Modulation of lipid utilisation by parenteral administration of a fish-oil-enriched new lipid formula (SMOFlipid^®) in surgical ICU patients: comparison with a lipid emulsion based on olive and soybean oil

Introduction

Within the frame of postoperative total parenteral nutrition, a frequent consequence due to postaggression metabolism is an inhibition of lipoprotein lipase leading to hypertriglyceridemia [1]. The aim of this study was to investigate whether the administration of a fish-oil-containing lipid emulsion (SMOF) compared with a lipid emulsion based on olive and soybean oil led to a better utilisation of the lipids.

Methods

A prospective randomised study. After approval of the ethical committee, 44 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. The sedation regimen was standardised (midazolam and fentanyl), propofol (a lipid emulsion) was avoided. Patients were divided into two groups: group A (n = 22) received SMOF (SMOFlipid^® 20%), and group B (n = 22) received an emulsion based on olive and soybean oil (ClinOleic20%). Lipid emulsions were administered for 5 days continuously. Trigylceride (TG) levels were measured before the start of infusion (d0), at day 1 (d1), day 2 (d2), and day 5 (d5) after the start of infusion. A pathological TG level was defined at 300 mg/dl and the significance level at P < 0.05.

Results

There were no significant differences in TG levels at baseline (d0: group A: 119 ± 35 vs. group B: 120 ± 45 mg/dl; P = 0.87), whereas at d2 (group A: 151 ± 52 vs. group B: 202 ± 108 mg/dl; P < 0.03) and at d5 (group A: 163 ± 72 vs. group B: 233 ± 94 mg/dl; P < 0.01) the TG levels in the SMOF group were significant lower than in the control group. At d5 the incidence of pathological TG levels was significant lower in patients receiving SMOF (0%) compared with the control group (31.8%).

Conclusion

The administration of a fish-oil-containing lipid emulsion within a parenteral nutrition regimen led at d2 and d5 of the nutrition regimen to significantly reduced TG levels compared with a lipid emulsion based on olive and soybean oil, indicating a better utilisation of the administered TGs.