A double-blind, randomized clinical trial comparing soybean oil-based versus olive oil-based lipid emulsions in adult medical-surgical intensive care unit patients requiring parenteral nutrition

• Type of Material: Article
• Authors: Guillermo Umpierrez, Emory University; Ronnie Spiegelman, Emory University; Vivian Zhao, Emory University; Dawn Smiley, Emory University; Dawn D. Smiley, Emory University; Ingrid Pinzon, Emory University; Daniel P. Griffith, Emory University; Limin Peng, Emory University; Timothy Morris, Emory University; Menghua Luo, Emory University; Hermes Garcia, Emory University; Christopher Thomas, Emory University; Christopher A. Newton, Emory University; Thomas R Ziegler, Emory University
• Language: English
• Date: 2012-06
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins
• Final Published Version (URL): http://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2012&issue=06000&article=00014&type=abstract
• Title of Journal or Parent Work: Critical Care Medicine
• ISSN: 0090-3493
• Volume: 40
• Issue: 6
• Start Page: 1792
• End Page: 1798
• Grant/Funding Information: This investigator-initiated study was supported by a research grant from Baxter Pharmaceuticals (Dr. Umpierrez) and National Institutes of Health UL1 RR025008 (Atlanta Clinical and Translational Science Institute), American Diabetes Association 7-03-CR-35 (Dr. Umpierrez).; Dr. Ziegler receives research support from the National Institute of Health (K24 RR023356).; Dr. Smiley receives research support from the National Institute of Health (K08 DK0830361).; Drs. Umpierrez and Smiley received funding from the National Institutes of Health.
• Keywords: lipid emulsion; olive oil; nutrition support; soybean oil; parenteral nutrition; hyperglycemia; inpatient diabetes
• Research Categories: Health Sciences, Nutrition

Abstract

Objective Parenteral nutrition has been associated with metabolic and infectious complications in intensive care unit patients. The underlying mechanism for the high risk of complications is not known but may relate to the proinflammatory effects of soybean oil–based lipid emulsions, the only Food and Drug Administration–approved lipid formulation for clinical use. Design Prospective, double-blind, randomized, controlled trial. Setting Medical–surgical intensive care units from a major urban teaching hospital and a tertiary referral university hospital. Patients Adult medical–surgical intensive care unit patients. Intervention Parenteral nutrition containing soybean oil–based (Intralipid) or olive oil–based (ClinOleic) lipid emulsions. Measurements Differences in hospital clinical outcomes (nosocomial infections and noninfectious complications), hospital length of stay, glycemic control, inflammatory and oxidative stress markers, and granulocyte and monocyte functions between study groups. Results A total of 100 patients were randomized to either soybean oil–based parenteral nutrition or olive oil–based parenteral nutrition for up to 28 days. A total of 49 patients received soybean oil–based parenteral nutrition (age 51 ± 15 yrs, body mass index 27 ± 6 kg/m2, and Acute Physiology and Chronic Health Evaluation II score 15.5 ± 7 [±SD]), and a total of 51 patients received olive oil–based lipid emulsion in parenteral nutrition (age 46 ± 19 yrs, body mass index 27 ± 8 kg/m2, and Acute Physiology and Chronic Health Evaluation II score 15.1 ± 6 [±SD]) for a mean duration of 12.9 ± 8 days. The mean hospital blood glucose concentration during parenteral nutrition was 129 ± 14 mg/dL, without differences between groups. Patients treated with soybean oil–based and olive oil–based parenteral nutrition had a similar length of stay (47 ± 47 days and 41 ± 36 days, p = .49), mortality (16.3% and 9.8%, p = .38), nosocomial infections (43% vs. 57%, p = .16), and acute renal failure (26% vs. 18%, p = .34). In addition, there were no differences in inflammatory and oxidative stress markers or in granulocyte and monocyte functions between groups. Conclusion The administration of parenteral nutrition containing soybean oil–based and olive oil–based lipid emulsion resulted in similar rates of infectious and noninfectious complications and no differences in glycemic control, inflammatory and oxidative stress markers, and immune function in critically ill adults.