Parenteral nutrition-associated liver disease and lipid emulsions | Endocrinología y Nutrición (English Edition)

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"autores" => array:3 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Zugasti Murillo" "email" => array:1 [ 0 => "ana.zugasti.murillo@cfnavarra.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Estrella" "apellidos" => "Petrina Jáuregui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Javier" "apellidos" => "Elizondo Armendáriz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra, Pamplona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Farmacia, Complejo Hospitalario de Navarra, Pamplona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hepatopatía asociada a nutrición parenteral y emulsiones lipídicas" ] ] "textoCompleto" => "IntroductionThe first safe lipid emulsion, still on the market, was developed in 1961 and consisted of soybean oil and egg lecithin. From that date, lipid emulsions became a feature of parenteral nutrition (PN). One decade later, these emulsions were combined with all the other nutrients to obtain the well known “all-in-one” admixtures currently used.The latest generation of these emulsions includes formulas enriched with fish oil, based on omega-3 fatty acids (W3FA), and with a lower concentration of omega-6 fatty acids (W6FA), the main component of the original emulsions.The traditional management of PN-associated liver disease (PNALD) includes the cyclic administration of PN for as short a time as possible, the early detection and treatment of catheter sepsis, the start of enteral nutrition as early as possible, the administration of ursodeoxycholic acid to decrease bile viscosity and antibiotics to prevent bacterial overgrowth, and an adequate provision of macronutrients and macronutrients in PN.Data in the literature suggest that nutritional supplementation with fish oil may modify the inflammatory response, and some authors have reported positive results with the use of lipid emulsions with a high W3FA content in the treatment of PNALD in both children and adults.Liver changes associated with parenteral nutritionThe administration of PN has been associated with liver changes such as steatosis, steatohepatitis, fibrosis, cirrhosis, and biliary changes such as cholestasis, cholelithiasis, and cholecystitis.<a class="elsevierStyleCrossRefs" href="#bib0160">1,2</a> These changes may occur in 25–100% of adult patients who receive PN.<a class="elsevierStyleCrossRef" href="#bib0170">3</a> In Spanish studies, the prevalence of such changes has been reported as 30% in critically ill patients with PN, and as 36% in patients on home PN.<a class="elsevierStyleCrossRef" href="#bib0175">4</a> If liver involvement progresses, it may lead to cirrhosis and liver and bowel transplant may be required.Diagnosis is mainly based on bilirubin and liver enzyme levels, although the cut-off points for these markers may change depending on the hospital or in different studies.<a class="elsevierStyleCrossRef" href="#bib0180">5</a>Moreover, the correlation between changes in these laboratory tests and histopathological findings in liver biopsies is low.<a class="elsevierStyleCrossRef" href="#bib0165">2</a> The etiology of changes has not been fully elucidated, and is thought to be multifactorial.<a class="elsevierStyleCrossRefs" href="#bib0160">1,6</a> Changes have been related to factors associated with both PN itself, such as therapy duration, calorie overload, carbohydrate overload, amino acid overload or deficiency, carnitine, choline, or taurine deficiency, excess manganese and copper administration, and continuous infusion, and to patient-associated factors such as underlying disease, sepsis, intestinal bacterial overgrowth, the presence of short bowel syndrome, a lack of enteral stimulation, or hyperinsulinism.<a class="elsevierStyleCrossRefs" href="#bib0170">3,6</a>As regards lipids in PN, four factors have been related to liver dysfunction:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Lipid dose: both a deficiency and an excess provision of essential fatty acids may cause liver damage. A lipid dose >1g/kg/day is associated with a marked increase in liver changes and a 2–5 times greater risk of experiencing some severe change in the liver,<a class="elsevierStyleCrossRefs" href="#bib0170">3,6</a> and has been included in current European guidelines as the value that should not be exceeded.<a class="elsevierStyleCrossRef" href="#bib0190">7</a> At least 2–4% of total calories should be administered as lineoleic acid to prevent deficiency. The ratio of calories provided by carbohydrates and lipids also appears to be important, and should not exceed 60:40 in home patients according to various recommendations.<a class="elsevierStyleCrossRef" href="#bib0190">7</a> The mechanism by which toxicity related to lipid dose occurs is not clear, but it could be changes in liver macrophages, phospholipid elimination in bile, or a blockade of liver capacity to mobilize lipids.<a class="elsevierStyleCrossRef" href="#bib0185">6</a></li><li class="elsevierStyleListItem" id="lsti0010">-Lipid composition: lipid emulsions based on soybean oil, with high W6FA contents, have been associated with greater liver toxicity, particularly when they are used over a long period of time.