Table 4.
Clinical outcomes of randomized controlled trials categorized as per lipid emulsion formulation type.
| No. | Type of LE | Patient subgroups | Significant outcomes | References |
|---|---|---|---|---|
| 1. | SOLE | Surgery | Nutrition | |
| ↑ glucagon, cumulative NB negative | (Furukawa et al., 2002) | |||
| Immune and inflammatory | ||||
| ↑ PMN cells | (Dionigi et al., 1985) | |||
| ↑ IL-2 | (Monson et al., 1986; Sedman et al., 1991) | |||
| ↓ LAK cell activity | (Sedman et al., 1991) | |||
| ↑ IL-6, ↑ CRP, ↓ lymphocyte proliferation | (Furukawa et al., 2002) | |||
| ↑ T cells and helper T cells, ↑ ADCC function | (Monson et al., 1986) | |||
| ↓ Bacteria killing mediated by neutrophils | (Waitzberg et al., 1997) | |||
| Clinical | ||||
| ↓ Sepsis score | (Dionigi et al., 1985) | |||
| ICU | Immune and inflammatory | |||
| ↓ Helper/suppressor T cells ratio Clinical |
(Gogos et al., 1990) | |||
| ↑ Infection, ↑ ICU stay, ↑ hospital stay, ↑ duration MV | (Battistella et al., 1997) | |||
| 2. | Physical | Surgery | Nutrition | |
| MCT/LCT | ↓ Body weight, ↓ TG, ↑ β hydroxybutyrate | (Jiang et al., 1993) | ||
| ↑ Pre-albumin | (Chen et al., 2005) | |||
| ↑ Insulin | (Jiang et al., 1993; Chen et al., 2005) | |||
| Immune and inflammatory | ||||
| ↑ NK and ↑ LAK cell activity Clinical | (Sedman et al., 1991) | |||
| ↓ Intra-abdominal infection | (Grau et al., 2003) | |||
| ↓ Mortality | (Grau et al., 2003) | |||
| ICU | Nutrition | |||
| ↓ Negative NB | (Ball, 1993; Garnacho-Montero et al., 2002) | |||
| ↑ Retinol binding protein, ↑ insulin | (Garnacho-Montero et al., 2002) | |||
| Immune and inflammatory | ||||
| No change in immune markers | (Iovinelli et al., 2007) | |||
| Clinical | ||||
| ↑ Oxygen consumption, VO2 | (Smirniotis et al., 1998) | |||
| ↓ Duration of MV | (Iovinelli et al., 2007) | |||
| 3. | STG-LE | Surgery | Nutrition | |
| No ↑ TG, No ↑ ASAT, No ↑ ALAT, NB positive | (Chambrier et al., 1999) | |||
| Improved cumulative NB | (Chambrier et al., 1999; Kruimel et al., 2001) | |||
| Less ↑ TG | (Kruimel et al., 2001) | |||
| ↑ Carbon dioxide production, ↑ whole-body fat oxidation, ↑ free fatty acid, ↑ plasma glycerol, ↑ 3-hydroxybutyric acid | (Sandstrom et al., 1995) | |||
| ICU | Nutrition | |||
| Improved cumulative NB | (Lindgren et al., 2001) | |||
| 4. | OOLE | HPN | Cellular fatty acid changes | |
| ↑ γ-LA, ↑ oleic acid, ↑ mead acid | (Vahedi et al., 2005) | |||
| Surgery | Nutrition | |||
| ↑ Body weight | (Demirer et al., 2016) | |||
| ↓ TBARS | (Demirer et al., 2016) | |||
| ↑ ALP, ↑ GGT, ↑ total protein, ↑ albumin, ↓ total bilirubin | (Onar et al., 2011) | |||
| Clinical | ||||
| No changes on catheter infections | (Onar et al., 2011) | |||
| 5. | FOLE | Surgery | Nutrition | |
| ↑ α-Tocopherol | (Linseisen et al., 2000; Klek et al., 2003; Grimm et al., 2006; Wichmann et al., 2007) | |||
| ↓ AST, ↓ ALT | (Klek et al., 2003; Piper et al., 2009) | |||
| ↓ α-GST, ↓TG | (Piper et al., 2009) | |||
| ↓ LDL | (Ma et al., 2012) | |||
| ↑ APTT, | (Wang et al., 2012) | |||
| ↓ Total bilirubin, | (Klek et al., 2003; Wang et al., 2012) | |||
| ↓ Glucose | (Wu et al., 2014) | |||
| Less ↓ HDL, less ↓ free fatty acid | (Ma et al., 2015) | |||
| ↑ Body weight, ↓ TBARS | (Demirer et al., 2016) | |||
| Cellular fatty acid changes | ||||
| ↑ EPA or DHA | (Morlion et al., 1996; Roulet et al., 1997; Linseisen et al., 2000; Mayer et al., 2003b; Klek et al., 2003; Grimm et al., 2006; Senkal et al., 2007; Berger et al., 2008) | |||
| ↑ ALA | (Morlion et al., 1996) | |||
| ↑ EPA/AA ratio | (Roulet et al., 1997; Grimm et al., 2006; Senkal et al., 2007) | |||
| ↓ LA | (Linseisen et al., 2000) | |||
| ↑ Total n-3 PUFA, ↑ n-3:n-6 PUFA ratio | (Klek et al., 2003; Grimm et al., 2006; Senkal et al., 2007) | |||
| Immune and inflammatory | ||||
| ↓ IL-6 | (Clayton et al., 1993; Mayer et al., 2003b; Liang et al., 2008; Zhu et al., 2012; de Miranda Torrinhas et al., 2013) | |||
