Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid) - A double-blind, randomised, multicentre study in adults

Stanislaw Klek, Cecile Chambrier, Pierre Singer, Moshe Rubin, Tim Bowling, Michael Staun, Francisca Joly, Henrik Rasmussen, Boyd J. Strauss, Geert Wanten, Ross Smith, Arun Abraham, Kinga Szczepanek, Jon Shaffer

Research output: Contribution to journalArticlepeer-review

Abstract

Precis: The aim of this study was to evaluate the safety and tolerance of a soybean/MCT/olive/fish oil emulsion in intestinal failure patients on long-term parenteral nutrition. 73 patients took part in a randomized, double-blind, multi-centre study. The study demonstrates that the lipid emulsion containing four different types of oils is safe and well tolerated in long-term PN. Background & aim: Long-term safety and efficacy of a lipid emulsion containing soybean oil, medium-chain triglycerides (MCT), olive oil and fish oil and enriched in vitamin E have not yet been evaluated in adult patients requiring long-term parenteral nutrition (PN). Methods: Randomised, controlled, double-blind, multicentre study in 73 patients with stable intestinal failure, requiring PN with either soybean/MCT/olive/fish emulsion (SMOFlipid, n = 34) or soybean emulsion (Intralipid, control n = 39) for 4 weeks. Safety and tolerance were monitored with standard clinical laboratory parameters, adverse events (AEs, according to the Common Terminology Criteria for Adverse Events (CTCAE) classification v 3.0) and vital signs. Fatty acid pattern in red blood cell phospholipids and plasma lipoproteins, serum Vitamin E, Interleukin (IL)-6, and soluble tumour necrosis (s-TNF)-receptor(R)II were also evaluated. Results: Mean concentrations of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin, whilst remaining within the reference range, were significantly lower with soybean/MCT/olive/fish (SMOF) oil emulsion after the treatment period compared to control. Eicosapentaenoic acid, docosahexaenoic acid and n-3/. n-6 fatty acid ratio increased in the SMOF group, while they remained unchanged in the control in plasma and RBC. Serum α-tocopherol concentrations significantly increased in the study group compared to control (p = 0.0004). IL-6 and sTNF-RII levels did not change during the study period. Grade 4 (serious) adverse events occurred in 2 SMOF patients and in 8 control patients (p = 0.03). Conclusions: Soybean/MCT/olive/fish emulsion was safe and well tolerated over 4 weeks and leads to positive change in fatty acids profile.

Original languageEnglish
Pages (from-to)224-231
Number of pages8
JournalClinical Nutrition
Volume32
Issue number2
DOIs
StatePublished - Apr 2013
Externally publishedYes

Keywords

  • Lipid emulsions
  • Liver function
  • Long-term intestinal failure
  • Parenteral nutrition
  • SMOFlipid
  • Short bowel syndrome

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