<a class="elsevierStyleCrossRefs" href="#bib0170">3,6,7</a> To decrease this toxicity, the alternatives proposed have included lipid emulsions with lower W6FA contents, such as those consisting of mixtures of medium (MCT) and long-chain triglycerides (LCT), those based on olive oil, those containing W3FA,<a class="elsevierStyleCrossRefs" href="#bib0170">3,6,8</a> or even the provision of W3FA as the only lipid.<a class="elsevierStyleCrossRef" href="#bib0200">9</a></li><li class="elsevierStyleListItem" id="lsti0015">-Phytosterolemia: lipid emulsions are mostly of plant origin and contain substantial amounts of phytosterols.<a class="elsevierStyleCrossRefs" href="#bib0170">3,6,10</a> These phytosterols have been related to liver toxicity in PN because they are considered to be able to alter cholesterol and bile acid production and to contribute to cholestasis.<a class="elsevierStyleCrossRefs" href="#bib0170">3,10</a></li><li class="elsevierStyleListItem" id="lsti0020">-α-Tocoferol: this may act as a potent antioxidant in cases of steatosis, protecting the liver from oxidative damage. W3FA-enriched formulas have greater amounts of α-tocoferol than those derived from soybean.</li></ul>Types of lipid emulsions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)To date, there have been three generations of intravenous lipid emulsions.<a class="elsevierStyleCrossRef" href="#bib0210">11</a> The fatty acid profile of these emulsions has evolved with our increased understanding of their metabolism and their importance in the regulation of processes triggered by aggression and immunity (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The first generation (based on soybean or safflower oil, Intralipid®)These were the first lipid emulsions to be marketed (1961). Derived from soybean oil, they contain long-chain triglycerides ([LCTs] 16–18 carbon atoms) only. They were originally intended to provide essential fatty acids to prevent their deficiency, and were subsequently accepted as a concentrated source of energy.<a class="elsevierStyleCrossRef" href="#bib0210">11</a> They contain a high proportion of W6FA, approximately 50–60%, mainly as linoleic acid, an essential fatty acid. Cumulative observations of the adverse effects derived from the high proportion of W6FA in these initial lipid emulsions indicated the need to develop new emulsions having a much lower content of this type of fat.The second generation (developed to decrease the provision of W6FA in the first generation products; a mixture with medium- and long-chain triglycerides)Emulsions containing 50% of MCTs have been in clinical use since 1984. MCTs have 6–12 carbon atoms and are mainly found in coconut oil. They oxidate easily and enter mitochondria without the need for carnitine. MCTs are therefore more rapidly available for tissues than LCT emulsions and are considered immunologically neutral. As they are saturated fatty acids, they are resistant to lipid peroxidation,<a class="elsevierStyleCrossRef" href="#bib0215">12</a> do not participate in eicosanoid synthesis,<a class="elsevierStyleCrossRef" href="#bib0195">8</a> are not stored as triglycerides, and have a ketogenic effect.<a class="elsevierStyleCrossRefs" href="#bib0195">8,13,14</a>Lipid emulsions based on a mixture of soybean oil and medium-chain triglycerides (Lipofundina®)Chronologically, this emulsion appeared after the first-generation emulsions. It is a mixture of 50% soybean oil and 50% coconut or palm oil that contains a very high proportion of MCTs.<a class="elsevierStyleCrossRef" href="#bib0205">10</a>Lipid emulsions based on soybean and olive oil (Clinoleic®)Another solution for decreasing W6FA content was to base the emulsion on olive oil (80%), with EFA provision being completed with soybean oil (20%). This emulsion contains oleic acid as the main component, a monounsaturated acid of the omega-9 family (W9FA), and has some benefits such as resistance to lipid peroxidation, an effect that is considered neutral and poorly toxic on the immune system, and a decreased generation of pro-inflammatory cell mediators.<a class="elsevierStyleCrossRefs" href="#bib0195">8,12,13</a> It has also been postulated that some phenolic compounds contained in olive oil could provide additional advantages as being antioxidant and anti-inflammatory.<a class="elsevierStyleCrossRef" href="#bib0230">15</a>Lipid emulsions based on a chemical mixture of soybean oil and medium-chain triglycerides. Structured lipids (Structolipid®)These are emulsions consisting of synthetic lipids obtained through the hydrolysis of soybean and coconut oils, equivalent to 64% of soybean oil and 34% of coconut oil, and subsequent random reesterification. The result is a fat that contains LCTs and MCTs in the same glycerol and in a resulting equimolecular proportion.<a class="elsevierStyleCrossRefs" href="#bib0195">8,12,16</a> It appears that fewer changes occur in the liver<a class="elsevierStyleCrossRef" href="#bib0240">17</a> and immune system<a class="elsevierStyleCrossRef" href="#bib0215">12</a> as compared with physical mixture or soybean emulsions.The third generationThis refers to the incorporation of W3FA into emulsions of a prior generation, decreasing W6FA provision, to positively modulate inflammation and immunosuppression. This generation is clearly aimed at achieving a pharmaconutrient effect.W3FA doses >0.05g/kg/day have been reported to provide benefits, with optimal doses of 0.14–0.30g/kg/day.