In the United States, a composite lipid emulsion (CLE) consisting of soybean oil, medium-chain triglycerides, olive oil, and fish oil is authorised for parenteral feeding adults. CLE has theoretical benefits over soybean-based intravenous lipid emulsion for stable children discharged on home parenteral nutrition (HPN) without cholestasis due to reduced phytosterol exposure with higher calorie support to allow reduced glucose infusion rates (GIRs), omega-3 supplementation, and supplemental -tocopherol. In this prospective, single-center open-label research trial, individuals with HPN less than 18 years old were treated with CLE at 1 to 3 g kg1 day1 for a period of 12 months. The primary result was a difference in anthropometrics and GIRs from baseline. Changes in fatty acid profiles, liver function, and enzyme testing were secondary outcomes compared to baseline. A total of 57 people were treated, with a median age of 7 years. In 72% of cases, the diagnosis was short bowel syndrome. At 4-6 months postbaseline and beyond, a change in practise was linked with a drop in mean GIRs from 17 to 14 mg kg1 h1, as well as a concomitant decrease in mean arachidonic acid and stable growth characteristics.
At one year, CLE was safe and well-tolerated in stable children with HPN, but more research in this cohort is needed to understand long-term effects.
