition support in burn patients. J Parenter Enter Nutr 19, 482–491.CrossRefGoogle ScholarPubMed
German, G, Barthold, U, Lefering, R, Raff, T & Hartmann, B (1997) The impact of risk factors and pre-existing conditions on the mortality of burn patients and the precision of predictive admission-scoring systems. Burns 23, 195–203.CrossRefGoogle Scholar
Gobel, Y, Koletzko, B, Bohles, HJ, Engelsberger, I, Forget, D, Le Brun, A, Peters, J & Zimmermann, A (2003) Parenteral fat emulsions based on olive and soybean oils: a randomized clinical trial in preterm infants. J Pediatr Gastroenterol Nutr 37, 161–167.Google ScholarPubMed
Goulet, O, De Potter, S, Antebi, H, et al. (1999) Long-term efficacy and safety of a new olive oil-based intravenous fat emulsion in paediatric patients: a double blind randomized study. Am J Clin Nutr 70, 338–345.CrossRefGoogle ScholarPubMed
Granato, D, Blum, S, Rössle, C, Le Boucher, J, Malnoe, A & Dutot, G (2000) Effects of parenteral lipid emulsions with different fatty acid composition on immune cell functions in vitro. J Parenter Enter Nutr 24, 113–118.CrossRefGoogle ScholarPubMed
Guo, Y, Dickerson, C, Chrest, FJ, Adler, WH, Munster, AM & Winchurch, RA (1990) Increased levels of circulating interleukin 6 in burn patients. Clin Immunol Immunopathol 54, 361–371.CrossRefGoogle ScholarPubMed
Hageman, JR, McCulloch, K, Gora, P, Olsen, EK, Pachman, L & Hunt, CE (1983) Intralipid alterations in pulmonary prostaglandin metabolism and gas exchange. Crit Care Med 11, 794–798.CrossRefGoogle ScholarPubMed
Herndon, DN, Stein, MD, Rutan, TC, Abston, S & Linares, H (1987) Failure of TPN supplementation to improve liver function, immunity, and mortality in thermally injured patients. J Trauma 27, 195–204.CrossRefGoogle ScholarPubMed
Herruzo-Cabrera, R, Fernandez-Arjona, M, Garcia-Torres, V, Martinez-Ratero, S, Lenguas-Portero, F & Rey-Calero, J (1995) Mortality evolution study of burn patients in a critical care burn unit between 1971 and 1991. Burns 21, 106–109.CrossRefGoogle Scholar
Holman, RT (1960) The ratio of trienoic:tetraenoic acids in the tissue lipids as a measure of essential fatty acid requirement. J Nutr 70, 405–410.CrossRefGoogle ScholarPubMed
Karlstad, MD, DeMichele, SJ, Leathem, WD & Peterson, MB (1993) Effect of intravenous lipid emulsions enriched with gamma-linolenic acid on plasma n-6 fatty acids and prostaglandin biosynthesis after burn and endotoxin injury in rats. Crit Care Med 21, 1740–1749.CrossRefGoogle ScholarPubMed
Kinsella, JE, Lokesh, B, Broughton, S & Whelan, J (1990) Dietary polyunsaturated fatty acids and eicosanoids: potential effects on the modulation of inflammatory and immune cells: an overview. Nutrition 6, 24–44.Google ScholarPubMed
Kono, H, Fujii, H, Asakawa, M, Matsuda, M, Maki, A & Matsumoto, Y (2003) Protective effects of medium-chain triglycerides on the liver and gut in rats administered endotoxin. Ann Surg 237, 246–255.CrossRefGoogle ScholarPubMed
Kowal-Vern, A, Walenga, JM, Hoppensteadt, D, Sharp-Pucci, M & Gamelli, RL (1994) Interleukin-2 and interleukin-6 in relation to burn wound size in the acute phase of thermal injury. J Am Coll Surg 178, 357–362.Google ScholarPubMed
McManus, AT, Mason, AD Jr, McManus, WF & Pruitt, BA Jr (1985) Twenty-five year review of Pseudomonas aeruginosa bacteremia in a burn center. Eur J Clin Microbiol 4, 219–223.CrossRefGoogle Scholar
