Are Present Fat Emulsions Appropriate?

  • Y. A. Carpentier
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 17)


Lipid emulsions used in parenteral nutrition are administered to supply both energy and essential fatty acids to different tissues. Traditionally, these emulsions have been prepared using long-chain triglycerides (LCT) derived from soybean oil and phospholipids derived from egg yolk [1]. They have been marketed as 10% and 20% preparations, differing in the phospholipid/triglyceride ratio since the same amount of phospholipids (1.2 g/dL) was used in both types of preparations. Including these emulsions in the parenteral regimen of critically ill patients was shown to have beneficial effects, with respect to:
  1. 1.

    providing efficiently utilized energy substrates;

  2. 2.

    reducing the carbohydrate load and the associated respiratory and hepatic complications; and

  3. 3.

    avoiding or correcting essential fatty acid deficiency syndromes.



High Density Lipoprotein Parenteral Nutrition Visceral Leishmaniasis Lipoprotein Lipase Lipid Emulsion 
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  1. 1.
    Wretlind A (1981) Development of fat emulsions. JPEN 5:230–235CrossRefGoogle Scholar
  2. 2.
    Carpentier YA, Van Gossum A, Dubois DY, Deckelbaum RJ (1993) Lipid Metabolism. In: JL Rombeau, MD Caldwell (eds): “Clinical Nutrition: Parenteral Nutrition, 2nd edition”. WB Saunders Philadelphia, USA, pp:35–74Google Scholar
  3. 3.
    Haumont D, Deckelbaum RJ, Richelle M, et al (1989) Plasma lipid and plasma lipoprotein concentrations in low birth weight infants given parenteral nutrition with twenty or ten percent lipid emulsion. J Pediatr 115:787–793PubMedCrossRefGoogle Scholar
  4. 4.
    Olivecrona T, Bengtsson-Olivecrona G (1990) Lipases involved in lipoprotein metabolism. Curr Opin Lipidol 1:116–121CrossRefGoogle Scholar
  5. 5.
    Tonouchi H, Iriyama K, Carpentier YA (1990) Transfer of apolipoproteins between plasma lipoproteins and exogenous lipid particles after repeated bolus injections or during a continuous infusion of fat emulsion. JPEN 14:381–385CrossRefGoogle Scholar
  6. 6.
    Deckelbaum RJ, Hamilton JA, Moser A, et al (1990) Medium-chain versus long-chain triacylglycerol emulsion hydrolysis by lipoprotein lipase and hepatic lipase: Implications for the mechanisms of lipase action. Biochemistry 29:1136–1142PubMedCrossRefGoogle Scholar
  7. 7.
    Peterson J, Bihain BE, Bengtsson-Olivecrona G, Deckelbaum RJ, Carpentier YA, Olivecrona T (1990) Fatty acid control of lipoprotein lipase. A link between energy metabolism and lipid transport. Proc Natl Acad Sci 87:909–913PubMedCrossRefGoogle Scholar
  8. 8.
    Beisigel U, Weber W, Bengtsson-Olivecrona G (1991) Lipoprotein lipase enhances the binding of chylomicrons to low density lipoprotein receptor-related protein. Proc Natl Acad Sci USA 88:8342–8346CrossRefGoogle Scholar
  9. 9.
    Rumsey SC, Obunike JC, Arad Y, Deckelbaum RJ, Goldberg IJ (1992) Lipoprotein lipase-mediated uptake and degradation of low density lipoproteins by fibroblasts and macrophages. J Clin Invest 90:1504–1512PubMedCrossRefGoogle Scholar
  10. 10.
    Sniderman A, Baldo A, Cianflone K (1992) The potential role of acylation stimulating protein as a determinant of plasma trigylceride clearance and intracellular triglyceride synthesis. Curr Opin Lipidol 3:202–207CrossRefGoogle Scholar
  11. 11.
