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Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: A Systematic Review and Meta-Analysis.
JPEN J Parenter Enteral Nutr 2015; 39(6):656-67JJ

Abstract

BACKGROUND

Soybean oil lipid emulsion may compromise immune function and promote hepatic damage due to its composition of long-chain fatty acids, phytosterols, high proportion of ω-6 fatty acids, and low α-tocopherol levels. Combination lipid emulsions have been developed using medium-chain triglyceride oil, fish oil, and/or olive oil, which provide adequate essential fatty acids, a smaller concentration of ω-6 fatty acids, and lower levels of phytosterols. The purpose of this systematic review is to determine if combination lipid emulsions have a more favorable impact on bilirubin levels, triglyceride levels, and incidence of infection compared with soybean oil lipid emulsions in children receiving parenteral nutrition.

METHODS

This study comprises a systematic review of published studies. Data were sufficient and homogeneous to conduct a meta-analysis for total bilirubin and infection.

RESULTS

Nine studies met the inclusion criteria. Meta-analysis showed that combination lipid emulsion decreased total bilirubin by a mean difference of 2.09 mg/dL (95% confidence interval, -4.42 to 0.24) compared with soybean oil lipid emulsion, although the result was not statistically significant (P = .08). Meta-analysis revealed no statistically significant difference in incidence of infection between the combination lipid emulsion and the soybean oil lipid emulsion groups (P = .846). None of the 4 studies that included triglyceride as an outcome detected a significant difference in triglyceride levels between the combination lipid emulsion and soybean oil lipid emulsion groups.

CONCLUSION

There is inadequate evidence that combination lipid emulsions offer any benefit regarding bilirubin levels, triglyceride levels, or incidence of infection compared with soybean oil lipid emulsions.

Authors+Show Affiliations

Rutgers, The State University of New Jersey, Cranford, New Jersey lawlerkr@shrp.rutgers.edu.Tufts University, Medford, Massachusetts.Rutgers, The State University of New Jersey, Cranford, New Jersey.Rutgers, The State University of New Jersey, Cranford, New Jersey.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

25057053

Citation

Finn, Kristen Lawler, et al. "Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: a Systematic Review and Meta-Analysis." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 39, no. 6, 2015, pp. 656-67.
Finn KL, Chung M, Rothpletz-Puglia P, et al. Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: A Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr. 2015;39(6):656-67.
Finn, K. L., Chung, M., Rothpletz-Puglia, P., & Byham-Gray, L. (2015). Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: A Systematic Review and Meta-Analysis. JPEN. Journal of Parenteral and Enteral Nutrition, 39(6), pp. 656-67. doi:10.1177/0148607114542515.
Finn KL, et al. Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: a Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr. 2015;39(6):656-67. PubMed PMID: 25057053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Providing a Combination Lipid Emulsion Compared With a Standard Soybean Oil Lipid Emulsion in Children Receiving Parenteral Nutrition: A Systematic Review and Meta-Analysis. AU - Finn,Kristen Lawler, AU - Chung,Mei, AU - Rothpletz-Puglia,Pamela, AU - Byham-Gray,Laura, Y1 - 2014/07/23/ PY - 2014/05/01/received PY - 2014/06/12/accepted PY - 2014/7/25/entrez PY - 2014/7/25/pubmed PY - 2016/4/26/medline KW - lipids KW - parenteral nutrition KW - pediatrics SP - 656 EP - 67 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 39 IS - 6 N2 - BACKGROUND: Soybean oil lipid emulsion may compromise immune function and promote hepatic damage due to its composition of long-chain fatty acids, phytosterols, high proportion of ω-6 fatty acids, and low α-tocopherol levels. Combination lipid emulsions have been developed using medium-chain triglyceride oil, fish oil, and/or olive oil, which provide adequate essential fatty acids, a smaller concentration of ω-6 fatty acids, and lower levels of phytosterols. The purpose of this systematic review is to determine if combination lipid emulsions have a more favorable impact on bilirubin levels, triglyceride levels, and incidence of infection compared with soybean oil lipid emulsions in children receiving parenteral nutrition. METHODS: This study comprises a systematic review of published studies. Data were sufficient and homogeneous to conduct a meta-analysis for total bilirubin and infection. RESULTS: Nine studies met the inclusion criteria. Meta-analysis showed that combination lipid emulsion decreased total bilirubin by a mean difference of 2.09 mg/dL (95% confidence interval, -4.42 to 0.24) compared with soybean oil lipid emulsion, although the result was not statistically significant (P = .08). Meta-analysis revealed no statistically significant difference in incidence of infection between the combination lipid emulsion and the soybean oil lipid emulsion groups (P = .846). None of the 4 studies that included triglyceride as an outcome detected a significant difference in triglyceride levels between the combination lipid emulsion and soybean oil lipid emulsion groups. CONCLUSION: There is inadequate evidence that combination lipid emulsions offer any benefit regarding bilirubin levels, triglyceride levels, or incidence of infection compared with soybean oil lipid emulsions. SN - 1941-2444 UR - https://www.unboundmedicine.com/medline/citation/25057053/Impact_of_Providing_a_Combination_Lipid_Emulsion_Compared_With_a_Standard_Soybean_Oil_Lipid_Emulsion_in_Children_Receiving_Parenteral_Nutrition:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://doi.org/10.1177/0148607114542515 DB - PRIME DP - Unbound Medicine ER -