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.
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, Sèvres, 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.
Chambrier
Cécile
C
Centre Agréé de Nutrition Parentérale à Domicile, Hôpital E. HERRIOT, 69437 Lyon, France. cecile.chambrier@chu-lyon.fr
Bannier
Edith
E
Lauverjat
Madeleine
M
Drai
Jocelyne
J
Bryssine
Sylvie
S
Boulétreau
Paul
P
D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D005217:Fat Emulsions, Intravenous / Q000737:chemistry*; D005228:Fatty Acids, Essential / Q000097:blood* / Q000172:deficiency; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010743:Phospholipids / Q000097:blood; D011446:Prospective Studies; D013997:Time Factors; D014280:Triglycerides / Q000008:administration & dosage* / Q000737:chemistry; D010837:Vitamin K 1 / Q000097:blood*
D005217:Fat Emulsions, Intravenous; D005228:Fatty Acids, Essential; D010743:Phospholipids; D014280:Triglycerides; D010837:Vitamin K 1