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Parenteral fat emulsions based on olive and soybean oils: a randomized clinical trial in preterm infants
Yvonne Göbel1, Berthold Koletzko, Hans-Josef Böhles
1Dr. von Haunersches Kinderspital, Ludwig-Maximilians-University of Munich, Germany.
Insights
A new olive/soybean oil emulsion improved vitamin E status in premature infants by reducing polyunsaturated fatty acids (PUFA) and increasing antioxidant intake. This offers a safer parenteral nutrition option for vulnerable newborns.
Area of Science:
- Neonatal Nutrition
- Parenteral Nutrition
- Lipid Emulsions
Background:
- Premature infants have immature antioxidant defenses, increasing susceptibility to oxidative stress.
- Standard parenteral lipid emulsions are high in polyunsaturated fatty acids (PUFA), potentially exacerbating oxidative damage.
- Novel lipid formulations are needed to improve nutrient delivery and reduce oxidative stress in neonates.
Purpose of the Study:
- To evaluate a new parenteral lipid emulsion composed of olive and soybean oils (4:1 ratio) in premature infants.
- To compare this new emulsion, with lower PUFA and higher alpha-tocopherol, against a standard soybean oil emulsion.
- To assess the impact on plasma phospholipid fatty acids, vitamin E status, and markers of oxidative stress.
Main Methods:
- Randomized controlled trial involving premature infants (28-<37 weeks gestational age).
- Infants received either the olive/soybean oil emulsion or a standard soybean oil emulsion within 72 hours of birth.
- Plasma phospholipid fatty acids, alpha-tocopherol/lipid ratio, and urinary malondialdehyde (MDA) excretion were measured at baseline and after 7 days.
Main Results:
- The olive oil group showed higher plasma phospholipid intermediates of linoleic acid conversion (C18:3n-6 and C20:3n-6).
- The plasma alpha-tocopherol/total lipid ratio was significantly higher in the olive oil group (2.45 vs. 1.90 micromol/mmol).
- No significant differences were observed in urinary malondialdehyde excretion between the groups.
Conclusions:
- The olive/soybean oil emulsion enhances linoleic acid conversion, suggesting improved fatty acid metabolism.
- The reduced PUFA content and higher alpha-tocopherol intake improve vitamin E status in preterm infants.
- This novel emulsion is a promising alternative for parenteral nutrition in preterm infants, mitigating oxidative stress risks.
Objective:
To evaluate in premature infants a new parenteral lipid emulsion based on olive and soybean oils (ratio 4:1), with less polyunsaturated fatty acids (PUFA) and more alpha-tocopherol than standard soybean oil emulsion.
Study Design:
Premature infants (gestational age, 28-<37 weeks) were randomized to receive one of the two emulsions within the first 72 hours of life. The triglyceride dose was increased to 2 g/kg/day within 3 days. Plasma phospholipid fatty acids, alpha-tocopherol/lipid ratio, and urinary malondialdehyde (MDA) excretion were determined at baseline and after 7 days.
Results:
Of 45 recruited infants, 33 completed the study per protocol (15 soybean oil, 18 olive oil emulsion). At study end, groups did not differ in plasma phospholipid arachidonic acid, total n-6 and n-3 metabolites, but the olive oil group showed higher values of the PUFA intermediates C18:3n-6 (0.19% +/- 0.01% vs. 0.13% +/- 0.02%, P < 0.05) and C20:3n-6 (2.92% +/- 0.12% vs. 2.21% +/- 0.17%, P = 0.005). The plasma alpha-tocopherol/total lipd ratio was higher in the olive oil group (2.45 +/- 0.27 micromol/mmol vs. 1.90 +/- 0.08 micromol/mmol, P = 0.001), whereas urinary MDA excretion did not differ.
Conclusion:
The lower PUFA supply with the olive/soybean oil emulsion appears to enhance linoleic acid conversion. The reduced PUFA content, combined with a higher antioxidant intake in the olive oil group, results in an improved vitamin E status. The olive oil-based emulsion is a valuable alternative for parenteral feeding of preterm infants who are often exposed to oxidative stress, while their antioxidative defense is weak.