No deficiency of essential fatty acids in home parenteral nutrition

Introduction

Home parenteral nutrition (HPN) provides patients with essential fatty acids in the form of a lipid emulsion. By combining different types of oils contained in HPN, the amount of pro-inflammatory essential fatty acids (EFAs), particularly linoleic acid, which is abundantly present in soybean oil, can be reduced. Parenteral nutrition with a combination of soybean and olive oil contains 3 times less linoleic acid than nutrition with soybean oil alone.

The primary concern is whether patients who rely entirely on HPN have an adequate intake of EFAs. Insufficient intake may result in EFA deficiency in the body, which can manifest as fluid loss due to increased skin permeability, susceptibility to infections, poor wound healing, hematological complications, or impaired fat absorption and metabolism.

Study Design and Population

The presented study evaluated whether patients using home parenteral nutrition with a combination of soybean (20%) and olive (80%) oil exhibit clinical or biochemical signs of EFA deficiency.

Thirty patients were included in the study, with a median age of 57 years, who had been using HPN for more than 3 months with a frequency of at least 5 times per week. Indications for HPN included mainly short bowel syndrome, gastrointestinal motility disorders, chronic intestinal pseudo-obstruction, or Crohn's disease. Patients with metabolic disorders or allergies were excluded from the study. The control group consisted of 30 healthy individuals.

Results

None of the monitored patients or control subjects showed clinical or biochemical signs of EFA deficiency, such as skin lesions or elevated Holman index values (> 0.2). This index, which indicates the ratio of eicosatrienoic (Mead's) acid to arachidonic acid and serves as a marker of potential EFA deficiency, was higher in HPN patients (0.019) than in the control subjects (0.015; p < 0.01). No difference was found between the groups in functional immunological parameters, except for 3.6 times higher production of tumor necrosis factor alpha (TNF-α) in HPN patients. This difference was likely not related to EFA levels.

Conclusion

According to the authors of the study, patients who exclusively and long-term use home parenteral nutrition with a combination of soybean and olive oil are not at increased risk of essential fatty acid deficiency.

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Source: Olthof E. D., Roelofs H. M. J., Fisk H. L. et al. No clinical or biochemical evidence for essential fatty acid deficiency in home patients who depend on long-term mixed olive oil- and soybean oil-based parenteral nutrition. JPEN J Parenter Enteral Nutr 2016; 40 (7): 982–988, doi: 10.1177/0148607115581375.