    Melin T, Qi C, Bengtsson-Olivecrona G, Akesson A, Nilsson A (1991) Hydrolysis of chylomicron polyenoic fatty acid esters with lipoprotein lipase and hepatic lipase. Bio- chim Biophys Acta 1075:259–266CrossRefGoogle Scholar
  12. 12.
    Tall AR (1986) Plasma lipid transfer protein. J Lipid Res 27:361–368PubMedGoogle Scholar
  13. 13.
    Packard CJ, Munro A, Lorimer AR, Gotto AM, Sheperd J (1984) Metabolism of apoli- poprotein B in large triglyceride-rich hypertriglyceridemic subjects. J Clin Invest 74:2178–2192PubMedCrossRefGoogle Scholar
  14. 14.
    Mahley RW, Weisgraber KH, Hussain MM, et al (1989) Intravenous infusion of apoli- poprotein E accelerates clearance of plasma lipoproteins in rabbits. J Clin Invest 83:2125–2130PubMedCrossRefGoogle Scholar
  15. 15.
    Yamada N, Shimano H, Mokuno H, et al (1989) Increased clearance of plasma cholesterol after injection of apolipoprotein E into Watanabe heritable hyperlipidemic rab- bitts. Proc Natl Acad Sci 86:665–669PubMedCrossRefGoogle Scholar
  16. 16.
    Brown MS, Herz J, Kowal RC, Goldstein JL (1991) The low-density lipoprotein recep- tor-related protein: Double agent or decoy? Curr Opin Lipidol 2:65–72CrossRefGoogle Scholar
  17. 17.
    Bessesen DH, Richards CL, Etienne J, Goers JW, Eckel RH (1993) Spinal cord of the rat contains more lipoprotein lipase than other brain regions. J Lipid Res 34:229–238PubMedGoogle Scholar
  18. 18.
    Haumont D, Richelle M, Deckelbaum RJ, Coussaert E, Carpentier YA (1992) Effect of liposomal content of lipid emulsions on plasma lipids in low birth weight infants receiving parenteral nutrition. J Pediatrics 121:759–763CrossRefGoogle Scholar
  19. 19.
    Griffin E, Breckenridge WC, Kuksis A, Bryan MH, Angel A (1979) Appearance and characterization of lipoprotein X during continuous Intralipid infusions in the neonate. J Clin Invest 64:1703–1712PubMedCrossRefGoogle Scholar
  20. 20.
    Untracht S (1982) Alterations of serum lipoproteins resulting from total parenteral nutrition with Intralipid. Biochim Biophys Acta 711:176–192PubMedGoogle Scholar
  21. 21.
    Williams KJ, Scanu AM (1986) Uptake of endogenous cholesterol by a synthetic liopo- protein. Biochim Biophys Acta 875:183–194PubMedGoogle Scholar
  22. 22.
    Dahlan W, Richelle M, Kulapongse S, Deckelbaum RJ, Carpentier YA (1992) Modification of erythrocyte membrane lipid composition induced by a single intravenous infusion of phospholipid-triacylglycerol emulsions in man. Clin Nutr 11:255–261PubMedCrossRefGoogle Scholar
  23. 23.
    Degott C, Messing B, Moreau D, et al (1988) Liver phospholipidosis induced by parenteral nutrition: Histologic, histochemical, and ultrastructural investigations. Gastroenterology 95:183–191PubMedGoogle Scholar
  24. 24.
    Harris HW, Grunfeld C, Feingold KR, Rapp JH (1990) Human very low density lipoproteins and chylomicrons can protect against endotoxin-induced death in mice. J Clin Invest 86:696–702PubMedCrossRefGoogle Scholar
  25. 25.
    Dubois DY (1993) Contribution à l’étude du métabolisme des HDL chez l’être humain. Mise en évidence de fonctions spécifiques des HDL en dehors du Reverse Cholesterol Transport. PhD Thesis, Université Libre de Bruxelles, BrusselsGoogle Scholar
  26. 26.
    Blackburn WD, Dohlman JG, Venkachalapathi YV, et al (1991) Apolipoprotein A-I decreases neutrophil degranulation and superoxide production. J Lipid Res 32:1911–1918PubMedGoogle Scholar
  27. 27.
