The effects of two mixed intravenous lipid emulsions on clinical outcomes in infants after gastrointestinal surgery: a prospective, randomized study

  • Weiwei Jiang
  • GuangLin Chen
  • Jie Zhang
  • Xiaofeng Lv
  • Changgui Lu
  • Huan Chen
  • Wei Li
  • Hongxing Li
  • Qiming Geng
  • Xiaoqun Xu
  • Weibing Tang
Original Article



There are many advantages of a SMOF emulsion (SMOF-lipid), such as liver-protective properties and anti-inflammatory effects. The objective of this study was to compare the clinical outcomes of SMOF-lipid with medium-chain triglycerides (MCT) /long-chain triglycerides (LCT) in infants after intestinal surgery.


This was a prospective, randomized study. Neonates receiving intravenous nutrient solution, including lipid emulsion after gastrointestinal surgery, were included in this study. The patients were randomly assigned to the SMOF-lipid or MCT/LCT groups. Infants who received intravenous lipid emulsion continuously for > 2 weeks were considered to have completed the study. Differences in weight gain, nutrition indices, alanine transaminase (ALT), aspartate transaminase (AST), and direct bilirubin (DB), and inflammation cytokine markers (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) were measured.


The final sample included 160 infants. One hundred fourteen infants received intravenous SMOF-lipid (74) or MCT/LCT (86) > 2 weeks and 46 infants received intravenous SMOF-lipid (22) or MCT/LCT (24) > 4 weeks. There were no significant differences in weight gain, nutrition indices, inflammation cytokine markers, and sepsis between the groups at the end of 2 and 4 weeks; however, in the SMOF group, the ALT, AST, and DB levels were significantly lower than the MCT/LCT group at the end of 4 weeks.


The mixture and balanced emulsion of SMOF-lipid was well-tolerated in infants who have undergone gastrointestinal surgery, and liver-protective properties were demonstrated following long-term venous nutrition, especially > 4 weeks.


Lipid emulsions SMOF-lipid Medium-chain triglycerides (MCT)/long-chain triglycerides (LCT) Infants Gastrointestinal surgery Parenteral nutrition 



