Composite Intravenous lipid emulsion (ILE): soybean (30%), medium chain triglycerides (30%), olive (25%) and fish (15%) oil (SMOFlipid®) is now used in prematures, and children on parenteral nutrition (PN) especially for cholestatic liver disease (CLD). The aim was to assess the fatty acids (FAs) profile on long-term home-PN.

Population: 31 intestinal failure (IF) children (6 mths-16yrs): SBS = 16, congenital enteropathy: 7, total aganglionosis:5,  pseudo-obstruction: 3, on HPN for 5 mths to 16 yrs, with severe IFas supported by plasma citrulline and PN intake. All received SMOFlipid® as sole source of ILE for 6 to 38 mths at the dose: 2.1 ± 0.39 g/kg/day, 6.7 ± 0.7 days per wk.

Methods: Sampling after ≥ 24h fat free PN & 6-8h after PN discontinuation. After RBC NaCl 9/1000 washing, RBC-FA profiles were established by using gas-chromatography. Citrulline plasma levels, ratio PN-intake/resting energy expenditure (REE), using Schofield equation, growth and total plasma bilirubin were assessed. FA profiles compared to those obtained from a former RCT comparing Intralipid® and SMOFlipid® for 4 wks (JPEN 2010).

Results: Citrulline: 6.1±6.3 mmol/l (med: 4); PN / REE ratio: 130±20 %, (med: 130); Total bilirubin 12.2±8.5 mmol/l (med: 9). Growth within normal range: BW: + 0.1±1.8 SD; height: - 0.1±1.4 SD. RBC-FA profiles and comparison by t tests (table).

Conclusion: Long-term administration of an ILE rich in fish oil in highly PN dependent children was well tolerated. Bilirubin plasma levels remained low and growth was normal. RBC-FA profile did not change in the short term (4 wks), differs on the long term for C18:2n-6, C20:5n-3, and C22:6n-3 without significant change in Arachidonic acid. It reflects the n-3/n-6 FA acid composition of this new fish oil rich ILE without harmful effect.

In % of FAs

ND: No differenceIntralipid® 4 wks (n=13)

SMOF® 4 wks

(n=15)

Current SMOF®

(n=31)

P (t tests)

Intralipid®/SMOF® 4 wks

& SMOF® 4 wks/long termC16: 0 Palmitic33.7 ± 3.732.9 ± 4.023.8 ± 3.0ND & p =  0.18C18: 1n-9 Oleic15.2 ± 1.516.7 ± 1.614.1 ± 1.5ND & p = 0.73C18: 2 n-6 Linoleic Ac11.8 ± 2.311.6 ± 3.86.1 ± 1.2ND &  p < 0.001C20: 4 n-6 Arachidonic10.4 ± 2.09.7 ± 1.96.2 ± 1.5ND & p = 0.27C20: 5 n-3  EPA0.27 ± 0.110.84 ± 0.299.30 ± 2.20ND & p < 0.001C22: 6 n-3  DHA2.13 ± 0.813.06 ± 1.0012.50 ± 1.80ND & p = 0.02