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Utilization of fat emulsion during total parenteral nutrition in children
Insights
High caloric intake during parenteral nutrition (PN) increases lipoprotein lipase (LPL) activity. Monitoring plasma Intralipid levels helps prevent hyperlipaemia, but the intravenous fat tolerance test (IVFTT) is not ideal for assessing fat elimination capacity.
Area of Science:
- Pediatric Nutrition
- Metabolic Studies
- Lipid Metabolism
Background:
- Total parenteral nutrition (PN) requires careful management of fat emulsion (Intralipid) administration.
- Understanding lipid tolerance in children receiving PN is crucial for preventing complications.
Purpose of the Study:
- To assess Intralipid tolerance in pediatric patients undergoing PN.
- To investigate the relationship between caloric intake, plasma Intralipid levels, and fat metabolism markers.
- To evaluate the utility of the intravenous fat tolerance test (IVFTT) in this context.
Main Methods:
- Studied 6 children receiving PN, monitoring daily plasma Intralipid levels.
- Assessed fat removal using IVFTT and plasma postheparin lipoprotein lipase (LPL) activity.
- Correlated LPL activity with total daily caloric intake.
Main Results:
- Plasma Intralipid levels above 100 mg/100 ml were associated with hyperlipaemia.
- Most patients exhibited increased postheparin LPL activity during PN, normalizing post-discontinuation.
- Maximal LPL activity significantly correlated with caloric intake (r=0.95).
Conclusions:
- High caloric intake during PN markedly increases postheparin LPL activity.
- Monitoring plasma Intralipid levels aids in adjusting dosage to prevent hyperlipaemia and optimize fat tolerance.
- The IVFTT demonstrated limited value in estimating children's fat elimination capacity.
Abstract:
Tolerance for Intralipid fat emulsion during total parenteral nutrition (PN) was studied in 6 children. The Intralipid dose was monitored by the daily determination of plasma Intralipid levels. Fat removal was investigated at the start of and during the PN period by the intravenous fat tolerance test (IVFTT) and by determining the plasma postheparin lipoprotein lipase (LPL) activity. When the plasma Intralipid levels exceeded a value of 100 mg/100 ml, hyper pre-beta lipoproteinaemia, hypertriglyceridaemia, hypercholesterolaemia and hyperphospholipidaemia appeared. During PN most patients showed marked increases of postheparin LPL. Return to normal values occurred after discontinuation of PN. Maximal LPL activities were found to correlate significantly with total daily caloric intake (r=0.95, 0.05 less than p less than 0.01). The Intralipid elimination constant hardly changed during PN, with the exception of patient 6, who showed a marked increase (from 7 to 22%). Conclusions of this study are as follows: First a high caloric intake during PN leads to a marked increase of postheparin LPL activity. Second, by monitoring plasma Intralipid levels at 100 mg/100 ml approximately, it is possible to adjust the Intralipid dose in order to prevent hyperlipaemia and to take maximal benefit from rising fat tolerance. Thirdly the IVFTT appeared to be of little value to estimate the child's fat elimination capacity.