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

Affiliations
  • 1Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey.
  • 2Ankara Numune Education and Research Hospital, Ankara, Turkey. karacaahmetserdar@gmail.com
  • 3Ankara University School of Medicine Nutrition Team, Ankara, Turkey.
  • 4Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.

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

  • 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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Young-Dong Yu, Jae-hyun Han, Sung-Won Jung, Dong-Sik Kim
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