Aktuelle Ernährungsmedizin, Inhaltsverzeichnis Aktuelle Ernährungsmedizin 2007; 32: S22-S29DOI: 10.1055/s-2006-951866 Leitlinie Parenterale Ernährung der DGEM © Georg Thieme Verlag KG Stuttgart · New York 6 Lipidemulsionen M. Adolph (gemeinsamer AG-Leiter), A. Heller (gemeinsamer AG-Leiter), T. Koch, B. Koletzko, K. G. Kreymann, K. Krohn, E. Pscheidl, M. Senkal Artikel empfehlen Abstract Artikel einzeln kaufen Schlüsselwörter Fettemulsionen - α-Tocopherol - hepatische Steatose - mehrfach ungesättigte Fettsäuren - kritisch Kranke Key words lipid emulsions - α-tocopherol - hepatic steatosis - polyunsaturated fatty acids - critically ill Volltext Referenzen Literatur 1 Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung .Referenzwerte für die Nährstoffzufuhr. Frankfurt am Main; Umschau Braus Verlag 2000 2 Biolo G, Grimble G, Preiser J C. et al . Position paper of the ESICM Working Group on Nutrition and Metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions. Intensive Care Med. 2002; 28 1512-1520 3 Adolph M, Hailer S, Echart J. Serum phospholipid fatty acids in severely injured patients on total parenteral nutrition with medium chain/long chain triglyceride emulsions. Ann Nutr Metab. 1995; 39 251-260 4 Mascioli E A, Lopes S M, Champagne C, Driscoll D F. Essential fatty acid deficiency and home total parenteral nutrition patients. Nutrition. 1996; 12 245-249 5 Friedman Z, Danon A, Stahlman M T, Oates J A. Rapid onset of essential fatty acid deficiency in the newborn. Pediatrics. 1976; 58 640-649 6 Koletzko B. Essentielle Fettsäuren: Bedeutung für Medizin und Ernährung. Akt Endokrinol Stoffw. 1986; 7 18-27 7 Koletzko B, Innis S M. Lipids. In: Tsang R, Uauy R, Koletzko B, Zlotkin S (eds) Nutrition of the preterm infant: scientific basis and practical guidelines. Cincinnati, Ohio; Digital Educational Publishing 2005: 97-139 8 Tappy L, Schwarz J M, Schneiter P. et al . Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients. Crit Care Med. 1998; 26 860-867 9 Battistella F D, Widergren J T, Anderson J T, Siepler J K, Weber J C, MacColl K. A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma. 1997; 43 52-58 10 Heyland D K, Montalvo M, MacDonald S, Keefe L, Su X Y, Drover J W. Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg. 2001; 44 102-111 11 Stouthard J M, Endert E, Romijn J A, Sauerwein H P. Infusion of long-chain or medium-chain triglycerides inhibits peripheral glucose metabolism in men. JPEN J Parenter Enteral Nutr. 1994; 18 436-441 12 Tissot S, Normand S, Khalfallah Y. et al . Effects of a continuous lipid infusion on glucose metabolism in critically ill patients. Am J Physiol. 1995; 269 E753-E758 13 Craig R M, Coy D, Green R, Meersman R, Rubin H, Janssen I. Hepatotoxicity related to total parenteral nutrition: comparison of low-lipid and lipid-supplemented solutions. J Crit Care. 1994; 9 111-113 14 Baker A L, Rosenberg I H. Hepatic complications of total parenteral nutrition. Am J Med. 1987; 82 489-497 15 Driscoll D F, Blackburn G L. Total parenteral nutrition 1990. A review of its current status in hospitalised patients, and the need for patient-specific feeding. Drugs. 1990; 40 346-363 16 Jeejeebhoy K N, Anderson G H, Nakhooda A F, Greenberg G R, Sanderson I, Marliss E B. Metabolic studies in total parenteral nutrition with lipid in man. Comparison with glucose. J Clin Invest. 1976; 57 125-136 17 Sheldon G F, Peterson S R, Sanders R. Hepatic dysfunction during hyperalimentation. Arch Surg. 1978; 113 504-508 18 Reif S, Tano M, Oliverio R, Young C, Rossi T. Total parenteral nutrition-induced steatosis: reversal by parenteral lipid infusion. JPEN J Parenter Enteral Nutr. 1991; 15 102-104 19 Balistreri W F, Bove K E. Hepatobiliary consequences of parenteral alimentation. Prog Liver Dis. 1990; 9 567-601 20 Tulikoura I, Huikuri K. Morphological fatty changes and function of the liver, serum free fatty acids, and triglycerides during parenteral nutrition. Scand J Gastroenterol. 