Parenteral nutrition with a lipid emulsion containing 10% fish oil: effects on plasma lipids and long-chain PUFA

Docosahexaenoic acid (DHA) is the most abundant n-3 long-chain polyunsaturated fatty acid (LC-PUFA) in cell membranes and its accretion occurs primarily during the last trimester of pregnancy and in the early postnatal months. Premature infants are deprived of the intrauterine DHA supply and physiological DHA requirements are highest in the perinatal period..DHA supplementation of preterm formula lipid blends has become standard practice since it was shown to improve both visual and cognitive development in preterm infants in randomized controlled trials. However, currently used fat emulsions for the parenteral nutrition of preterm infants do not provide n-3 LC-PUFA. Recently, fish oil containing lipid emulsions have become available for adult and pediatric parenteral nutrition, but data in infants and in preterm infants are limited.
On this basis, an Italian group has conducted a randomized pilot study to compare plasma lipids in preterm infants receiving a new lipid emulsion containing 10% fish oil versus a standard preparation. Preterm infants weighing <1250 g at birth who routinely received parenteral nutrition from the first hour of life were randomized to parenteral nutrition with a fish oil lipid (n=23) or standard lipid (n=24) preparation. Plasma lipid classes and plasma and red blood cell fatty acids were determined at birth and on postnatal day 7.
Infants receiving fish oil lipid had significantly lower plasma phospholipids, cholesterol esters, and free cholesterol but similar triglyceride concentrations. They also had significantly higher phospholipid docosahexaenoic acid (2.77±0.08 vs 2.46±0.01 mol%, p<0.01) and eicosapentaenoic acid (1.58±0.01 vs 0.25±0.01 mol%, p<0.01) as well as lower arachidonic acid (10.64±0.29 vs 11.93±0.29 mol%, p<0.01) compared with those receiving standard preparation. Similar differences were found in red blood cells. Further studies are required to ascertain whether lower plasma lipids are a consequence of increased clearance or reduced de novo lipogenesis.
In conclusion, the use of a parenteral nutrition emulsion containing 10% fish oil in preterm infants in the first 2 weeks of life was safe and well tolerated. This new lipid emulsion induced lower plasma phospholipids, cholesterol esters, and free cholesterol levels and considerable changes in membrane fatty acid composition in plasma and red blood cells. The impact of 10% fish oil emulsion on inflammation and growth requires further larger studies.

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