Abstract
Purpose of Review
Parenteral nutrition (PN) is a widely accepted form of nutrition administration in patients in whom enteral feeding is contraindicated or insufficient. This is true in surgical patient populations, as well. As a component of PN, intravenous fat emulsions (IVFEs) are essential for the administration of essential fatty acids (EFAs) and adequate energy intake. The oils that make up standard IVFE formulations have evolved over time.
Recent Findings
A newer formulation, known as SMOF, contains a combination of soybean oil, medium chain triglycerides, olive oil, and fish oil and is gaining popularity for its purported beneficial effects on liver function, inflammation, and anti-oxidant status.
Summary
This literature review examines the current data regarding the effects of SMOF in the patient receiving PN and examines the role SMOF may play in the future management of nutrition in the surgical population.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Vassilyadi F, Panteliadou AK, Panteliadis C. Hallmarks in the history of enteral and parenteral nutrition: from antiquity to the 20th century. Nutr Clin Pract. 2013;28(2):209–17.
• Anez-Bustillos L, Dao DT, Baker MA, Fell GL, Puder M, Gura KM. Intravenous fat emulsion formulations for the adult and pediatric patient: understanding the differences. Nutr Clin Pract. 2016;31(5):596–609. Understanding the metabolic actions of the various lipid components available in PN solutions is foundational to PN administration. This article is an excellent review of the various mixtures and compounds available that make up the lipid component of PN.
Quigley EM, Marsh MN, Shaffer JL, Markin RS. Hepatobiliary complications of total parenteral nutrition. Gastroenterology. 1993;104(1):286–301.
Kelly DA. Liver complications of pediatric parenteral nutrition--epidemiology. Nutrition. 1998;14(1):153–7.
Kumpf VJ. Parenteral nutrition-associated liver disease in adult and pediatric patients. Nutr Clin Pract. 2006;21(3):279–90.
Squires RH, Duggan C, Teitelbaum DH, et al. Natural history of pediatric intestinal failure: initial report from the pediatric intestinal failure consortium. J Pediatr. 2012;161(4):723–8. e722
Nandivada P, Fell GL, Gura KM, Puder M. Lipid emulsions in the treatment and prevention of parenteral nutrition-associated liver disease in infants and children. Am J Clin Nutr. 2016;103(2):629S–34S.
Messing B, Bories C, Kunstlinger F, Bernier JJ. Does total parenteral nutrition induce gallbladder sludge formation and lithiasis? Gastroenterology. 1983;84(5 Pt 1):1012–9.
Calder PC. Functional roles of fatty acids and their effects on human health. JPEN. J Parenter Enter Nutr. 2015;39(1 Suppl):18S–32S.
Shinohara M, Mirakaj V, Serhan CN. Functional metabolomics reveals novel active products in the DHA metabolome. Front Immunol. 2012;3:81.
Serhan CN, Dalli J, Colas RA, Winkler JW, Chiang N. Protectins and maresins: new pro-resolving families of mediators in acute inflammation and resolution bioactive metabolome. Biochim Biophys Acta. 2015;1851(4):397–413.
Fell GL, Nandivada P, Gura KM, Puder M. Intravenous lipid emulsions in parenteral nutrition. Adv Nutr. 2015;6(5):600–10.
Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr. 1997;66(3):683–706.
Villet S, Chiolero RL, Bollmann MD, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24(4):502–9.
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506–17.
de Aguilar-Nascimento JE, Bicudo-Salomao A, Portari-Filho PE. Optimal timing for the initiation of enteral and parenteral nutrition in critical medical and surgical conditions. Nutrition. 2012;28(9):840–3.
Souba WW. Nutritional support. N Engl J Med. 1997;336(1):41–8.
Sandstrom R, Drott C, Hyltander A, et al. The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg. 1993;217(2):185–95.
Grimble RF. Dietary lipids and the inflammatory response. Proc Nutr Soc. 1998;57(4):535–42.
Jolliet P, Pichard C. Immunonutrition in the critically ill. Intensive Care Med. 1999;25(6):631–3.
Santos JI. Nutrition, infection, and immunocompetence. Infect Dis Clin N Am. 1994;8(1):243–67.
Clayton PT, Bowron A, Mills KA, Massoud A, Casteels M, Milla PJ. Phytosterolemia in children with parenteral nutrition-associated cholestatic liver disease. Gastroenterology. 1993;105(6):1806–13.
Iyer KR, Spitz L, Clayton P. BAPS prize lecture: new insight into mechanisms of parenteral nutrition-associated cholestasis: role of plant sterols. British Association of Paediatric Surgeons. J Pediatr Surg. 1998;33(1):1–6.
Ulrich H, Pastores SM, Katz DP, Kvetan V. Parenteral use of medium-chain triglycerides: a reappraisal. Nutrition. 1996;12(4):231–8.
Mok KT, Maiz A, Yamazaki K, et al. Structured medium-chain and long-chain triglyceride emulsions are superior to physical mixtures in sparing body protein in the burned rat. Metab Clin Exp. 1984;33(10):910–5.
Baldermann H, Wicklmayr M, Rett K, Banholzer P, Dietze G, Mehnert H. Changes of hepatic morphology during parenteral nutrition with lipid emulsions containing LCT or MCT/LCT quantified by ultrasound. JPEN. J Parenter Enter Nutr. 1991;15(6):601–3.
