title: Higher docosahexaenoic acid, lower arachidonic acid and reduced lipid tolerance with high doses of a lipid emulsion containing 15% fish oil: a randomized clinical trial.
abstract: OBJECTIVE
  Lipid emulsions containing fish oil, as source of long chain omega 3 fatty acids, have recently became available for parenteral nutrition in infants, but scanty data exist in extremely low birth weight preterms. The objective of this study was to compare plasma fatty acids and lipid tolerance in preterm infants receiving different doses of a 15% fish oil vs. a soybean oil based lipid emulsion.
  
  
  METHODS
  Preterm infants (birth weight 500-1249 g) were randomized to receive parenteral nutrition with MOSF (30% Medium-chain triglycerides, 25% Olive oil, 30% Soybean oil, 15% Fish oil) or S (S, 100% Soybean oil) both at two levels of fat intake: 2.5 or 3.5 g kg(-1) d(-1), named 2.5Fat and 3.5Fat respectively. Plasma lipid classes and their fatty acid composition were determined on postnatal day 7 and 14 by gas chromatography together with routine biochemistry.
  
  
  RESULTS
  We studied 80 infants. MOSF infants had significantly higher plasma phospholipid Docosahexaenoic acid and Eicosapentaenoic and lower Arachidonic acid. Plasma phospholipids, triglycerides and free cholesterol were all significantly higher in the MOSF-3.5Fat group, while cholesterol esters were lower with MOSF than with S. The area under the curve of total bilirubin was significantly lower with MOSF than with S.
  
  
  CONCLUSIONS
  The use of a lipid emulsion with 15% FO resulted in marked changes of plasma long-chain fatty acids. Whether the benefits of increasing Docosahexaenoic acid outweigh the potential negative effect of reduced Arachidonic acid should be further studied. MOSF patients exhibited reduced lipid tolerance at 3.5 g kg(-1) d(-1) fat intake. The trial was conducted between January 2008 and December 2012 so we had not registered it in a public trials registry as it is now required for trials that started after July 2008.
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. Electronic address: rita.dascenzo@gmail.com.
authors: Rita
authors: R
authors: D'Ascenzo
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors: Sara
authors: S
authors: Savini
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors: Chiara
authors: C
authors: Biagetti
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors: Maria P
authors: MP
authors: Bellagamba
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors: Paolo
authors: P
authors: Marchionni
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors: Adriana
authors: A
authors: Pompilio
authors: DMCCP, Pediatric Hospital "Bambino Gesù", Rome, Italy.
authors: Paola E
authors: PE
authors: Cogo
authors: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors: Virgilio P
authors: VP
authors: Carnielli
mesh_terms: D016718:Arachidonic Acid / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D001724:Birth Weight; D004281:Docosahexaenoic Acids / Q000097:blood*; D015118:Eicosapentaenoic Acid / Q000097:blood; D004655:Emulsions / Q000008:administration & dosage / Q000737:chemistry; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood / Q000254:growth & development; D008297:Male; D000069463:Olive Oil; D010288:Parenteral Nutrition / Q000379:methods; D057947:Parenteral Nutrition Solutions / Q000008:administration & dosage / Q000737:chemistry*; D010743:Phospholipids / Q000097:blood; D010938:Plant Oils / Q000008:administration & dosage; D013024:Soybean Oil / Q000008:administration & dosage; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D000069463:Olive Oil; D057947:Parenteral Nutrition Solutions; D010743:Phospholipids; D010938:Plant Oils; D014280:Triglycerides; D004281:Docosahexaenoic Acids; D016718:Arachidonic Acid; D013024:Soybean Oil; D015118:Eicosapentaenoic Acid; D001663:Bilirubin
keywords: Arachidonic acid; Docosahexaenoic acid; Fish oil; Lipid tolerance; Parenteral nutrition; Preterm infants