1982; 17 177-185 21 Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005; 41, Suppl 2 S1-S87 22 Reimund J M, Duclos B, Arondel Y, Baumann R. Persistent inflammation and immune activation contribute to cholestasis in patients receiving home parenteral nutrition. Nutrition. 2001; 17 300-304 23 Bindl L, Lutjohann D, Buderus S, Lentze M J, Bergmann K. High plasma levels of phytosterols in patients on parenteral nutrition: a marker of liver dysfunction. J Pediatr Gastroenterol Nutr. 2000; 31 313-316 24 Clayton P T, Bowron A, Mills K A, Massoud A, Casteels M, Milla P J. Phytosterolemia in children with parenteral nutrition-associated cholestatic liver disease. Gastroenterology. 1993; 105 1806-1813 25 Clayton P T, Whitfield P, Iyer K. The role of phytosterols in the pathogenesis of liver complications of pediatric parenteral nutrition. Nutrition. 1998; 14 158-164 26 Deitel M, Kaminsky V M, Fuksa M. Growth of common bacteria and Candida albicans in 10 % soybean oil emulsion. Can J Surg. 1975; 18 531-535 27 Gilbert M, Gallagher S C, Eads M, Elmore M F. Microbial growth patterns in a total parenteral nutrition formulation containing lipid emulsion. JPEN J Parenter Enteral Nutr. 1986; 10 494-497 28 Keammerer D, Mayhall C G, Hall G O, Pesko L J, Thomas R B. Microbial growth patterns in intravenous fat emulsions. Am J Hosp Pharm. 1983; 40 1650-1653 29 Melly M A, Meng H C, Schaffner W. Microbiol growth in lipid emulsions used in parenteral nutrition. Arch Surg. 1975; 110 1479-1481 30 Fox M, Molesky M, Aerde J E Van, Muttitt S. Changing parenteral nutrition administration sets every 24 h versus every 48 h in newborn infants. Can J Gastroenterol. 1999; 13 147-151 31 Bennett S N, McNeil M M, Bland L A. et al . Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med. 1995; 333 147-154 32 Didier M E, Fischer S, Maki D G. Total nutrient admixtures appear safer than lipid emulsion alone as regards microbial contamination: growth properties of microbial pathogens at room temperature. JPEN J Parenter Enteral Nutr. 1998; 22 291-296 33 Pironi L, Ruggeri E, Zolezzi C. et al . Lipid peroxidation and antioxidant status in adults receiving lipid-based home parenteral nutrition. Am J Clin Nutr. 1998; 68 888-893 34 Göbel Y, Koletzko B, Böhles H J. et al . Parenteral fat emulsions based on olive and soybean oils: a randomized clinical trial in preterm infants. J Pediatr Gastroenterol Nutr. 2003; 37 161-167 35 Steephen A C, Traber M G, Ito Y, Lewis L H, Kayden H J, Shike M. Vitamin E status of patients receiving long-term parenteral nutrition: is vitamin E supplementation adequate?. JPEN J Parenter Enteral Nutr. 1991; 15 647-652 36 Manuel-y-Keenoy B, Nonneman L, Bosscher H De. et al . Effects of intravenous supplementation with alpha-tocopherol in patients receiving total parenteral nutrition containing medium- and long-chain triglycerides. Eur J Clin Nutr. 2002; 56 121-128 37 Goulet O, Potter S de, Antebi H. et al . Long-term efficacy and safety of a new olive oil-based intravenous fat emulsion in pediatric patients: a double-blind randomized study. Am J Clin Nutr. 1999; 70 338-345 38 Huschak G, Zur N K, Hoell T, Riemann D, Mast H, Stuttmann R. Olive oil based nutrition in multiple trauma patients: a pilot study. Intensive Care Med. 2005; 31 1202-1208 39 Kinsella J E, Lokesh B. Dietary lipids, eicosanoids, and the immune system. Crit Care Med. 1990; 18 S94-S113 40 Palmblad J. Intravenous lipid emulsions and