Parenteral lipids: safety aspects and toxicity

Area of Science:

• Nutritional Science
• Biochemistry
• Clinical Medicine

Background:

• Lipid emulsions (LEs) are vital for parenteral nutrition, supplying calories and essential fatty acids (EFAs).
• Various LE generations exist, derived from different fatty acid sources, necessitating attention to their safe use.
• LEs are crucial for energy delivery, reducing dextrose needs and associated complications.

Purpose of the Study:

• To review the safety and efficacy of different generations of lipid emulsions used in parenteral nutrition.
• To discuss issues concerning LE composition, stability, sterility, and infusion-related adverse events.
• To explore the impact of LE fatty acid structure on inflammatory and immune responses, and organ function.

Main Methods:

• Review of existing preclinical and clinical evidence on various lipid emulsions.
• Analysis of lipid emulsion composition, including fatty acid profiles and bioactive agents.
• Evaluation of adverse effects, such as hypertriglyceridemia and lipid overload syndrome.

Main Results:

• Soybean oil-based LEs (SO-LEs) are established formulations.
• Next-generation LEs, particularly fish oil-based LEs (FO-LEs), demonstrate reduced pro-inflammatory characteristics.
• FO-LEs may offer benefits for immune function and organ health, including decreased liver damage compared to SO-LEs.

Conclusions:

• Lipid emulsions are essential in parenteral nutrition, but their safety and optimal use require careful consideration.
• Alternative lipid sources, such as fish oil, present potential advantages over traditional soybean oil.
• Further clinical validation is needed to confirm the benefits of newer lipid emulsion generations.