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New Parenteral Lipid Emulsions for Clinical Use
Dan L. Waitzberg, MD, PhD,
Raquel Susana Torrinhas, MSc and
Thiago Manzoni Jacintho, MSc
From the Laboratório de Fisiologia e Distúrbios
Esfincterianos of University of São Paulo, School of Medicine,
Department of Gastroenterology, Surgical Division, São Paulo,
Brazil
Correspondence: Dan Linetzky Waitzberg, Av. Dr. Arnaldo 455, Cerqueira
César, São Paulo (SP), CEP 01246–903, Brazil. Electronic
mail may be sent to
dan{at}ganep.com.br.
Routine use of parenteral lipid emulsions (LE) in clinical practice began
in 1961, with the development of soybean oil (SO) – based LE. Although
clinically safe, experimental reports indicated that SO-based LE could exert a
negative influence on immunological functions. Those findings were related to
its absolute and relative excess of -6 polyunsaturated fatty acids
(PUFA) and the low amount of -3 PUFA and also to its high PUFA content
with an increased peroxidation risk. This motivated the development of new LE
basically designed along the reduction of -6 PUFA and the -3
PUFA addition in order to obtain balanced levels of the -6/ -3
ratio. The new LE for clinical use (available in Europe and South America) are
differentiated by their content in polyunsaturated ( -6 and -3),
monounsaturated, and saturated fatty acids (FA), as well as FA source of their
origin, including soy, coconut, olive, and fish oil. This article presents the
new LE nutrition and energy functions but also its biochemical, metabolic, and
immunomodulating aspects, according to their FA content. LE at 20% when
infused from 1.0 to 2.0 g/kg body weight/day rates, either alone or in
association with amino acids and glucose, are safe and well tolerated in
routine clinical practice. LE combining SO with medium-chain triglycerides
and/or olive oil have less -6 PUFA and are better metabolized, with
less inflammatory and immunosuppressive effects than in relation to pure
SO-based LE. The -3 PUFA used alone or as component of a new and
complex LE (soy, MCT, olive and fish oil) has demonstrated anti-inflammatory
and immunomodulatory effects.
Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 4,
351-367 (2006)
DOI: 10.1177/0148607106030004351

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