Utilisation of structured triglycerides (Structolipid^®) in surgical ICU patients receiving parenteral nutrition

Background

Within the frame of postoperative total parenteral nutrition, a frequent consequence due to postaggression metabolism is an inhibition of lipoprotein lipase leading to hyper-triglyceridemia. The aim of this study was to investigate whether the administration of structured triglycerides (TGs) compared with conventional lipid emulsions led to a better utilisation of the lipids.

Methods

A prospective randomized study. After approval of the ethical committee, 45 postoperative surgical patients with an indication for parenteral nutrition therapy were included in the study. Nonprotein calories were given as 60% glucose and 40% lipid emulsion. The total energy intake per day was 25 kcal/kg body weight. Sedation regimen was standardized. Patients were divided into three groups: Group A (n = 15) received structured TGs (Structolipid^® 20%), group B (n = 15) received a MCT/LCT physical mixture (Lipofundin^® 20%) and group C (n = 15) received a pure LCT lipid emulsion (Lipovenoes^® 20%). Lipid emulsions were administered for 5 days postoperatively, corresponding to the observation time. TG levels were measured before the start of infusion (d0), at day 1 (d1), day 2 (d2), day 3 (d3) and day 5 (d5) after the start of infusion. The significance level was defined at P < 0.05.

Results

There were no significant differences in TG levels at d1 and d2, whereas at d3 and d5 the TG levels in group A (d3: 140 ± 31 mg/dl; d5 134 ± 36 mg/dl) were significantly lower than in group B (d3: 220 ± 91 mg/dl; d5 177 ± 52 mg/dl) and group C (d3: 239 ± 136 mg/dl; d5 256 ± 156 mg/dl).

Conclusion

The administration of structured lipid emulsions within a parenteral nutrition regimen led at d3 and d5 of the nutrition regimen to significantly reduced TG levels compared with a MCT/LCT physical mixture or a pure LCT lipid emulsion.