Incubation of lipid emulsions with plasma lipoproteins modifies the fluidity of each particle

Effects of a medium-chain triacylglycerol/long-chain triacylglycerol fat emulsion containing a reduced ratio of phospholipid to triacylglycerol in pediatric surgical patients

OBJECTIVE

Medium-chain triacylglycerol (MCT) has been shown to provide better nutritional support than long-chain triacylglycerol (LCT). We compared the efficacy of MCT/LCT fat emulsions containing a usual (0.12) or a decreased (0.06) ratio of phospholipid to triacylglycerol (PL:TG) in pediatric patients under surgical stress.

METHODS

Three patient groups (n=10 in each) received equivalent amounts of glucose (12 g.kg(-1).d(-1)) and amino acids (2 g.kg(-1).d(-1)), but group A received a 10% MCT fat emulsion (PL:TG 0.06), group B received a 20% MCT fat emulsion (PL:TG 0.06), and group C received a 10% MCT/LCT fat emulsion (PL:TG 0.12) in amounts of 1.5 g.kg(-1).d(-1) in a randomized study. Total parenteral nutrition was given for 7 d. Blood samples were collected before total parenteral nutrition administration and on days 4 and 7 for determination of various biochemical indexes.

RESULTS

Serum phospholipid concentrations were significantly higher in group C than in group A or B on days 4 and 7 (P<0.05). Serum triacylglycerol and cholesterol concentrations and the very-low-density lipoprotein percentage were also significantly higher in group C than in group A or B on days 4 and 7 (P<0.05). The high-density lipoprotein percentage was significantly higher in group B on days 4 and 7 (P<0.05).

CONCLUSIONS

In pediatric patients under surgical stress, a total parenteral nutrition regimen containing an MCT/LCT fat emulsion with a decreased PL:TG ratio (0.06) is likely to result in partly better lipid and lipoprotein metabolism than an emulsion containing the usual ratio (0.12).

LDL binding to lipid emulsion particles: effects of incubation duration, temperature, and addition of plasma subfractions

Lipid emulsions used in parenteral nutrition interact with lipoproteins leading to exchanges of lipids and acquisition of several apolipoproteins (apo). It has been previously observed that, during in vitro incubation of emulsions with purified LDL, a variable fraction of LDL binds to TG-rich emulsion particles. The purpose of this study was to better characterize such an interaction. Two emulsions containing 20% soybean oil (Endolipid, B. Braun AG, Melsungen, Germany) or fish oil were incubated with LDL, either alone or in the presence of various plasma subfractions, for different durations and at different temperatures. The fraction named M-LE (containing TG-rich particles modified after incubation) was separated by ultracentrifugation or gel filtration chromatography, and the apoB content was measured as an index of LDL binding to TG-rich emulsion particles. The formation of such complexes was visualized by freeze-fracture electron microscopy. LDL binding was not influenced by the method used for M-LE isolation. Binding occurred quickly, did not increase with prolonged incubation, was inversely related to increasing incubation or ultracentrifugation temperature, and withstood 40 h of ultracentrifugation at 163,000 x g. The presence of glycerol or excess phospholipids in the emulsion did not markedly affect the formation of the complexes. In contrast, adding very small amounts of lipoprotein-poor plasma (d > 1.210 g/mL) or HDL markedly reduced the process, and albumin had no effect. The TG composition of the emulsion influenced the binding of LDL to TG-rich particles, since more apoB was found in M-LE from fish oil than from soybean oil emulsion.