This study was supported by the National Natural Science Foundation of China (81100318), the Jiangsu Provincial key research and development program (BE2017609), Jiangsu youth medical talent project (QNRC2016081), and Children’s Hospital of Nanjing Medical University youth medical talent project (ETYYQM2014009), Nanjing Science and Technology Project (201823015).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Lee WS, Sokol RJ (2015) Intestinal microbiota, lipids, and the pathogenesis of intestinal failure—associated liver disease. J Pediatr 167:519–526CrossRefGoogle Scholar
  2. 2.
    Squires RH, Balint J, Horslen S et al (2014) Race affects outcome among infants with intestinal failure. J Pediatr Gastroenterol Nutr 59:537–543CrossRefGoogle Scholar
  3. 3.
    Goulet O, Joly F, Corriol O, Colomb-Jung V (2009) Some new insights in intestinal failure-associated liver disease. Curr Opin Organ Transpl 14:256–261CrossRefGoogle Scholar
  4. 4.
    Grimm H (2005) A balanced lipid emulsion—a new concept in parenteral nutrition. Clin Nutr Suppl 1:25–30CrossRefGoogle Scholar
  5. 5.
    Waitzberg DL, Torrinhas RS, Jacintho TM (2006) New parenteral lipid emulsions for clinical use. JPEN J Parenter Enteral Nutr 30:351–367CrossRefGoogle Scholar
  6. 6.
    Waitzberg DL, Torrinhas RS (2009) Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract 24:487–499CrossRefGoogle Scholar
  7. 7.
    Vlaardingerbroek H, Ng K, Stoll B et al (2014) New generation lipid emulsions prevent PNALD in chronic parenteral nutrition fed preterm pigs. J Lipid Res 55:466–477CrossRefGoogle Scholar
  8. 8.
    Schlotzer E, Kanning U (2004) Elimination and tolerance of a new parenteral lipid emulsion (SMOF)—a double-blind cross-over study in healthy male volunteers. Ann Nutr Metab 48:263–268. 15CrossRefGoogle Scholar
  9. 9.
    Klek S, Chambrier C, Singer P et al (2013) Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid)-a double-blind, randomised, multicentre study in adults. Clin Nutr 32:224–231CrossRefGoogle Scholar
  10. 10.
    Calder PC (2009) Hot topics in parenteral nutrition. Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults. Proc Nutr Soc 68:252–260CrossRefGoogle Scholar
  11. 11.
    Zugasti Murillo A, Petrina Jáuregui E, Elizondo Armendáriz J (2015) Parenteral nutrition-associated liver disease and lipid emulsions. Endocrinol Nutr 62:285–289CrossRefGoogle Scholar
  12. 12.
    Calder PC, Jensen GL, Koletzko BV et al (2010) Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med 36:735–749CrossRefGoogle Scholar
  13. 13.
    Demmelmair H, Koletzko B (2015) Importance of fatty acids in the perinatal period. World Rev Nutr Diet 112:31–47CrossRefGoogle Scholar
  14. 14.
    Wanten GJ, Calder PC (2007) Immune modulation by parenteral lipid emulsions. Am J Clin Nutr 85:1171–1184CrossRefGoogle Scholar
  15. 15.
    Kumpf VJ (2006) Parenteral nutrition-associated liver disease in adult and pediatric patients. Nutr Clin Pract 21:279–290CrossRefGoogle Scholar
  16. 16.
    Carpentier YA, Deckelbaum RJ (2015) In vivo handling and metabolism of lipid emulsions. World Rev Nutr Diet 112:57–62CrossRefGoogle Scholar
  17. 17.
    Siqueira J, Smiley D, Newton C et al (2011) Substitution of standard soybean oil with olive oil-based lipid emulsion in parenteral nutrition: comparison of vascular, metabolic, and inflammatory effects. J Clin Endocrinol Metab 96:3207–3216CrossRefGoogle Scholar
  18. 18.
    Carter BA, Karpen SJ (2007) Intestinal failure-associated liver disease: management and treatment strategies past, present, and future. Semin Liver Dis 27:251–258CrossRefGoogle Scholar
  19. 19.
    Cavicchi M, Beau P, Crenn P et al (2000) Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 132:525–532CrossRefGoogle Scholar
  20. 20.
    Calkins KL, DeBarber A, Steiner RD et al. Intravenous fish oil and pediatric intestinal failure-associated liver sisease: changes in plasma phytosterols, cytokines, and bile acids and erythrocyte fatty acids. JPEN J Parenter Enteral Nutr. 2017. (Epub ahead of print) CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Fuchs J, Fallon EM, Gura KM, Puder M (2011) Use of an omega-3 fatty acid-based emulsion in the treatment of parenteral nutrition-induced cholestasis in patients with microvillous inclusion disease. J Pediatr Surg 46:2376–2382CrossRefGoogle Scholar
  22. 22.
    Meisel JA, Le HD, de Meijer VE et al (2011) Comparison of 5 intravenous lipid emulsions and their effects on hepatic steatosis in a murine model. J Pediatr Surg 46:666–673CrossRefGoogle Scholar
  23. 23.
    Dai YJ, Sun LL, Li MY et al (2016) Comparison of formulas based on lipid emulsions of olive oil, soybean oil, or several oils for parenteral nutrition: a systematic review and meta-analysis. Adv Nutr 7:279–286CrossRefGoogle Scholar