<a class="elsevierStyleCrossRef" href="#bib0245">18</a> However, further studies confirming these results are needed.These emulsions are considered to be safe, and no significant adverse effects have been reported.<a class="elsevierStyleCrossRefs" href="#bib0195">8,13,19</a> They have even improved or reversed the toxicity of PN for the liver.<a class="elsevierStyleCrossRef" href="#bib0200">9</a>Two emulsions containing fish oil are currently being marketed in Spain:A lipid emulsion based on soybean oil, medium-chain triglycerides, and fish oil: MSF emulsion (Lipoplus®)This is an emulsion based on the second generation of the physical mixture of soybean oil and MCTs in which part of the soybean oil is replaced by fish oil to achieve final concentrations of 40%, 50%, and 10% respectively. This emulsion has been found to increase contents in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in plasma phospholipids and erythrocyte membranes, and to the modulated production of pro-inflammatory leukotrienes<a class="elsevierStyleCrossRef" href="#bib0250">19</a> with no negative impact on gas exchange or hemodynamics.A lipid emulsion based on soybean oil, medium-chain triglycerides, olive oil, and fish oil: SMOF emulsion (SMOFlipid®)This is based on a physical mixture of soybean oil, MCTs, and olive and fish oils at 30%, 30%, 25%, and 15% respectively. This is a new concept of emulsion that combines the conditions of an “ideal” emulsion in the light of our current knowledge, with a balanced and more physiological fatty acid composition, and a ω-6/ω-3 ratio within the optimum range.<a class="elsevierStyleCrossRefs" href="#bib0195">8,19</a> This emulsion is metabolized 40% faster than soybean oil-based emulsions.Increased plasma levels of W3FA, together with decreased W6FA levels, reduce levels of pro-inflammatory mediators, have a neutral impact on inflammatory and immune variables, and have been shown in several studies to decrease both hospital stay and mortality and the number of days of mechanical ventilation in critically ill patients.<a class="elsevierStyleCrossRefs" href="#bib0195">8,12,13,20</a>Omegaven® (not marketed in Spain)This is a 100% ultra-refined fish oil emulsion available on the market since 1998. It is recommended that it be administered together with other lipid emulsions at a maximum dose of 1–2mL/kg. The first case in which this product was used alone in a patient with soybean allergy to prevent EFA deficiency was reported in 2005.<a class="elsevierStyleCrossRef" href="#bib0260">21</a>Emulsions of omega-3 fatty acids alone and the improvement of parenteral nutrition-associated liver diseaseSeveral articles reporting PNALD improvement with the use of Omegaven® (as a supplement of another lipid emulsion or as a single formula) in both children<a class="elsevierStyleCrossRefs" href="#bib0265">22–25</a> and adults have been published in recent years.<a class="elsevierStyleCrossRefs" href="#bib0285">26–30</a> In adult patients, liver function improvement has been seen in a short period (4–8 weeks), but no data are available beyond 16 weeks of follow-up.<a class="elsevierStyleCrossRef" href="#bib0300">29</a>The patient reported by Jurewitsch et al.<a class="elsevierStyleCrossRef" href="#bib0285">26</a> initially received a mixture of soybean emulsion together with Omegaven® (0.25g/kg/day) for four weeks. In view of the stabilization of bilirubin levels, Omegaven® alone was continued at the same dose as maintenance therapy, resulting in the normalization of bilirubin levels at 16 weeks, decreased hepatomegaly, and the disappearance of cholestasis in a biopsy performed five months after treatment start.Xu et al.<a class="elsevierStyleCrossRef" href="#bib0290">27</a> reported a series of 15 adults (9 females and 6 males) in which an emulsion of soybean oil and MCTs was replaced by Omegaven® (0.15–2g/kg/day, maximum 10g/day) for two months. Eighty percent of the subjects experienced a normalization of esterified bilirubin levels within four weeks, as well as decreased cholestasis and inflammation at biopsies.Burns et al.<a class="elsevierStyleCrossRef" href="#bib0295">28</a> replaced an emulsion based on soybean oil only by Omegaven® (1g/kg 5 days weekly) in a patient, resulting in laboratory data improvement at five weeks and a normalization of bilirubin levels at eight weeks. These results persisted at 29 weeks.Venecourt et al.<a class="elsevierStyleCrossRef" href="#bib0300">29</a> reported a patient receiving an emulsion of soybean and olive oil whose bilirubin levels decreased (at 8 weeks) and whose transaminase levels normalized (at 10 weeks) after switching to Omegaven® (1g/kg 6 days weekly).The most recent series, reported by Pastor-Clerigues et al.,<a class="elsevierStyleCrossRef" href="#bib0305">30</a> provided data on the anti-inflammatory and antifibrotic effect of Omegaven® administered to two patients for four months (1g/kg 5 days weekly). Liver function impairment recurred on the replacement of this emulsion by a mixture of soybean oil, MCTs, and olive and fish oils.ConclusionsPatients diagnosed with PNALD have a high mortality rate as a result of liver cirrhosis/failure if PN discontinuation or liver and bowel transplant is not possible. An understanding of all the mechanisms involved in the development of this disease and the availability of effective and safe treatments are therefore especially important. In recent years there has been an increasing interest in treatment and prevention using W3FA-enriched lipid