Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients.
OBJECTIVE
We assessed the effects of a novel lipid emulsion with reduced content of n-6 fatty acids (FA), increased share of MUFA and n-3 FA and supplemental vitamin E on fatty acid and leukotriene pattern in surgical patients.


METHODS
In a double-blind, randomized study 33 patients received isonitrogenous, isocaloric TPN over 5 postoperative days following major abdominal surgery. 19 patients received the new SMOFlipid 20% and 14 patients a standard soybean oil emulsion (Lipovenoes 20%, both Fresenius Kabi), each 1.5 g fat/kg body weight (BW)/d. Routine lipid biochemistry, plasma tocopherol, fatty acid pattern in plasma phospholipids, as well as leukotriene (LT) release in leukocytes were assessed. Additionally, fatty acid pattern in leukocyte and platelet phospholipids were analysed, but results are not presented.


RESULTS
On day 6, plasma alpha-tocopherol (34.2 +/- 10.3 vs. 17.6 +/- 2.9 micromol/L) and, in plasma PL, total n-3 FA were higher (11.1 +/- 1.9 vs. 4.9 +/- 0.9 mol%; p < 0.05) and total n-6 FA lower (23.8 +/- 2.2 vs. 31.8 +/- 1.7 mol%; P < 0.05); the ratio n-3/n-6 FA being elevated (0.5 +/- 0.1 vs. 0.2 +/- 0.0 p < 0.05) with SMOFlipid compared to the soybean oil emulsion. The shares of EPA (3.3+/-1.0 vs. 0.4+/-0.2 mol%; p<0.05) and DHA (6.9 +/- 1.8 vs. 3.7 +/- 0.8 mol%; p < 0.05) were highly increased but that of arachidonic acid (AA) was unchanged with SMOFlipid while the ratio EPA/AA was increased (0.7 +/- 0.2 vs. 0.1 +/- 0.0 p < 0.05). LTB(5) release was enhanced on day 6 (8.1 +/- 5.3 vs. 1.8 +/- 3.8 pmol/10(7) PMN, p < 0.05) and liberation of LTB(4) was lowered, yet not significantly with SMOFlipid (124.0 +/- 51.2 vs. 152.1 +/- 68.8 pmol/10(7) PMN). Length of hospital stay was significantly shorter with SMOFlipid (13.4 +/- 2.0 vs. 20.4 +/- 10.0 days, p < 0.05).


CONCLUSIONS
Treatment with the new emulsion SMOFlipid is well tolerated and modulates FA and leukotriene pattern suggesting favourable anti-inflammatory effects and further clinical benefits.
Grimm
Helmut
H
Clinic for General, Visceral, Thoracic, Vascular and Pediatric Surgery, Clinical Centre Passau, Innstr. 76, 94032 Passau, Germany. helmut.grimm@klinikum-passau.de
Mertes
Norbert
N
Goeters
Christiane
C
Schlotzer
Ewald
E
Mayer
Konstantin
K
Grimminger
Friedrich
F
Fürst
Peter
P
D000005:Abdomen / Q000601:surgery; D000975:Antioxidants / Q000008:administration & dosage / Q000378:metabolism; D004311:Double-Blind Method; D005217:Fat Emulsions, Intravenous / Q000032:analysis / Q000737:chemistry; D005227:Fatty Acids / Q000032:analysis* / Q000378:metabolism; D015525:Fatty Acids, Omega-3 / Q000032:analysis / Q000627:therapeutic use*; D043371:Fatty Acids, Omega-6 / Q000032:analysis; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D006801:Humans; D007902:Length of Stay; D015289:Leukotrienes / Q000032:analysis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D000069463:Olive Oil; D010289:Parenteral Nutrition, Total / Q000379:methods*; D010743:Phospholipids / Q000737:chemistry*; D010938:Plant Oils / Q000008:administration & dosage; D013024:Soybean Oil / Q000008:administration & dosage; D016896:Treatment Outcome; D014810:Vitamin E / Q000008:administration & dosage / Q000097:blood
D000975:Antioxidants; D005217:Fat Emulsions, Intravenous; D005227:Fatty Acids; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005395:Fish Oils; D015289:Leukotrienes; D000069463:Olive Oil; D010743:Phospholipids; D010938:Plant Oils; D014810:Vitamin E; D013024:Soybean Oil