Effect of Parenteral Medium- and Long-Chain Triglycerides on Lymphocytes Subpopulations and Functions in Patients With Acquired Immunodeficiency Syndrome: A Prospective Study

Background: Total parenteral nutrition (TPN) may offer significant clinical benefit in malnourished patients with acquired immunodeficiency syndrome (AIDS). However, the immunologic effect of parenteral lipids remains unknown in these severely immunodepressed patients. Methods: We undertook a prospe...

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Published in:JPEN. Journal of parenteral and enteral nutrition 1998-03, Vol.22 (2), p.67-71
Main Authors: Gelas, Patrick, Cotte, Laurent, Poitevin-Later, Françoise, Pichard, Claude, Leverve, Xavier, Barnoud, Didier, Leclercq, Pascale, Touraine-Moulin, Françoise, Trépo, Christian, Boulétreau, Paul
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome - complications
Acquired Immunodeficiency Syndrome - immunology
Acquired Immunodeficiency Syndrome - therapy
AIDS/HIV
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cohort Studies
Double-Blind Method
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Fat Emulsions, Intravenous - administration & dosage
Fat Emulsions, Intravenous - chemistry
Humans
Intensive care medicine
Lymphocyte Subsets - drug effects
Lymphocyte Subsets - immunology
Medical sciences
Nutrition Disorders - complications
Nutrition Disorders - immunology
Nutrition Disorders - therapy
Parenteral Nutrition, Total - methods
Prospective Studies
Time Factors
Triglycerides - administration & dosage
Triglycerides - chemistry
Triglycerides - pharmacology
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Summary:Background: Total parenteral nutrition (TPN) may offer significant clinical benefit in malnourished patients with acquired immunodeficiency syndrome (AIDS). However, the immunologic effect of parenteral lipids remains unknown in these severely immunodepressed patients. Methods: We undertook a prospective randomized double-blind multicenter study comparing the effects of two IV lipid emulsions used during TPN: long-chain triglycerides (LCT) or balanced emulsion of long- and medium-chain triglycerides (LCT/MCT). Thirty-three AIDS patients requiring TPN for wasting and reduced oral intake were allocated randomly to receive a ternary TPN mixture consisting of 1.5 g/kg/d proteins, 18 kcal/kg/d lipids, and 12 kcal/kg/d carbohydrates for 6 days. The following tests were performed at days 0 and 7: immunoglobulins, complement fractions, lymphocyte subpopulations count, and lymphocyte proliferation with mitogens. Results: Patients were all severely malnourished (weight loss: — 14.0 ± 1.3 kg). No clinical or biological differences were observed between the groups at baseline. At day 7, both groups reported a significant increase in weight. Patients in the LCT group exhibited a significant decrease in phytohemagglutinin A response (p = .04) compared with baseline. Patients in the LCT/ MCT group exhibited a lower level of IgM (p = .03) and a significant increase in C3 fraction (p = .03) compared with baseline. They also showed a tendency to have a higher CD4/CD8 lymphocyte ratio ( p = .07), whereas other immunological parameters remained unchanged. Conclusions: Parenteral ternary mixture containing LCT or LCT/MCT are clinically well tolerated in AIDS patients over 6 days. With 2 g/kg/d of lipids, LCT seems to induce significant abnormalities in lymphocyte function. Such abnormalities are not observed with LCT/MCT. (Journal of Parenteral and Enteral Nutrition 22:67-71, 1998)
ISSN:0148-6071
1941-2444
DOI:10.1177/014860719802200267