| ↓ LTB4 | (Wachtler et al., 1997) | |||
| ↓ TNF-α | (Wachtler et al., 1997; Mayer et al., 2003b; Zhu et al., 2012) | |||
| ↑ TNF-α | (Schauder et al., 2002; Wang et al., 2012) | |||
| ↑ HLA-DR | (Clayton et al., 1993) | |||
| ↑ IL-2 | (Schauder et al., 2002) | |||
| ↑ LTB5, ↑ LTB5/LTB4 ratio | (Wachtler et al., 1997; Köller et al., 2003; Grimm et al., 2006; Wichmann et al., 2007; Wang et al., 2012) | |||
| ↓ IL-1β, and ↓ IL-8 | (Mayer et al., 2003b) | |||
| ↑ CD4+/CD8+ | (Schauder et al., 2002; Liang et al., 2008) | |||
| ↓ CD4+/CD8+ | (Zhu et al., 2012) | |||
| ↑ NF-Kβ | (Wang et al., 2012) | |||
| ↓ IL-10 | (de Miranda Torrinhas et al., 2013) | |||
| Clinical | ||||
| ↓ Post-operative stay on medical ward | (Clayton et al., 1993) | |||
| ↓ Length of hospital stay | (Grimm et al., 2006; Jiang et al., 2010; Zhu et al., 2012) | |||
| ↓ Infection rates | (Badia-Tahull et al., 2010) | |||
| ↓ Duration of SIRS | (Jiang et al., 2010; Zhu et al., 2012) | |||
| ICU | Nutrition | |||
| ↑ Albumin | (Gultekin et al., 2014) | |||
| Cellular fatty acid changes | ||||
| ↑ EPA and DHA | (Mayer et al., 2003a; Mayer et al., 2003b; Wang et al., 2008; Barbosa et al., 2010) | |||
| Immune and inflammatory | ||||
| ↓ IL-6 | (Mayer et al., 2003b; Barbosa et al., 2010; Sungurtekin et al., 2011; Han et al., 2012; Metry et al., 2014) | |||
| ↓ TNF-α | (Mayer et al., 2003b; Barbosa et al., 2010; Sungurtekin et al., 2011; Han et al., 2012) | |||
| ↓ IL-10 | (Barbosa et al., 2010; Sungurtekin et al., 2011) | |||
| ↑ Neutrophil inositol phosphate, ↑ PAF, ↑LTB5 | (Mayer et al., 2003a) | |||
| ↑ Respiratory burst | (Mayer et al., 2003a) | |||
| ↓ IL-8 | (Mayer et al., 2003b; Han et al., 2012) | |||
| ↓ CRP | (Wang et al., 2008; Gultekin et al., 2014) | |||
| ↓ IL-1β | (Mayer et al., 2003b; Barbosa et al., 2010) | |||
| ↓ IL-1 | (Sungurtekin et al., 2011; Han et al., 2012) | |||
| ↓ LTB4 | (Sabater et al., 2011; Gultekin et al., 2014) | |||
| ↓ IFN-γ | (Han et al., 2012) | |||
| Clinical | ||||
| Improvement in oxygenation index | (Wang et al., 2008; Barbosa et al., 2010) | |||
| ↓ CRRT days | (Wang et al., 2008) | |||
| ↓ Hospital stay | (Barbosa et al., 2010) | |||
| ↓ Nosocomial infections, ↑ predicted time free of infection | (Grau-Carmona et al., 2015) | |||
| ↓ 60-day mortality | (Chen et al., 2017) | |||
| HPN | Cellular fatty acid changes | |||
| ↑EPA,↑ DHA, ↑DPA in erythrocytes,platelets, serum phospholipids | (Bohnert et al., 2018) |
AA, arachidonic acid; ADCC, antibody-dependent cellular cytotoxicity; ALA, α-linolenic acid; ALAT, alanine aminotransferase; ALP, alkaline phosphatase; ALT, alanine transaminase; APTT, activated partial thromboplastin time; ASAT/AST, aspartate aminotransferase; CD4/CD8+, T4 helper cells/T8 suppressor cells; CRP, C-reactive protein; CRRT, continuous renal replacement therapy; EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid; DPA, docosapentaenoic acid; FOLE, fish oil lipid emulsion; GGT, gamma-glutamyl transferase; GST, glutathione S-transferase; HDL, high-density lipoprotein; HLA-DR, human leukocyte antigen-antigen D related; HPN, home parenteral nutrition; ICU, intensive care unit; IFN, interferon; Ig, immunoglobulin; IL, interleukin; LA, linoleic acid; LAK, lymphokine activated killer; LDL, low-density lipoprotein; LTB4, leukotriene B4; LTB5, leukotriene B5; MV, mechanical ventilation; NB, nitrogen balance; NK, natural killer; NF-Kβ, nuclear factor kappa β; OOLE, olive oil lipid emulsion, PAF, platelet activating factor; PMN, polymorphonuclear; PN, parenteral nutrition; PO2/FiO2, partial pressure of oxygen/fraction of inspired oxygen; PUFA, polyunsaturated fatty acid; SIRS, systemic inflammatory response syndrome; SOLE, soybean oil-based lipid emulsion; STG-LE, structured triglyceride lipid emulsion; TBARS, thiobarbituric acid-reactive substances; TG, triglyceride; TNF, tumor necrosis factor; VO2, oxygen consumption. For more details, please refer to Supplementary File ( Table 1 ).