title: Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Soybean oil lipid emulsion may compromise immune function and promote hepatic damage due to its composition of long-chain fatty acids, phytosterols, high proportion of ω-6 fatty acids, and low α-tocopherol levels. Combination lipid emulsions have been developed using medium-chain triglyceride oil, fish oil, and/or olive oil, which provide adequate essential fatty acids, a smaller concentration of ω-6 fatty acids, and lower levels of phytosterols. The purpose of this systematic review is to determine if combination lipid emulsions have a more favorable impact on bilirubin levels, triglyceride levels, and incidence of infection compared with soybean oil lipid emulsions in children receiving parenteral nutrition.
  
  
  METHODS
  This study comprises a systematic review of published studies. Data were sufficient and homogeneous to conduct a meta-analysis for total bilirubin and infection.
  
  
  RESULTS
  Nine studies met the inclusion criteria. Meta-analysis showed that combination lipid emulsion decreased total bilirubin by a mean difference of 2.09 mg/dL (95% confidence interval, -4.42 to 0.24) compared with soybean oil lipid emulsion, although the result was not statistically significant (P = .08). Meta-analysis revealed no statistically significant difference in incidence of infection between the combination lipid emulsion and the soybean oil lipid emulsion groups (P = .846). None of the 4 studies that included triglyceride as an outcome detected a significant difference in triglyceride levels between the combination lipid emulsion and soybean oil lipid emulsion groups.
  
  
  CONCLUSIONS
  There is inadequate evidence that combination lipid emulsions offer any benefit regarding bilirubin levels, triglyceride levels, or incidence of infection compared with soybean oil lipid emulsions.
authors: Rutgers, The State University of New Jersey, Cranford, New Jersey lawlerkr@shrp.rutgers.edu.
authors: Kristen Lawler
authors: KL
authors: Finn
authors: Tufts University, Medford, Massachusetts.
authors: Mei
authors: M
authors: Chung
authors: Rutgers, The State University of New Jersey, Cranford, New Jersey.
authors: Pamela
authors: P
authors: Rothpletz-Puglia
authors: Rutgers, The State University of New Jersey, Cranford, New Jersey.
authors: Laura
authors: L
authors: Byham-Gray
mesh_terms: D001663:Bilirubin / Q000097:blood; D002648:Child; D003141:Communicable Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D005217:Fat Emulsions, Intravenous / Q000737:chemistry* / Q000494:pharmacology; D005227:Fatty Acids / Q000737:chemistry; D043371:Fatty Acids, Omega-6 / Q000737:chemistry; D005395:Fish Oils / Q000737:chemistry; D006801:Humans; D015994:Incidence; D000069463:Olive Oil / Q000737:chemistry; D010288:Parenteral Nutrition / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D013024:Soybean Oil / Q000737:chemistry* / Q000494:pharmacology; D014280:Triglycerides / Q000097:blood; D024502:alpha-Tocopherol / Q000737:chemistry
chemical_list: D005217:Fat Emulsions, Intravenous; D005227:Fatty Acids; D043371:Fatty Acids, Omega-6; D005395:Fish Oils; D000069463:Olive Oil; D014280:Triglycerides; D013024:Soybean Oil; D024502:alpha-Tocopherol; D001663:Bilirubin
keywords: lipids; parenteral nutrition; pediatrics