    Packman CH, Rosenfeld SI, Leddy JP (1985) High-density lipoproteins and its apolipoproteins inhibit cytolytic activity of complement. Studies on the nature of the inhibitory moieties. Biochim Biophys Acta 812:107–115PubMedCrossRefGoogle Scholar
  28. 28.
    Jordan-Stack TC, Witte DP, Aronow BJ, Harmony JAK (1992) Apolipoprotein J: A membrane policeman? Curr Opin Lipidol 3:75–85CrossRefGoogle Scholar
  29. 29.
    Cuthbert JA, Lipsky PE (1987) Provision of cholesterol to lymphocytes by high density and low density lipoproteins. Requirement for low density lipoprotein receptors. J Biol Chem 262:7808–7818PubMedGoogle Scholar
  30. 30.
    Ginsberg H, Grabowski GH, Gibson JC, et al (1984) Reduced plasma concentrations of total, low density lipoprotein and high density lipoprotein cholesterol in patients with Gaucher type I disease. Clin Genetics 26:109–116CrossRefGoogle Scholar
  31. 31.
    Malmendier CL, Lontie J-F, Dubois DY (1991) Mechanisms of hypocholesterolemia. Adv Exp Med Biol 285:173–182PubMedGoogle Scholar
  32. 32.
    Hajri T, Ferezou J, Steinmetz P, Lutton C (1993) Total parenteral nutrition and plasma lipoproteins in the rat: Evidence for accelerated clearance of apo-A-I-rich HDL. Biochim Biophys Acta 1166:84–91PubMedGoogle Scholar
  33. 33.
    Yui Y, Aoyama T, Morishita H, Takahashi M, Takatsu Y, Kawai C (1988) Serum prostacyclin stabilizing factor is identical to apolipoprotein A-I (Apo A-I). A novel function of Apo A-I. J Clin Invest 82:803–807PubMedCrossRefGoogle Scholar
  34. 34.
    Bekaert ED, Dole E, Dubois DY, et al (1992) Alterations in lipoprotein density classes in infantile visceral Leishmaniasis: Presence of apolipoprotein SAA. Eur J Clin Invest 22:190–199PubMedCrossRefGoogle Scholar
  35. 35.
    Dubois DY, personal communicationGoogle Scholar
  36. 36.
    Endres S, Ghorbani R, Kelley VE, et al (1989) The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med 320:265–271PubMedCrossRefGoogle Scholar
  37. 37.
    Tisdale MJ, Beck SA (1991) Inhibition of tumor-induced lipolysis in vitro and cachexia and tumour growth in vivo by eicosapentaenoic acid. Biochem Pharmacol 41:103–107PubMedCrossRefGoogle Scholar
  38. 38.
    Lemoyne M, Van Gossum A, Kurian R, Jeejeebhoy KN (1988) Plasma vitamin E and selenium and breath pentane in home parenteral nutrition patients. Am J Clin Nutr 48:1310–1315PubMedGoogle Scholar
  39. 39.
    Van Gossum A, Lemoyne M, Sharriff R, Kurian A, Jeejeebhoy KN (1988) Increased lipid peroxidation after lipid emulsion as measured by breath pentane output. Am J Clin Nutr 48:1394–1399PubMedGoogle Scholar
  40. 40.
    Pitkanen O, Hallmann M, Andersson S (1991) Generation of free radicals in lipid emulsion used in parenteral nutrition. Pediatr Res 29:56–59PubMedCrossRefGoogle Scholar
  41. 41.
    Traber MG, Carpentier YA, Kayden HJ, Richelle M, Galeano N, Deckelbaum RJ (1993) Alterations in the distribution of alpha- and gamma-tocopherols in human lipoproteins in response to intravenous infusion of triglyceride-rich emulsions. Metabolism (in press)Google Scholar
  42. 42.
    Carpentier YA, Kinney JM, Siderova VS, et al (1990) Hypertriglyceridaemia clamp: A new model for studying lipid metabolism. Clin Nutr 9 (Suppl): 1CrossRefGoogle Scholar
  43. 43.
    Carpentier YA, Bihain B, Rubin M, et al (1990) Stabilization of plasma substrate concentrations: A model for conducting metabolic studies. Clin Nutr 9:313–318PubMedCrossRefGoogle Scholar
  44. 44.
