Composition and History
Primary Metabolites of Omega-3 fatty acids
EPA - Eicosapentanoic Acid
DHA - Docosahexanoic Acid
concentrations of individual lipid sources in SMOF
Soy 30%
MCT 30%
Olive 25%
Fish Oil 15%
Can Omegaven be used as a sole source of IVLE in patients receiving parenteral nutrition
No
It doesn't contain the EFAs humans require
composition of ClinOleic
80% Olive oil
20% Soybean oil
Composition of Intralipid
100% Soybean oil
Name the two essential fatty acids that humans require exogenously.
1. Linoleic Acid (Omega 6) - vegetable oil, nuts, seeds
2. Alpha Linolenic Acid (Omega 3) - walnuts, chia seeds
SMOFlipid is indicated in Neonates, Paediatric and Adult populations
TRUE OR FALSE
TRUE
Omegaven can be added to other IVLEs to ensure omega-3 provision.
TRUE OR FALSE?
True
1 standard dose is 100ml which is 10g FO. However, achieving an optimal omega6:omega3 ratio in this scenario depends on the dose of Omegaven and total volume of lipid it is being added to.
9:1
recommendation is 4:1 - 2:1
SMOFlipid ratio is ~2.5:1
Current and future packaging
Currently Glass bottles
Moving to plastic bags
How are Medium Chain Triglycerides (MCTs) absorbed differently to long chain triglycerides (LCTs)?
1. MCTs can be absorbed directly into the bloodstream from the GI tract without need for bile salts
2. MCTs can enter mitochondria with minimal reliance on the carnitine transport system
Explain why Soybean oil remains an important component in SMOFLipid even though it is recognised that the precursors for pro-inflammatory mediators are derived from Omega 6 FA.
- Essential Fatty Acid delivery
- Linoleic and alpha linolenic acid not produced endogenously.
Omegaven should not be given to patients with Soy or peanut allergy as all IVLE contain soy oil.
TRUE OR FALSE
FALSE
Omegaven is 100% Fish Oil and can be considered a safe alternative in patients with soy or peanut allergy (EFA deficiency considerations aside)
ClinOleic contains higher amounts of alpha tocopherol and higher amounts of phytosterols than SMOFlipid
TRUE OR FALSE
FALSE
ClinOleic contains higher amounts of Phytosterols (bad) than SMOFLipid but much lower amounts of alpha tocopherol (vitamin E - anti-oxidant, good)
List two main uses in developed countries
- IVF (potentially suppressing NK cell activity)
Briefly explain the history of IV lipid emulsions
- 1960s 100% SO, Intralipid
-1980s MCT:LCT, Structolipid, Lipovonoes
-1990s OO:SO, ClinOleic
-2000s SO:MCT:OO:FO, SMOF, Omegaven
Name 2 main reasons why SMOFLipid is chosen in neonates
1. DHA supplementation - visual, neural and mental development
2. Favourable FA pattern - more similar to human cord blood & breast milk than other IVLE
others: high energy reqs, improved antioxidant status, liver parameters, weight gain, well tolerated
Phytosterol content in mg/l
0
that was a trick question. LOL
ClinOleic contains more Linoleic (omega-6) acid than SMOFlipid
TRUE OR FALSE
FALSE
ClinOleic contains slightly less Linoleic acid than SMOFlipid (18.5% vs 21.4%)
It also contains less alpha linolenic acid than SMOFLipid (2% vs 2.5%)
Omega 6: Omega 3 Ratio
7:1
Describe the composition of fatty acids at a molecular level. Include references to chain length and the differences between saturated, mono and poly unsaturated.
- carbon chain with methyl end and acidic end
- chain length + degree of saturation
- Short chain <C4, Medium C6-C12, long C14-C26
- no c=c is saturated, 1 c=c is mono, >1 c=c poly
List 4 clinical benefits of FO containing PN that studies (e.g. Pradelli, Notz) have found over non FO containing PN.
1. Reduction in infection rate
2. Reduction in ICU LOS
3. Reduction in Hospital LOS
4. Reduction in Sepsis rate
Name 1 common use of Omegaven in the clinical setting
Rescue therapy for paediatric liver disease, particularly IFALD.
Note: Fresenius-Kabi still considers this off-label use. Omegaven should not be used in premature infants, newborns, infants and children due to limited experience.
- source of EFA to prevent deficiency
- immune & inflammatory neutral
- lower amounts of phytosterols than SO and MCT:LCT based IVLE
- Oleic acid - less susceptible to lipid peroxidation
- well tolerated in critically ill patients
Phytosterol Content in mg/l
348 +/-33