host defense - a critical review. Clin Nutr. 1991; 10 303-308 41 Llop J, Sabin P, Garau M. et al . The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia. Clin Nutr. 2003; 22 577-583 42 Carpentier Y A. Lipids. In: Sobotka L, Allison SP, Fürst P, Meier R, Pertkiewicz M, Soeters PB (eds) Basics in clinical nutrition. Prag; Galén 2004: 153-156 43 Druml W. Fett in der parenteralen Ernährung. In: Schauder P, Ollenschläger G (Hrsg) Ernährungsmedizin. Prävention und Therapie. München; Urban & Fischer 2006: 310-317 44 Sane S, Baba M, Kusano C, Shirao K, Yamada H, Aikou T. Influence of exogenous fat emulsion on pulmonary gas exchange after major surgery. World J Surg. 2002; 26 297-302 45 Suchner U, Katz D P, Furst P. et al . Impact of sepsis, lung injury, and the role of lipid infusion on circulating prostacyclin and thromboxane A(2). Intensive Care Med. 2002; 28 122-129 46 Carpentier Y A, Richelle M, Bury J. Phospholipid excess of fat emulsions slows triglyceride removal and increases lipoprotein remodelling. Arteriosclerosis. 1987; 7 541a 47 Garcia-de-Lorenzo A, Lopez-Martinez J, Planas M. et al . Safety and metabolic tolerance of a concentrated long-chain triglyceride lipid emulsion in critically ill septic and trauma patients. JPEN J Parenter Enteral Nutr. 2003; 27 208-215 48 Haumont D, Richelle M, Deckelbaum R J, Coussaert E, Carpentier Y A. Effect of liposomal content of lipid emulsions on plasma lipid concentrations in low birth weight infants receiving parenteral nutrition. J Pediatr. 1992; 121 759-763 49 Tashiro T, Mashima Y, Yamamori H, Sanada M, Nishizawa M, Okui K. Intravenous intralipid 10 % vs. 20 %, hyperlipidemia, and increase in lipoprotein X in humans. Nutrition. 1992; 8 155-160 50 Calder P C, Yaqoob P, Thies F, Wallace F A, Miles E A. Fatty acids and lymphocyte functions. Br J Nutr. 2002; 87, Suppl 1 S31-S48 51 Mayer K, Grimm H, Grimminger F, Seeger W. Parenteral nutrition with n-3 lipids in sepsis. Br J Nutr. 2002; 87, Suppl 1 S69-S75 52 Waitzberg D L, Bellinati-Pires R, Salgado M M. et al . Effect of total parenteral nutrition with different lipid emulsions of human monocyte and neutrophil functions. Nutrition. 1997; 13 128-132 53 Waitzberg D L, Lotierzo P H, Logullo A F, Torrinhas R S, Pereira C C, Meier R. Parenteral lipid emulsions and phagocytic systems. Br J Nutr. 2002; 87, Suppl 1 S49-S57 54 Furukawa K, Yamamori H, Takagi K. et al . Influences of soybean oil emulsion on stress response and cell-mediated immune function in moderately or severely stressed patients. Nutrition. 2002; 18 235-240 55 Heyland D K, MacDonald S, Keefe L, Drover J W. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA. 1998; 280 2013-2019 56 Mayer K, Meyer S, Reinholz-Muhly M. et al . Short-time infusion of fish oil-based lipid emulsions, approved for parenteral nutrition, reduces monocyte proinflammatory cytokine generation and adhesive interaction with endothelium in humans. J Immunol. 2003; 171 4837-4843 57 Chambrier C, Bannier E, Lauverjat M, Drai J, Bryssine S, Bouletreau P. Replacement of long-chain triglyceride with medium-chain triglyceride/long-chain triglyceride lipid emulsion in patients receiving long-term parenteral nutrition: effects on essential fatty acid status and plasma vitamin K1 levels. JPEN J Parenter Enteral Nutr. 2004; 28 7-12 58 Lehner F, Demmelmair H, Röschinger W. et al . Metabolic effects of intravenous LCT or MCT/LCT lipid emulsions in preterm infants. J Lipid Res. 2006; 47 404-411 59 Martin-Pena G, Culebras J M, De P, Barro-Ordovas J P, Catala-Pizarro R, Ruiz-Galiana J. Effects of 2 lipid emulsions (LCT versus MCT/LCT) on the fatty acid composition of plasma phospholipid: a double-blind randomized trial. JPEN J Parenter Enteral Nutr. 2002; 26 30-41 60 Hailer S, Jauch K W, Wolfram G. Influence of different fat emulsions with 10 or 20 % MCT/LCT or LCT on lipoproteins in plasma of patients after abdominal surgery. Ann Nutr Metab. 