    Richelle M (1992) Influence of intravenous lipid emulsions on cholesterol homeostasis. Clin Nutr 11:49–52CrossRefGoogle Scholar
  45. 45.
    Carpentier YA, Richelle M, Haumont D, Deckelbaum RJ (1990) New developments in fat emulsions. Proc Nutr Soc 49:375–380PubMedCrossRefGoogle Scholar
  46. 46.
    Dahlan W, Richelle M, Rössle C, Deckelbaum RJ, Carpentier YA (1992) Effects of essential fatty acid contents of lipid emulsions on erythrocyte polyunsaturated fatty acid composition in patients on long-term parenteral nutrition. Clin Nutr 11:262–268PubMedCrossRefGoogle Scholar
  47. 47.
    Rössle C, Carpentier YA, Richelle M, et al (1990) Medium chain triglycerides induce alterations in carnitine metabolism. Am J Physiol 258 : E944–E947PubMedGoogle Scholar
  48. 48.
    Oliviera T, Carpentier YA, Hansen I, Deckelbaum RJ (1992) Triglyceride hydrolysis of soy vs fish oil LCT emulsions. Clin Nutr 11 (suppl):44CrossRefGoogle Scholar
  49. 49.
    Rössle C (1993) Intravascular metabolism of a fish oil-supplemented lipid emulsion in an experimental dog model: Effects on plasma and liver lipids, lipoproteins and incorporation of long-chain n3 fatty acids into plasma lipids. Clin Nutr (in press)Google Scholar
  50. 50.
    Palombo J, Lydon E, Bistrian B, Forse A (1993) Rapid modulation of rat alveolar macrophage and lung phospholipid fatty acids (PLFA) by continuous enteral feeding with fish oil. JPEN 17:27SGoogle Scholar
  51. 51.
    Pomposelli JJ, Flores E, Hirschberg Y, et al (1990) Short-term TPN containing n-3 fatty acids ameliorate lactic acidosis induced by endotoxin in guinea pigs. Am J Clin Nutr 52:548–552PubMedGoogle Scholar
  52. 52.
    Pscheidl EM, Wan JM, Blackburn GL, Bistrian BR, Istfan NW (1992) Influence of w-3 fatty acids on splanchnic blood flow and lactate metabolism in an endotoxemic rat model. Metabolism 41:698–705PubMedCrossRefGoogle Scholar
  53. 53.
    Mok KT, Maiz A, Yamazaki K, et al (1984) Structured medium-chain and long-chain trigylceride emulsions are superior to physical mixtures in sparing body protein in the burned rat. Metabolism 33:910PubMedCrossRefGoogle Scholar
  54. 54.
    Ling PR, Istfan NW, Lopes SM, et al (1991) Structured lipid made from fish oil and medium-chain triglycerides alters tumor and host metabolism in Yoshida-sarcoma- bearing rats. Am J Clin Nutr 53:1177PubMedGoogle Scholar
  55. 55.
    Gollaher CJ, Swenson ES, Mascioli EA, Babayan VK, Blackburn GL, Bistrain BR (1992) Dietary fat level as determinant of protein-sparing actions of structured triglycerides. Nutrition 8:348–353PubMedGoogle Scholar
  56. 56.
    Redgrave TG, Kodali DR, Small DM (1988) The effect of triacyl-sn-glycerol structure on the metabolism of chylomicrons and triacylglycerol-rich emulsions in the rat. J Biol Chem 263:5118–5123PubMedGoogle Scholar
  57. 57.
    Olivecrona T, Bengtsson-Olivecrona G, Carpentier YA, Deckelbaum RJ, Hansen T, Frokjaer S (1990) Lipolysis of emulsions containing structured triglycerides with medium and long chain fatty acids. Clin Nutr 9 (Suppl) : 10CrossRefGoogle Scholar
  58. 58.
    Richelle M, Deckelbaum RJ, Olivecrona T, Hansen T, Frokjaer S, Carpentier YA (1990) Triglyceride structure determines cholesterol transport by lipid emulsions. Clin Nutr 9 (Suppl):32CrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1993

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  • Y. A. Carpentier

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