Fettemulsionen - Strukturierte Lipide und Omega-3-Fettsäuren

E. Pscheidl

doi:10.1055/s-2001-11913

Aktuelle Ernährungsmedizin, Table of Contents

Aktuelle Ernährungsmedizin 2001; 26(2): 62-69
DOI: 10.1055/s-2001-11913

ORIGINALBEITRAG

Originalbeitrag
© Georg Thieme Verlag Stuttgart · New York

Fettemulsionen - Strukturierte Lipide und Omega-3-Fettsäuren

E. Pscheidl

Klinik für Anästhesiologie, Universität Erlangen-Nürnberg

Abstract

Zusammenfassung

Die unerwünschten Wirkungen von Omega-6-fettsäurereichen Fettemulsionen sind in den letzten Jahren in den Mittelpunkt des wissenschaftlichen Interesses gerückt. Zur Vermeidung dieser Nebenwirkungen wurden verschiedene Wege eingeschlagen. Zum einen wurde versucht, mit einer Reduzierung des Omega-6-Fettsäurenanteils durch den teilweisen Ersatz mit mittelkettigen Fettsäuren oder Omega-9-Fettsäuren in den Emulsionen, die unerwünschten Effekte zu minimieren. Bei anderen Studien mit Omega-3-Fettsäuren wurde nicht nur der Präkursorenpool aus den Omega-6-Fettsäuren vermindert, sondern zusätzlich die Synthese von Mediatoren mit zum Teil sehr unterschiedlichen Wirkungen ermöglicht. Weitere Forschungsansätze beinhalteten die Zufuhr von chemisch synthetisierten Triglyzeridmolekülen mit einem in der Natur nicht vorkommenden Molekülaufbau. Auch Kombinationen dieser neuen Triglyzeridstrukturen mit verschiedenen Fettsäureklassen scheinen durchaus positive Effekte zu haben. Alle diese neuen Fettemulsionen wurden in unterschiedlichen Tiermodellen sowie bei verschiedenen Erkrankungen und unterschiedlichen Krankheitsstadien getestet. Die publizierten Ergebnisse waren jedoch zum Teil widersprüchlich. Zum einen waren deutlich positive Effekte gefunden worden, während andere Autoren keine oder sogar negative Auswirkungen fanden. Da die neuen Fettemulsionen in der Herstellung zum Teil mit erheblichen Mehrkosten belastet sind, müssen bis zur routinemäßigen Anwendung kontrollierte Studien klinische Vorteile dieser neuen Lipide beweisen, aber auch Indikationen für den Einsatz der unterschiedlichen Emulsionen aufzeigen. Neben den rein nutritiven Eigenschaften der Fette können durch Veränderungen der Fettsäuremuster zum Teil positive Effekte auf den Metabolismus, die Mikrozirkulation und auf Entzündungsreaktionen bewirkt werden. Durch die Modulation des Präkursorenpools für die Eicosanoidbildung wird jedoch auch in Signalwege eingegriffen, die bis heute noch nicht vollständig aufgeklärt sind. Dies muss bei der Übertragung der Befunde aus Tiermodellen auf klinische Studien sorgfältig beachtet werden, um nicht einen vermeintlichen Nutzen durch wesentlich schädlichere Nebenwirkungen zu erkaufen. Diesbezügliche Untersuchungen werden auch von einem Konsensuspapier des National Institutes of Health und der beiden großen amerikanischen Ernährungsgesellschaften gefordert [73]. Zusammenfassend kann man sicherlich feststellen, dass es im 21. Jahrhundert keine Lipidemulsion geben wird, die für alle Erkrankungen die optimale Zusammensetzung hat. Die Studien der letzten Jahre haben deutlich gezeigt, dass die einzelnen Fettsäureklassen mit ihren unterschiedlichen Auswirkungen auf den Metabolismus, den Immunstatus und die Mikrozirkulation differenziert eingesetzt werden müssen. Lipide werden in Zukunft nicht nur aufgrund ihrer kalorischen Wertigkeit, sondern auch aufgrund pharmakologischer Wirkungen Verwendung finden.

Fatty Emulsions - Structural Lipids and Omega-3-Fatty-Acids

Side effects of poly-unsaturated fatty acids (PUFA) used for clinical nutrition have been extensively investigated in recent years. To avoid the negative effects of omega-6-fatty-acids, it is recommended to use preparations with a reduced content of these PUFA. For this, medium-chain fatty acids or omega-9-fatty-acids can be used instead of omega-6-fatty-acids. The use of omega-3-fatty-acids not only reduces the amount of omega-6-fatty-acids, but also leads additionally to synthesis of prostaglandins and leukotrienes with a function different to those derived from the omega-6-fatty-acids. A genuinely new substrate in the evolution of lipid emulsions are the structured triglycerides. In these emulsions the individual molecules are composed of fatty acids of different fatty acid classes. All these recent lipid emulsions have been used in different animal models and clinical settings to define their effects on metabolism, immunology, pulmonary function and microcirculation. The results of these studies were sometimes controversial and confusing. However, it seems that the exchange of a part of the omega-6-fatty-acids in the lipid emulsions is beneficial in some diseases. In conclusion, the properties of the different fatty acids lead to a pharmacological use of lipid emulsions in addition to their caloric value. With this in mind, there will be not only one emulsion for all critical ill patients in future, but for different diseases different lipid emulsion will be required.

Full Text

References

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Dr. med. E. Pscheidl

Klinik für Anästhesiologie, Universität Erlangen-Nürnberg

Krankenhausstraße 12
91054 Erlangen