Faculdade de Medicina Christus
Hospital Fernandes Távoraand Faculdade de Medicina Christus
Faculdade de Medicina Christus, Maria Cecilia Freitas Cesarino dos Santos
Hospital Fernandes Távora
Introduction: This study aims to compare the effects of two lipid emulsions(olive oil versus MCT/LCT) upon several inflammatory mediators in critically ill patients using total parenteral nutrition (TPN).
Hypothesis: Olive oil-based lipid emulsions have been used for more than a decade to reduce polyunsaturated fatty acids (PUFA) contend in TPN preventing the deleterious effects associated with PUFA excess in opposition to MCT/LCT-based lipid emulsions. The MCT-LCT-based lipid emulsions have been associated with deleterious effects such as lipotoxicity, activation of inflammatory cascade and increased risk of cardiovascular disease [Pontes-Arruda. ClinNutr. Supplements 4:19,2009], however there are few prospective evidences available regarding the effects of these lipid emulsions upon the level of inflammatory mediators.
Methods: Serum was collected from 132 critically ill patients using parenteral nutrition in a multicenter and prospective open label study (NCT#00798681). Patients received either an olive oil-based lipid emulsion (OLI, n= 79, ClinOleic, Baxter) or an MCT-LCT lipid-emulsion (MCT, n=53). All samples were collected at baseline, Day 4 and Day 7. Changes in the levels of inflammatory markers from baseline to Day 7were compared using analysis of covariance (ANCOVA) and a p<.05 was considered statistically significant.
Results: The main baseline demographic characteristics were balanced between the groups. Patients receiving OLI presented at day 4 lower levels of: (OLI vs. MCB) IL-8 (52.4 vs. 132.1 pg/mL), TNF-alpha (3.5 vs.14.3 pg/mL), lymphocytes phosphatidylserine externalization (PS) (5.5 vs. 17.9%), and Resistin (R) (8.9 vs. 17.2 ng/mL) (all p<0.05). No differences were observed in the levels of IL-10 and CRP. Statistically significant differences were maintained throughoutday 7 for IL-8, TNF-alpha, PS and R.
Conclusions: The administration olive oil-based lipid emulsions within TPN regimen led to a significant reduction in the markers of inflammatory response when compared with LCT/MCT. It is particularly relevant to notice the differences for resistin (an indicator of insulin resistance) and PS (an indicator of apoptosis).