Structured triacylglycerol emulsion, containing both medium- and long-chain fatty acids, in long-term home parenteral nutrition: A double-blind randomized cross-over study

Structured lipid emulsion, an innovative approach in which both medium-chai n and long-chain fatty acids are esterified to the same glycerol backbone, has been recently shown to be a safe and efficient way of providing energy to patients requiring parenteral nutrition. As yet, no assessment has been made of its safety and effect on Liver functions during long-term treatment . Twenty-two home parenteral nutrition patients with Crohn's disease or sho rt bowel syndrome were enrolled in a double-blind randomized, cross-over st udy. Twenty patients who completed the study were treated for 4 wk with a s tructured lipid emulsion and for 4 wk with long-chain triacylglycerol emuls ion. Determined every 1 or 2 wk were blood pressure, body weight, respirato ry rate, blood count, liver functions, albumin, transferrin, plasma lipids, free fatty acids (FFAs), and, at the end of each treatment period (weeks 4 and 8), plasma dicarboxylic acids and 3-OH-fatty acids. No differences wer e observed between the groups or within the groups between the two treatmen ts with respect to either clinical safety and adverse event occurrence or l aboratory assessments. Plasma dicarboxylic acids and 3-OH-fatty acids were similar and within normal range. No alteration of liver function occurred i n any of the patients treated with the structured lipid emulsion, whereas t wo of the patients receiving long-chain triaclyglycerol emulsion developed abnormal liver function, which resolved after switching to the structured L ipid emulsion. In conclusion, structured triacylyglycerols containing both medium- and long-chain fatty acids appear to be safe and well tolerated on a long-term basis in patients on home parenteral nutrition, and it may be a ssociated with possible reduction in liver dysfunction. Nutrition 2000;16:9 5-100. (C) Elsevier Science Inc. 2000.