Metabolic impact of high lipid low dextrose parenteral nutrition.
Hyperglycemia
Lipids
Liver enzymes
Parenteral nutrition
Journal
Clinical nutrition ESPEN
ISSN: 2405-4577
Titre abrégé: Clin Nutr ESPEN
Pays: England
ID NLM: 101654592
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
09
04
2023
revised:
13
06
2023
accepted:
03
07
2023
medline:
25
9
2023
pubmed:
23
9
2023
entrez:
22
9
2023
Statut:
ppublish
Résumé
Parenteral nutrition (PN) containing 100% soybean oil lipids and high amounts of dextrose may lead to liver dysfunction and hyperglycemia. Mixed lipids have less pro-inflammatory components, so higher doses may be given to decrease the amount of dextrose provided. The purpose of this study is to provide a descriptive analysis of patients who received PN with high mixed lipid and low dextrose content versus PN with lower 100% soybean oil lipid and high dextrose content. We retrospectively reviewed 62 patients aged ≥18 years receiving PN ≥ 7 days from 2016 to 2021 in an acute care hospital. Participants were divided into two groups: high lipid low dextrose (HLLD) containing a four-oil lipid (>30% kcal or ≥1 g/kg) vs adequate lipid high dextrose (ALHD) containing a 100% soybean oil lipid (<30% kcal or <1 g/kg SO-ILE). Patients in the HLLD group (n = 31) had 64.1% lower incidence of blood glucose levels >180 mg/dL, decreased insulin requirements, 52.7% lower alkaline phosphatase levels, 40.6% higher prealbumin levels, and 42.6% lower c-reactive protein levels while maintaining similar calorie targets compared to the ALHD group (n = 31). Changing from 100% soybean oil to a mixed lipid in PN is helpful to reduce soybean oil intake. However, it is also important to increase the mixed lipid dose to decrease the amount of dextrose provided. PNs containing higher amounts of mixed lipids (40-45% kcal) with lower amounts of dextrose (20-30% kcal) may have clinical benefits that warrant further exploration.
Sections du résumé
BACKGROUND
Parenteral nutrition (PN) containing 100% soybean oil lipids and high amounts of dextrose may lead to liver dysfunction and hyperglycemia. Mixed lipids have less pro-inflammatory components, so higher doses may be given to decrease the amount of dextrose provided. The purpose of this study is to provide a descriptive analysis of patients who received PN with high mixed lipid and low dextrose content versus PN with lower 100% soybean oil lipid and high dextrose content.
METHODS
We retrospectively reviewed 62 patients aged ≥18 years receiving PN ≥ 7 days from 2016 to 2021 in an acute care hospital. Participants were divided into two groups: high lipid low dextrose (HLLD) containing a four-oil lipid (>30% kcal or ≥1 g/kg) vs adequate lipid high dextrose (ALHD) containing a 100% soybean oil lipid (<30% kcal or <1 g/kg SO-ILE).
RESULTS
Patients in the HLLD group (n = 31) had 64.1% lower incidence of blood glucose levels >180 mg/dL, decreased insulin requirements, 52.7% lower alkaline phosphatase levels, 40.6% higher prealbumin levels, and 42.6% lower c-reactive protein levels while maintaining similar calorie targets compared to the ALHD group (n = 31).
CONCLUSION
Changing from 100% soybean oil to a mixed lipid in PN is helpful to reduce soybean oil intake. However, it is also important to increase the mixed lipid dose to decrease the amount of dextrose provided. PNs containing higher amounts of mixed lipids (40-45% kcal) with lower amounts of dextrose (20-30% kcal) may have clinical benefits that warrant further exploration.
Identifiants
pubmed: 37739659
pii: S2405-4577(23)00535-1
doi: 10.1016/j.clnesp.2023.07.002
pii:
doi:
Substances chimiques
Soybean Oil
8001-22-7
Glucose
IY9XDZ35W2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
213-218Informations de copyright
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest None declared.