1998; 42 170-180 61 Rubin M, Naor N, Sirota L. et al . Are bilirubin and plasma lipid profiles of premature infants dependent on the lipid emulsion infused?. J Pediatr Gastroenterol Nutr. 1995; 21 25-30 62 Treskova E, Carpentier Y A, Ramakrishnan R, Al Haideri M, Seo T, Deckelbaum R J. Blood clearance and tissue uptake of intravenous lipid emulsions containing long-chain and medium-chain triglycerides and fish oil in a mouse model. JPEN J Parenter Enteral Nutr. 1999; 23 253-257 63 Ball M J. Parenteral nutrition in the critically ill: use of a medium chain triglyceride emulsion. Intensive Care Med. 1993; 19 89-95 64 Garnacho-Montero J, Ortiz-Leyba C, Jimenez-Jimenez F J. et al . Clinical and metabolic effects of two lipid emulsions on the parenteral nutrition of septic patients. Nutrition. 2002; 18 134-138 65 Demirer S, Aydintug S, Ustun C. et al . Comparison of the efficacy of medium chain triglycerides with long chain triglycerides in total parenteral nutrition in patients with hematologic malignancies undergoing peripheral blood stem cell transplantation. Clin Nutr. 2000; 19 253-258 66 Mascioli E A, Randall S, Porter K A. et al . Thermogenesis from intravenous medium-chain triglycerides. JPEN J Parenter Enteral Nutr. 1991; 15 27-31 67 Mu H, Porsgaard T. The metabolism of structured triacylglycerols. Prog Lipid Res. 2005; 44 430-448 68 Lindgren B F, Ruokonen E, Magnusson-Borg K, Takala J. Nitrogen sparing effect of structured triglycerides containing both medium-and long-chain fatty acids in critically ill patients; a double blind randomized controlled trial. Clin Nutr. 2001; 20 43-48 69 Sandstrom R, Hyltander A, Korner U, Lundholm K. Structured triglycerides were well tolerated and induced increased whole body fat oxidation compared with long-chain triglycerides in postoperative patients. JPEN J Parenter Enteral Nutr. 1995; 19 381-386 70 Chambrier C, Guiraud M, Gibault J P, Labrosse H, Bouletreau P. Medium- and long-chain triacylglycerols in postoperative patients: structured lipids versus a physical mixture. Nutrition. 1999; 15 274-277 71 Kruimel J W, Naber T H, Vliet J A van der, Carneheim C, Katan M B, Jansen J B. Parenteral structured triglyceride emulsion improves nitrogen balance and is cleared faster from the blood in moderately catabolic patients. JPEN J Parenter Enteral Nutr. 2001; 25 237-244 72 Rubin M, Moser A, Vaserberg N. et al . Structured triacylglycerol emulsion, containing both medium- and long-chain fatty acids, in long-term home parenteral nutrition: a double-blind randomized cross-over study. Nutrition. 2000; 16 95-100 73 Thomas-Gibson S, Jawhari A, Atlan P, Brun A L, Farthing M, Forbes A. Safe and efficacious prolonged use of an olive oil-based lipid emulsion (ClinOleic) in chronic intestinal failure. Clin Nutr. 2004; 23 697-703 74 Granato D, Blum S, Rossle C, Boucher J Le, Malnoe A, Dutot G. Effects of parenteral lipid emulsions with different fatty acid composition on immune cell functions in vitro. JPEN J Parenter Enteral Nutr. 2000; 24 113-118 75 Reimund J M, Arondel Y, Joly F, Messing B, Duclos B, Baumann R. Potential usefulness of olive oil-based lipid emulsions in selected situations of home parenteral nutrition-associated liver disease. Clin Nutr. 2004; 23 1418-1425 76 Versleijen M, Roelofs H, Preijers F, Roos D, Wanten G. Parenteral lipids modulate leukocyte phenotypes in whole blood, depending on their fatty acid composition. Clin Nutr. 2005; 24 822-829 77 Garcia-de-Lorenzo A, Denia R, Atlan P. et al . Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long-chain triacylglycerols. Br J Nutr. 2005; 94 221-230 78 Gadek J E, DeMichele S J, Karlstad M D. et al . Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med. 1999; 27 1409-1420 79 Pscheidl E, Schywalsky M, Tschaikowsky K, Boke-Prols T. Fish oil-supplemented parenteral diets normalize splanchnic blood flow and improve killing of translocated bacteria in a low-dose endotoxin rat model. Crit Care Med. 2000; 28 1489-1496 80 Morlion B J, Torwesten E, Lessire H. et al . The effect of parenteral fish oil on leukocyte membrane fatty acid composition and leukotriene-synthesizing capacity in patients with postoperative trauma. Metabolism. 1996; 45 1208-1213 81 Köller M, Senkal M, Kemen M, König W, Zumtobel V, Muhr G. Impact of omega-3 fatty acid enriched TPN on leukotriene synthesis by leukocytes after major surgery. Clin Nutr. 2003; 22 59-64 82 Schauder P, Rohn U, Schafer G, Korff G, Schenk H D. Impact of fish oil enriched total parenteral nutrition on DNA synthesis, cytokine release and receptor expression by lymphocytes in the postoperative period. Br J Nutr. 2002; 87, Suppl 1 S103-S110 83 Roulet M, Frascarolo P, Pilet M, Chapuis G. Effects of intravenously infused fish oil on platelet fatty acid phospholipid composition and on platelet function in postoperative trauma. JPEN J Parenter Enteral Nutr. 1997; 21 296-301 84 Heller A R, Fischer S, Rossel T. et al . Impact of n-3 fatty acid supplemented parenteral nutrition on haemostasis patterns after major abdominal surgery. Br J Nutr. 2002; 87, Suppl 1 S95-S101 85 Heller A R, Rössler S, Litz R J, Stehr S N, Heller S C, Koch R, Koch T. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med. 2006; 34 972-979 86 Weiss G, Meyer F, Matthies B, Pross M, Koenig W, Lippert H. Immunomodulation by perioperative administration of n-3 fatty acids. Br J Nutr. 2002; 87, Suppl 1 S89-S94 87 Heller A R, Rossel T, Gottschlich B. et al . Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer. 2004; 111 611-616 88 Grecu I, Mirea L, Grintescu I. Parenteral fish oil supplementation in patients with abdominal sepsis. Clin Nutr. 2003; 22 S23 89 Heller A R, Rössler S, Litz R J. et al . Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med. 2006; 34 972-979 90 Planas M, Porta I, Sagrista M L, Mora M, Padro J B, Pico M. Fatty acid composition of platelet membrane lipids after administration of two different fat emulsions in critically ill patients. Intensive Care Med. 1999; 25 395-398 91 Wichman M W, Thul P, Czarnetzki H D, Morlion B, Kemen M, Jauch K W. Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF 541): data from a prospective, randomized, multicenter trial. Crit Care Med 2007 35 im Druck 92 Singer P, Zolotarski V, Yussim A, Lustig S, Attal-Singer J, Cohen J. Renal effects of parenteral fish oil administered to heart-beating organ donors and renal-transplant recipients: a tolerance study. Clin Nutr. 2004; 23 597-603 93 Schlotzer E, Kanning U. Elimination and tolerance of a new parenteral lipid emulsion (SMOF) - a double-blind cross-over study in healthy male volunteers. Ann Nutr Metab. 2004; 48 263-268 94 Mertes N, Grimm H, Fürst P, Stehle P. Safety and efficacy of a new parenteral lipid emulsion (SMOFlipid) in surgical patients: a randomized, double-blind, multicenter study. Ann Nutr Metab. 2006; 50 253-259 95 Schulzki C, Mertes N, Wenn A. et al . Effect of a new type of lipid emulsion based on soybean oil, MCT, olive oil and fish oil (SMOF) in surgical patients. Clin Nutr. 1999; 18, (Suppl 1) 7 96 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 55-60 97 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 Enteral Nutr. 2004; 28 142-148