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Replacement of long‐chain triglyceride with medium‐chain triglyceride/long‐chain triglyceride lipid emulsion in patients receiving long‐term parenteral nutrition: effects on essential fatty acid status and plasma vitamin K1 levels
Author(s) -
Chambrier C,
Bannier E,
Lauverjat M,
Drai J,
Bryssine S,
Bouletreau P
Publication year - 2004
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/014860710402800107
Subject(s) - triglyceride , parenteral nutrition , emulsion , chemistry , medium chain triglyceride , fatty acid , phospholipid , vitamin , vitamin e , medicine , food science , cholesterol , endocrinology , biochemistry , antioxidant , membrane
BACKGROUND: In long‐term parenteral nutrition (LTPN) patients, the use of a 50:50 mixture of medium‐ and long‐chain triglyceride emulsion (MCT/LCT) has been suggested to prevent or correct fatty liver infiltration. However, the use of MCT/LCT lipid emulsion results in a 50% reduction of essential fatty acids and vitamin K1 supply and could induce essential fatty acid and vitamin K1 deficiencies. This study evaluated the effect of a long‐term infusion of MCT/LCT lipid emulsion on plasma fatty acid (FA) and vitamin K1 levels on LTPN patients. METHODS: In a prospective nonrandomized crossover study, we measured plasma phospholipid FA composition by gas chromatography and vitamin K1 levels by high‐performance liquid chromatography in 11 LTPN patients before and after a 4‐month replacement of the usual 20% LCT lipid emulsion (20% Lipoven; Fresenius‐Kabi France, Sevres, France) by a 20% MCT/LCT lipid emulsion (Medialipide B; Braun Medical, Boulogne, France). RESULTS: Patient received LTPN for 46 +/‐ 40 months; IV lipid emulsion was 827 +/‐ 336 mL/week. MCT/LCT lipid substitution did not change most of the essential plasma fatty acid concentrations and did not induce essential fatty acid deficiency. With both lipid emulsions, the triene/tetraene (20:3n‐9/20:4n‐6) ratio remained within the normal ranges. However, with MCT/LCT lipid emulsion, 22:4n‐6 (LCT: 0.50 +/‐ 0.12; MCT/LCT: 0.63 +/‐ 0.11%) and 22:5n‐6 (LCT: 0.32 +/‐ 0.11; MCT/LCT: 0.48 +/‐ 0.15%) increased significantly (p =.022 and 0.011, respectively). Plasma vitamin K1 levels decreased drastically with MCT/LCT lipid emulsion. CONCLUSIONS: An amount of 2.85 +/‐ 1.55 g x kg(‐1) week(‐1) of MCT/LCT lipid emulsion neither induced essential fatty acid deficiency nor improved the fatty acid disturbances usually observed in LTPN patients but did induce a drop in plasma vitamin K1 levels.