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).
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.
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.
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.
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).
Faculdade de Medicina Christus
Hospital Fernandes Távoraand Faculdade de Medicina Christus
Faculdade de Medicina Christus, Maria Cecilia Freitas Cesarino dos Santos
Hospital Fernandes Távora