Ann Surg Treat Res.  2016 Dec;91(6):309-315. 10.4174/astr.2016.91.6.309.

Effects of postoperative parenteral nutrition with different lipid emulsions in patients undergoing major abdominal surgery

• Demirer S
• Sapmaz A
• Karaca AS
• Kepenekci
• Aydintug S
• Balci D
• Sonyurek P
• Kose K

• KMID: 2360391
• DOI: http://doi.org/10.4174/astr.2016.91.6.309

Abstract

PURPOSE
This study was designed to investigate the effects of total parenteral nutrition (PN) using different lipid emulsions in patients undergoing major abdominal surgery.
METHODS
Fifty-two patients were randomized to receive soybean oil + medium chain triglycerides (MCT) (group I), soybean oil + olive oil (group II), soybean oil + olive oil + fish oil (group III) as a lipid source. PN was started on postoperative day 1 and patients were maintained on PN for a minimum period of 4 days. Laboratory variables (CRP, prealbumin, transferrin) were measured before surgery and on postoperative days.
RESULTS
Three treatment groups were included in the study. Patients in group I received long chain triglycerides (LCT) + LCT/MCT emulsion (%75 LCT + %25 LCT/MCT); Patients in group II received olive oil based emulsion (80% olive oil + 20% soybean oil, ClinOleic); Patients in group III received fish oil in addition to olive oil based emulsion (%85 ClinOleic + %15 Omegaven; Fresenius Kabi). The following 14 parameters were assessed: body weight, CRP, prealbumin, transferrin, tumor necrosis factor-α, interleukin-6, total antioxidant status, thiobarbituric acid reactive substances, oxidized low density lipoprotein-2, complete blood cell, international normalized ratio, D-dimer, activated partially thromboplastin time, prothrombin time. All other parameters showed no differences among the groups.
CONCLUSION
The results of our trial demonstrate a potential beneficial effect of soybean oil/olive oil based lipid emulsions for use in PN regarding inflammatory response and oxidant capacity in the treatment of patients.

Keyword

Lipid emulsions; Inflammatory response; Total antioxidant status

MeSH Terms

Blood Cells
Body Weight
Emulsions*
Fish Oils
Humans
Interleukin-6
International Normalized Ratio
Necrosis
Olive Oil
Parenteral Nutrition*
Parenteral Nutrition, Total
Prealbumin
Prothrombin Time
Soybean Oil
Soybeans
Thiobarbituric Acid Reactive Substances
Thromboplastin
Transferrin
Triglycerides
Emulsions
Fish Oils
Interleukin-6
Olive Oil
Prealbumin
Soybean Oil
Thiobarbituric Acid Reactive Substances
Thromboplastin
Transferrin
Triglycerides

Figure

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  Fig. 1 Evaluation of body weight from preoperative body weight and on postoperative day 1 and 3 during the study period. There was no statistically significant difference between the groups. Group I, soybean oil + medium chain triglycerides; group II, soybean oil + olive oil; group III, soybean oil + olive oil + fish oil.

• 

  Fig. 2 Assessment of nutritional parameters, serum albumin (A), prealbumin (B), and transferrin (C) levels, before and after the operation. Group I, soybean oil + medium chain triglycerides; group II, soybean oil + olive oil; group III, soybean oil + olive oil + fish oil.

• 

  Fig. 3 Assessment of inflammatory and immunological parameters, CRP (A), tumor necrosis factor (TNF)-α (B), and interleukin (IL)-6 (C) levels, before and after the operation. Group I, soybean oil + medium chain triglycerides; group II, soybean oil + olive oil; group III, soybean oil + olive oil + fish oil.

• 

  Fig. 4 Assessment of total antioxidant status (TAS; A), thiobarbituric acide reactive substance (TBARS; B), and oxidized low density lipoprotein-2 (oxLDL-2; C) before and after the operation. Group I, soybean oil + medium chain triglycerides; group II, soybean oil + olive oil; group III, soybean oil + olive oil + fish oil.

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