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- Improving the usability of lipid emulsions and optimizing their user-friendliness: a narrative review
- Keisuke Kubota, Natsuko Ichikawa, Kazuhiro Isoda, Misato Enomoto, Miyoko Kosugi, Mari Tanabe, Naoya Sakuraba, Sayuri Endo, Atsushi Suzuki, Masanori Hashimoto
- Ann Clin Nutr Metab 2025;17(2):104-113. Published online August 1, 2025
- DOI: https://doi.org/10.15747/ACNM.25.0015
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Abstract
PDF - Purpose
Reluctance to administer lipid emulsions to patients receiving treatment, or as recommended by a nutritional support team, often stems from various restrictions or concerns about potential adverse effects. This paper aims to discuss the appropriate clinical use of lipid emulsions to enhance both patient safety and convenience.
Current concept
We conducted a literature review to assess the importance of nutritional therapy and nutritional intervention, the advantages and disadvantages of lipid-emulsion administration, the current situation in Japan, and differences between lipid formulations. Here, we address issues regarding lipid-emulsion use, including: administration rate, drug mixing, administration in critically ill patients, and early postoperative use. Our findings suggest the following solutions to each issue: although a rate below 0.1 g/kg/hr is generally recommended, faster administration is possible if needed, depending on the case; administration via a piggy tube to basic infusion formulations is unproblematic; second- and third-generation fat emulsions are safe for critically ill patients, though soybean oil should be used with caution; and while fat emulsion administration is feasible immediately after surgery, due to endogenous energy mobilization, it is preferable to initiate administration from the third to fourth postoperative day.
Conclusion
The provisional conclusions of this study are as follows: the introduction of medium-chain triglyceride formulations and fish oil (second- and third-generation lipid emulsions), which are not yet available in Japan, is urgently needed; and individualized administration is essential due to substantial interindividual variability in lipid emulsion usage.
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Original Article
- Influence of Fish Oil-Containing Lipid Emulsions on Parenteral Nutrition-Associated Liver Disease in Neonates
- Jeong-A Park, Ji-Eun Park, Min-Jae Jeong, Jae-Song Kim, Eun-Sun Son, Ho-Seon Eun
- J Clin Nutr 2017;9(1):21-29. Published online June 30, 2017
- DOI: https://doi.org/10.15747/jcn.2017.9.1.21
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Abstract
PDF
Supplementary Material Purpose:
This study is a comparative evaluation of the incidence of parenteral nutrition-associated liver disease (PNALD) when administering intravenous fat emulsions containing fish oil.
Methods:
The medical records of patients who were in the neonatal intensive care unit at Severance Hospital from January, 2012 to December 2015, were reviewed retrospectively. Patients who were administered either soybean oil (SO) or SMOF (containing soybean oil, medium chain triglycerides, olive oil, and fish oil) more than 14 days were included. The patients were excluded if they were administered both agents or had underlying hepatic disease. An increase in bilirubin to 2 mg/dL was defined as PNALD.
Results:
PNALD occurred in only 8 out of a total of 77 patients: 6 out of 31 (19.4%) in the SO group and 2 out of 46 (4.3%) in the SMOF group (P=0.055). The number of patients, whose lab values, such as direct bilirubin, total bilirubin, asparate aminotransferase (AST), alanine amino-transferase, gamma-glutamyl transpeptidase, C-reactive protein, serum triglyceride, and alkaline phosphate, exceeded the normal range, were similar in both groups. The gestational age, birth body weight, and APGAR score at 1 min and 5 min were significantly higher in the SO group and the PN duration was significantly long in the SMOF group. Considering only term infants, there were no significant differences in baseline characteristics and incidence of PNALD. The number of patients whose AST exceeded the normal range was significantly higher in the SO group (P=0.034).
Conclusion:
The incidence of PNALD was similar in both groups. On the other hand, considering the tendency, there was a high correlation between the type of lipid emulsion and an increased direct bilirubin level in the SO group.
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