Clayton PT, Whitfield P, Iyer K. The role of phytosterols in the pathogenesis of liver complications of pediatric parenteral nutrition. Nutrition. 1998;14(1):158–64.
Savini S, D'Ascenzo R, Biagetti C, et al. The effect of 5 intravenous lipid emulsions on plasma phytosterols in preterm infants receiving parenteral nutrition: a randomized clinical trial. Am J Clin Nutr. 2013;98(2):312–8.
Vlaardingerbroek H, Vermeulen MJ, Carnielli VP, Vaz FM, van den Akker CH, van Goudoever JB. Growth and fatty acid profiles of VLBW infants receiving a multicomponent lipid emulsion from birth. J Pediatr Gastroenterol Nutr. 2014;58(4):417–27.
Antebi H, Mansoor O, Ferrier C, et al. Liver function and plasma antioxidant status in intensive care unit patients requiring total parenteral nutrition: comparison of 2 fat emulsions. JPEN. J Parenter Enter Nutr. 2004;28(3):142–8.
•• Klek S, Chambrier C, Singer P, et al. Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid)--a double-blind, randomised, multicentre study in adults. Clin Nutr. 2013;32(2):224–31. PRCT of 73 patients comparing a SMOF mixture versus standard intralipid, patients were given 4 weeks of each. SMOF group demonstrated improvement in liver function tests, as well as improved lipid profiles when compared with control group. Study demonstrated longer term safety in use of the SMOF formulas.
•• Rayyan M, Devlieger H, Jochum F, Allegaert K. Short-term use of parenteral nutrition with a lipid emulsion containing a mixture of soybean oil, olive oil, medium-chain triglycerides, and fish oil: a randomized double-blind study in preterm infants. JPEN J Parenter Enteral Nutr. 2012;36(1 Suppl):81S–94S. Double blinded RCT comparing greater than 7 days of PN with soybean oil versus SMOF in preterm infants requiring PN. Statisitically significant reduction was seen in the SMOF group in total and direct bilirubin, as well as significant improvement overall fatty acid profiles, when compared with the soybean group.
Tomsits E, Pataki M, Tolgyesi A, Fekete G, Rischak K, Szollar L. Safety and efficacy of a lipid emulsion containing a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil: a randomised, double-blind clinical trial in premature infants requiring parenteral nutrition. J Pediatr Gastroenterol Nutr. 2010;51(4):514–21.
Goulet O, Antebi H, Wolf C, et al. 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. JPEN. J Parenter Enter Nutr. 2010;34(5):485–95.
Grimm H, Tibell A, Norrlind B, Blecher C, Wilker S, Schwemmle K. Immunoregulation by parenteral lipids: impact of the n-3 to n-6 fatty acid ratio. JPEN J Parenter Enter Nutr. 1994;18(5):417–21.
Simopoulos AP, Leaf A, Salem N Jr. Essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids. Ann Nutr Metab. 1999;43(2):127–30.
Kinsella JE, Broughton KS, Whelan JW. Dietary unsaturated fatty acids: interactions and possible needs in relation to eicosanoid synthesis. J Nutr Biochem. 1990;1(3):123–41.
Grimm H, Mertes N, Goeters C, et al. Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients. Eur J Nutr. 2006;45(1):55–60.
Ma CJ, Sun LC, Chen FM, et al. A double-blind randomized study comparing the efficacy and safety of a composite vs a conventional intravenous fat emulsion in postsurgical gastrointestinal tumor patients. Nutr Clin Pract. 2012;27(3):410–5.
Wu MH, Wang MY, Yang CY, Kuo ML, Lin MT. Randomized clinical trial of new intravenous lipid (SMOFlipid 20%) versus medium-chain triglycerides/long-chain triglycerides in adult patients undergoing gastrointestinal surgery. JPEN. J Parenter Enter Nutr. 2014;38(7):800–8.
Linseisen J, Hoffmann J, Lienhard S, Jauch KW, Wolfram G. Antioxidant status of surgical patients receiving TPN with an omega-3-fatty acid-containing lipid emulsion supplemented with alpha-tocopherol. Clin Nutr. 2000;19(3):177–84.
Skouroliakou M, Konstantinou D, Koutri K, et al. A double-blind, randomized clinical trial of the effect of omega-3 fatty acids on the oxidative stress of preterm neonates fed through parenteral nutrition. Eur J Clin Nutr. 2010;64(9):940–7.
Jones CJ, Calder PC. Influence of different intravenous lipid emulsions on fatty acid status and laboratory and clinical outcomes in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr. 2016.
Wanten GJ, Calder PC. Immune modulation by parenteral lipid emulsions. Am J Clin Nutr. 2007;85(5):1171–84.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Elizabeth H. Cameron, Neal Bhutiani, and Matthew C. Bozeman declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Gastroenterology, Critical Care, and Lifestyle Medicine
Rights and permissions
About this article
Cite this article
Cameron, E.H., Bhutiani, N. & Bozeman, M.C. Will Availability of SMOF Lipid Emulsions for Parenteral Nutrition Change Surgical Nutrition Practice?. Curr Nutr Rep 6, 266–273 (2017). https://doi.org/10.1007/s13668-017-0215-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13668-017-0215-9