Tolerance to a lipid emulsion containing a mixture of soybean, olive, coconut and fish oils compared with a standard fat emulsion containing only soybean oil

Standard lipid emulsions containing soybean oil have been linked to hyperlipemia, hyperglycemia, abnormal liver tests and an increased but rare occurrence of dyspnea, cyanosis, allergic reactions, flushing, temperature and pain in the chest and back. Changing the composition of lipid emulsions may counteract these undesirable effects. This study aimed at comparing the metabolic and clinical tolerance of a new lipid emulsion containing soybean, fish, olive and coconut oils (SMOF) with an isocaloric standard lipid emulsion (Lipovenoes), in patients expected to be under total parenteral nutrition (TPN) for at least 7 days. Thirty-two patients were randomized to TPN containing SMOF 20% or Lipovenoes 20%. Energy intake was adapted to energy expenditure measured by indirect calorimetry or estimated as 20-25 and 25-30 kcal/kg body weight/day for women and men, respectively, when calorimetry could not be performed. Blood samples were taken on day 0, 1, 7, and 11-14. The severity of adverse events in terms of blood parameters or clinical symptoms, and their relationship to the study treatment were reported according to the Good Clinical Practice. Groups were compared with ANOVA for repeated measures. Eight patients did not receive 7 days of TPN because of no further TPN indication (n = 4), high triglycerides (n = 1, SMOF), death (n = 2, Lipovenoes) or protocol violation (n = 1). Among the 24 remaining subjects, Lipovenoes and SMOF induced similar progressions of plasma triglycerides (P = 0.52), total cholesterol (P = 0.31), glucose (P = 0.14), and liver enzymes (P > 0.44). gamma GT was higher in the SMOF group before beginning TPN (P = 0.01) but decreased to values of the Lipovenoes group thereafter. No clinical symptoms related to study medication occurred with any of these lipid emulsions. Lipid emulsions containing a mixture of soybean, fish, olive and coconut oils are well-tolerated metabolically and clinically as standard lipid emulsions containing only soybean oil. It did not change lipid and blood glucose profile and liver tests compared with standard lipid emulsions.