The influence of total parenteral nutrition on the metabolism of non-esterified fatty acids in critically ill patients: Ongoing data from a prospective randomized study
Abstract
Introduction: Metabolic changes induced by stress reaction are, among other things, characterized by increased turnover of non-esterified fatty acids (NEFA), which results in an increase in their plasma concentration. The aim of the study was to determine how intravenous nutritional support (TPN) will affect the concentration of NEFA in critically ill individuals.
Methods: 38 patients in averaged 65 +- 11 years old hospitalized in a medical intensive care unit of university hospital in years 2015-2018 were examined. They were given isocaloric (30 kcal/kg/day) and isonitrogenic (1.8 g/kg/day) TPN in combination with glucose (5.8 g/kg/day; glucose group, G) or in combination with glucose (2.9 g/kg/day) and lipid emulsion (1.2 g/kg/day; lipid group, L).
NEFA measurements were performed before starting TPN (day 0) and then at days 1, 3, 6, 9, 14 and 28 using enzymatic and spectrophotometric method. Statistical program Jamovi and the Mann-Whitney U test were used.
Results: There was no significant difference in NEFA concentration (mmol/L) at day 0 (G 0.502 +- 0.291, L 0.409 +- 0.126). There was significant decrement (p < 0.001) in day 1 (G 0.220 +- 0.112, L 0.279 +- 0.126).
When comparing both groups decrease was more significant in the G, and statistical significance (p < 0.05) was achieved at days 6, 9, 14 and 28. Conclusion: Starting of TPN results in a decrease of NEFA concentration with a greater effect at a higher glucose dose.
Glucose administration is able to modify NEFA turnover in critical illness.