Masini, JP, Fichelle, A, Pescio, M, Béréziat, G, Desmonts, JM & Lienhart, A (1996) Tolérance clinique et biologique et effets sur les paramétres lipidiques de ClinOleic® comparé à l'Intralipide ® chez des patients de réanimation chirurgicale. Nutr Clin Métabol 10, 21S–24S.CrossRefGoogle Scholar
Montegut, WJ & Lowry, SF (1993) Nutrition in burn patients. Semin Nephrol 13, 400–408.Google ScholarPubMed
Morlion, BJ, Torwesten, E, Lessire, H, Sturm, G, Peskar, BM, Furst, P & Puchstein, C (1996) The effect of parenteral fish oil on leukocyte membrane fatty acid composition and leukotriene-synthesizing capacity in patients with postoperative trauma. Metabolism 45, 1208–1213.CrossRefGoogle ScholarPubMed
Moussa, M, Le Boucher, J, Garcia, J, Tkaczuk, J, Ragab, J, Dutot, G, Ohayon, E, Ghisolfi, J & Thouvenot, JP (2000) In vivo effects of olive oil-based lipid emulsion on lymphocyte activation in rats. Clin Nutr 19, 49–54.CrossRefGoogle ScholarPubMed
Nordenstrom, J, Jarstrand, C & Wirniek, A (1979) Decreased chemotactic and random migration of leukocytes during intralipid infusion. Am J Clin Nutr 32, 2416–2420.CrossRefGoogle ScholarPubMed
Pakula, R, Konikoff, FM, Moser, AM, Greif, F, Tietz, A, Gilat, T & Rubin, M (1999) The short term lipid infusion on plasma and hepatic bile lipids in humans. Gut 45, 453–458.CrossRefGoogle ScholarPubMed
Papini, RP, Wilson, AP, Steer, JA, Hill, G, McGrouther, DA & Parkhouse, N (1997) Plasma concentrations of tumour necrosis factor-alpha and interleukin-6 during burn wound surgery or dressing. Br J Plast Surg 50, 354–361.CrossRefGoogle ScholarPubMed
Peck, MD (1994) Interaction of lipids with immune function. I. Biochemical effects of dietary lipids on plasma membranes. J Nutr Biochem 5, 466–478.CrossRefGoogle Scholar
Pelaez, J, Garcia-de-Lorenzo, A, Denia, R, Martinez-Ratero, S, Lopez, J & Caparros, T (1997) Nutritional support for the large burn patient. Nutr Hosp 12, 121–133.Google ScholarPubMed
Pratt, VC, Tredget, EE, Clandinin, MT & Field, CJ (2001) Fatty acid content of plasma lipids and erythrocyte phospholipids are altered following burn injury. Lipids 36, 675–682.CrossRefGoogle ScholarPubMed
Pratt, VC, Tredget, EE, Clandinin, MT & Field, CJ (2002) Alterations in lymphocyte function and relation to phospholipid composition after burn injury in humans. Crit Care Med 30, 1753–1761.CrossRefGoogle ScholarPubMed
Reimer, T, Morlion, B, Fürsts, P, Le Brun, A, Atlan, P, Dutot, G & Puchstein, C (2001) Effects of an olive oil based intravenous lipid emulsion (ILE) on plasma and leukocyte membrane fatty acid (FA) composition and on clinical outcomes in postoperative patients. Clin Nutr 20, suppl.40.Google Scholar
Rocca, AS, LaGreca, J, Kalitsky, J & Brubaker, PL (2001) Monounsaturated fatty acid diets improve glycemic tolerance through increased secretion of glucagon-like peptide-1. Endocrinology 142, 1148–1155.CrossRefGoogle ScholarPubMed
Rossle, C, Breton, I, Bereziat, G, et al. (1992) Evolution of plasma phospholipid FA pattern in patients receiving postoperative TPN including soybean oil or olive oil-based lipid emulsions: a comparative multicenter study. Clin Nutr 11, suppl.19.CrossRefGoogle Scholar
Rubin, M, Halpern, Z, Charach, G, Dvir, A, Antebi, E, Gilat, T & Lichtenberg, D (1992) Effect of lipid infusion on bile composition and lithogenicity in patients without cholesterol gallstones. Gut 33, 1400–1403.CrossRefGoogle Scholar
Rubin, M, Pakula, R, Moser, A, Halpern, Z, Shimonov, M & Lichtenberg, D (1996) Does lipid infusion affect bile composition in humans? Isr J Med Sci 32, 1308–1313.Google ScholarPubMed
