![]() However, a collective examination of the functionality of LEs relating to the structure and composition of lipids and their properties to metabolic outcomes has not been related to parenteral therapy in literature. This development offers new challenges evidenced from emerging clinical studies with aspects relating to inflammation ( Calder, 2012 Miles and Calder, 2015), immunomodulation ( Waitzberg et al., 2002), and clinical outcomes ( Calder, 2013) been reviewed in specific patient populations. But side effects related to the high LA content added to a higher oxidative stress burden in critically ill patients ( Calder et al., 2010) leading to a decision to reduce the LA content in LEs, and opening the way for alternative LEs in parenteral applications ( Waitzberg et al., 2006). The first commercially available LE in 1961 was based exclusively on soybean oil, contributing ~ 50% from n-6 linoleic acid (LA) in its total fatty acid (FA) profile. Lipids were a late macronutrient addition to parenteral nutrition (PN) formulation in the 1960s, with experimentation leading to formulation of a broad range of intravenous LE products from variable fat sources ( Wretlind, 1981). I interestingly, although LEs are been administered intravenously in critical care and long-term nutrition support, there is little knowledge regarding the compositional nature and metabolic outcomes related to the nature of lipids in these formulations. On the other hand, benefits of lipid emulsions (LEs) in parenteral therapy has been evolving since the 1960s. Further, the differentiation of fats based on chemical structure has led to an understanding on metabolic risks associated with atherogenecity in the non-critical status ( Karupaiah et al., 2005). It appears that the FAC nature of LEs is the primary determinant of desired clinical outcomes, and we conclude that one type of LE alone cannot be uniformly applied to patient care.įundamental knowledge in lipid science is well elucidated in terms of the fat molecule’s contribution to total caloric needs, metabolic pathways of energy production, utilization, and storage in the human system. The Jaded score was applied to assess the quality of these studies, and we report outcomes categorized as per immuno-inflammatory, nutritional, clinical, and cellular level FAC changes. In addition to soybean oil-based LEs, this review covers clinical studies using the alternate LEs that incorporates physical mixtures combining medium- and long-chain triglycerides or structured triglycerides or the unusual olive oil or fish oil. This narrative review contrarily puts into perspective the fatty acid compositional (FAC) nature of LE formulations, and discusses clinical applications and outcomes according to the biological function and structural functionality of fatty acids and co-factors such as phytosterols, α-tocopherol, emulsifiers and vitamin K. Use of LEs in PN for surgical and critically ill patients is particularly well established, and there is enough literature assigning therapeutic and adverse effects to specific LEs. Lipid emulsions (LEs), an integral component in parenteral nutrition (PN) feeding, have shifted from the primary aim of delivering non-protein calories and essential fatty acids to defined therapeutic outcomes such as reducing inflammation, and improving metabolic and clinical outcomes. 6Malaysian Palm Oil Council (MPOC), Petaling Jaya, Malaysia. ![]() 5Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.4Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.3Dietetics Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.2Faculty of Health & Medical Science, School of BioSciences, Taylor’s University Lakeside Campus, Selangor, Malaysia.1Nutrition Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.Birinder Kaur Sadu Singh 1 Sreelakshmi Sankara Narayanan 2 Ban Hock Khor 3 Sharmela Sahathevan 3 Abdul Halim Abdul Gafor 4 Enrico Fiaccadori 5 Kalyana Sundram 6 Tilakavati Karupaiah 2*
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