  24. 24.
    Hermans D, Talbotec C, Lacaille F et al (2007) Early central catheter infections may contribute to hepatic fibrosis in children receiving long-term parenteral nutrition. J Pediatr Gastroenterol Nutr 44:459–463CrossRefGoogle Scholar
  25. 25.
    Goulet O, Olieman J, Ksiazyk J et al (2013) Neonatal short bowel syndrome as a model of intestinal failure: physiological background for enteral feeding. Clin Nutr 32:162–171CrossRefGoogle Scholar
  26. 26.
    Goulet O, Antebi H, Wolf C et al (2010) A new intravenous fat emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil: a single-center, double-blind randomized study on efficacy and safety in pediatric patients receiving home parenteral nutrition. J Parenter Enteral Nutr 34:485–495CrossRefGoogle Scholar
  27. 27.
    Gura KM, Lee S, Valim C et al (2008) Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition associated liver disease. Pediatrics 121:e678–e686CrossRefGoogle Scholar
  28. 28.
    Diamond IR, Sterescu A, Pencharz PB et al (2008) The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease. Pediatr Surg Int 24:773–778CrossRefGoogle Scholar
  29. 29.
    Zhao Y, Wu Y, Pei J,et al (2015) Safety and efficacy of parenteral fish oil-containing lipid emulsions in premature neonates. J Pediatr Gastroenterol Nutr 60:708–716CrossRefGoogle Scholar
  30. 30.
    Angsten G, Finkel Y, Lucas S et al. Improved outcome in neonatal short bowel syndrome using parenteral fish oil in combination with ω-6/9 lipid emulsions. 2012;36:587–595Google Scholar
  31. 31.
    Deshpande G, Simmer K, Deshmukh M et al (2014) Fish oil (SMOFlipid) and olive oil lipid (clinoleic) in very preterm neonates. J Pediatr Gastroenterol Nutr 58:177–182CrossRefGoogle Scholar
  32. 32.
    Schade I, Röhm KD, Schellhaass A et al (2008) Inflammatory response in patients requiring parenteral nutrition: comparison of a new fish oil-containing emulsion (SMOF) versus an olive/soybean oil-based formula. Crit Care 12:144CrossRefGoogle Scholar
  33. 33.
    Calder PC (2015) Functional roles of fatty acids and their effects on human health. JPEN J Parenter Enteral Nutr 39(1 Suppl):18S–32SCrossRefGoogle Scholar
  34. 34.
    Calder PC (2015) Marine omega-3 fatty acids and inflammatory processes: effects, mechanisms and clinical relevance. Biochim Biophys Acta 1851:469–484CrossRefGoogle Scholar
  35. 35.
    Nanhuck RM, Doublet A, Yaqoob P (2009) Effects of lipid emulsions on lipid body formation and eicosanoid production by human peripheral blood mononuclear and polymorphonuclear cells. Clin Nutr 28(5):556–564CrossRefGoogle Scholar
  36. 36.
    Simopoulos AP (2006) Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic disease. Biomed Pharmacother 60(9):502e7CrossRefGoogle Scholar
  37. 37.
    Grimm H, Mertes N, Goeters C et al (2006) Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients. Eur J Nutr 45:55–60CrossRefGoogle Scholar
  38. 38.
    Vlaardingerbroek H, van Goudoever JB (2015) Intravenous lipids in preterm infants: impact on laboratory and clinical outcomes and long-term consequences. World Rev Nutr Diet 112:71–80CrossRefGoogle Scholar
  39. 39.
    Ghazale H, Ramadan N, Mantash S et al (2018) Docosahexaenoic acid (DHA) enhances the therapeutic potential of neonatal neural stem cell transplantation post-Traumatic brain injury. Behav Brain Res 340:1–13CrossRefGoogle Scholar
  40. 40.
    Beken S, Dilli D, Fettah ND et al (2014) The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants: a randomized controlled trial. Early Hum Dev 90:27–31CrossRefGoogle Scholar
  41. 41.
    Nehra D, Fallon EM, Potemkin AK et al (2014) A comparison of 2 intravenous lipid emulsions: interim analysis of a randomized controlled trial. JPEN J Parenter Enteral Nutr 38:693–701CrossRefGoogle Scholar
  42. 42.
    Kidokoro H, Neil JJ, Inder TE (2013) New MR imaging assessment tool to define brain abnormalities in very preterm infants at term. AJNR Am J Neuroradiol 34:2208–2214CrossRefGoogle Scholar
  43. 43.
    Soden JS, Lovell MA, Brown K et al (2010) Failure of resolution of portal fibrosis duringomega-3 fatty acid lipid emulsion therapy in two patients with irreversible intestinalfailure. J Pediatr 156:327–331CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Weiwei Jiang
    • 1
  • GuangLin Chen
    • 1
  • Jie Zhang
    • 1
  • Xiaofeng Lv
    • 1
  • Changgui Lu
    • 1
  • Huan Chen
    • 1
  • Wei Li
    • 1
  • Hongxing Li
    • 1
  • Qiming Geng
    • 1
  • Xiaoqun Xu
    • 1
  • Weibing Tang
    • 1
  1. 1.Department of Neonatal SurgeryChildren’s Hospital of Nanjing Medical UniversityNanjingChina

Personalised recommendations