Sadeghi, S, Wallace, FA & Calder, PC (1999) Dietary lipids modify the cytokine response to bacterial lipopolysaccharide in mice. Immunology 96, 404–410.CrossRefGoogle ScholarPubMed
Schwacha, MG & Chaudry, IH (2002) The cellular basis of post-burn immunosuppression: macrophages and mediators. Int J Mol Med 10, 239–243.Google ScholarPubMed
Seidner, DL, Mascioli, EA, Istfan, NW, Porter, KA, Selleck, K, Blackburn, GL & Bistrian, BR (1989) Effects of long-chain triglyceride emulsions on reticuloendothelial system function in humans. J Parenter Enter Nutr 13, 614–619.CrossRefGoogle ScholarPubMed
Sparkes, BG (1997) Immunological responses to thermal injury. Burns 23, 106–113.CrossRefGoogle ScholarPubMed
Spielmann, D, Bracco, U, Traitler, H, Crozier, G, Holman, R, Ward, M & Cotter, R (1988) Alternative lipids to usual n-6 PUFAS: γ-linolenic acid, α-linolenic acid, stearidonic acid, EPA, etc. J Parenter Enter Nutr 12, 111S–123S.CrossRefGoogle Scholar
Suissa, S & Shuster, JJ (1985) Exact unconditional sample sizes for the 2 by 2 binomial trial. J Roy Statist Soc A148, 317–327.CrossRefGoogle Scholar
Thomas-Gibson, S, Jawhari, AU, Atlan, P, Le Brun, A, Farthing, A & Forbes, A (2004) Safe and efficacious prologed use of an olive oil-based lipid emulsion (ClinOleic) in chronic intestinal failure. Clin Nutr 23, 697–703.CrossRefGoogle Scholar
Tobiasen, J, Hiebert, JM & Edlich, RF (1982) The abbreviated burn severity index. Ann Emerg Med 11, 260–262.CrossRefGoogle ScholarPubMed
Ueyama, M, Maruyama, I, Osame, M & Sawada, Y (1992) Marked increase in plasma interleukin-6 in burn patients. J Lab Clin Med 120, 693–698.Google ScholarPubMed
Vahedi, K, Bereziat, G, Le Brun, A, Perennec, V, Evard, D, Atlan, P, Dutot, G & Messing, B (1999) A randomised, double-blind 3-month study in home parenteral nutrition (HPN) patients with olive or soy oil-based lipid emulsions (ILE): safety, nutritional status, plasma and cell-membrane fatty acid profiles. Clin Nutr 18, Suppl.48.Google Scholar
Van den Berghe, G, Wouters, P, Weekers, F, Verwaest, C, Bruyninckx, F, Schetz, M, Vlasselaers, D, Ferdinande, P, Lauwers, P & Bouillon, R (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345, 1359–1367.CrossRefGoogle ScholarPubMed
Waitzberg, DL, Bellinati Pires, R, Salgado, MM, Hypolito, IP, Colleto, GM, Yagi, O, Yamamuro, EM, Gama-Rodrigues, J & Pinotti, HW (1997) Effect of total parenteral nutrition with different lipid emulsions on human monocyte and neutrophils functions. Nutrition 13, 128–132.CrossRefGoogle Scholar
Wanten, GJA, Roos, D & Naber, AHJ (2000) Effects of structurally different lipid emulsions on human neutrophil migration. Clin Nutr 19, 327–331.CrossRefGoogle ScholarPubMed
Warden, GD, Wilmore, DW, Rogers, PW, Mason, AD & Pruitt, BA Jr (1973) Hypernatremic state in hypermetabolic burn patients. Arch Surg 106, 420–427.CrossRefGoogle Scholar
Weissman, C (1999) Nutrition in the intensive care unit. Crit Care 3, 67R–75R.CrossRefGoogle ScholarPubMed
Yamada, Y, Endo, S & Inada, K (1996) Plasma cytokine levels in patients with severe burn injury with reference to the relationship between infection and prognosis. Burns 22, 587–593.CrossRefGoogle Scholar
Ythier-Moury, P, Dutot, G & Melin, C (1990) Modifications of biliary secretion associated with parenteral nutrition in the rat: influence of fat emulsion composition. Clin Nutr 9, suppl.26.CrossRefGoogle Scholar
Zawacki, BE, Azen, SP, Imbus, SH & Chang, YT (1979) Multifactorial probit analysis of mortality in burned patients. Ann Surg 189, 1–5.CrossRefGoogle ScholarPubMed