formulas. Although the exact mechanism is unknown, it could lie in a decreased hepatic apoptosis due to the effect of EPA and DHA contained in these types of formulas, along with an essential anti-inflammatory role, and to decreased W6FA provision.Elsewhere<a class="elsevierStyleCrossRef" href="#bib0310">31</a> in this issue of the journal we report the case of a patient who was treated with W3FA alone for 50 weeks, the longest treatment with Omegaven® reported in Spain. We believe that this case may lead to a new approach to the treatment of patients with PNALD. The improvement in the laboratory results was important, but the change in portal flow direction detected in the imaging tests was even more significant as indirect evidence of portal hypertension improvement. No deficiencies in essential fatty acids were found during the follow-up period.Larger series and longer follow-up periods will provide more information about the ideal proportions of W3FA and W6FA and the dose that should be given in PN to cover nutritional requirements and prevent hepatic complications.Conflicts of interestThe authors state that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres982722" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec950268" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres982721" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec950267" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Liver changes associated with parenteral nutrition" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Types of lipid emulsions (Table 1)" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "The first generation (based on soybean or safflower oil, Intralipid)" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "The second generation (developed to decrease the provision of W6FA in the first generation products; a mixture with medium- and long-chain triglycerides)" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Lipid emulsions based on a mixture of soybean oil and medium-chain triglycerides (Lipofundina)" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Lipid emulsions based on soybean and olive oil (Clinoleic)" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Lipid emulsions based on a chemical mixture of soybean oil and medium-chain triglycerides. Structured lipids (Structolipid)" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "The third generation" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "A lipid emulsion based on soybean oil, medium-chain triglycerides, and fish oil: MSF emulsion (Lipoplus)" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "A lipid emulsion based on soybean oil, medium-chain triglycerides, olive oil, and fish oil: SMOF emulsion (SMOFlipid)" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Omegaven (not marketed in Spain)" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Emulsions of omega-3 fatty acids alone and the improvement of parenteral nutrition-associated liver disease" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-24" "fechaAceptado" => "2015-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec950268" "palabras" => array:3 [ 0 => "Parenteral nutrition-associated liver disease" 1 => "Fish oil-based lipid emulsion" 2 => "Omegaven" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec950267" "palabras" => array:3 [ 0 => "Hepatopatía asociada a nutrición parenteral" 1 => "Emulsión lipídica ácidos grasos omega-3" 2 => "Omegaven" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Parenteral nutrition-associated liver disease (PNALD) is a particularly important problem in patients who need this type of nutritional support for a long time. Prevalence of the condition is highly variable depending on the series, and its clinical presentation is different in adults and children. The etiology of PNALD is not well defined, and participation of several factors at the same time has been suggested. When a bilirubin level >2mg/dl is detected for a long time, other causes of liver disease should be ruled out and risk factors should be minimized.The composition of lipid emulsions used in parenteral nutrition is one of the factors related to PNALD. This article reviews the different types of lipid emulsions and the potential benefits of emulsions enriched with omega-3 fatty acids." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La afectación de la función hepática asociada con la nutrición parenteral es un problema especialmente importante en los pacientes que precisan este tipo de soporte nutricional durante un tiempo prolongado. La prevalencia es muy variable según las series, y se presenta clínicamente de forma distinta en adultos y en niños. Su etiología no está bien definida y se contempla la participación de varios factores al mismo tiempo. Cuando se detecta un nivel de bilirrubina > 2mg/dl durante un período prolongado se deben descartar otras causas de hepatopatía y minimizar los factores de riesgo.La composición de las emulsiones lipídicas empleadas en la nutrición parenteral es uno de los factores relacionados con la alteración de la función hepática. En este artículo se revisan los distintos tipos de emulsiones lipídicas, así como los posibles beneficios de las fórmulas enriquecidas con ácidos grasos omega-3." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Zugasti Murillo A, Petrina Jáuregui E, Elizondo Armendáriz J. Hepatopatía asociada a nutrición parenteral y emulsiones lipídicas. Endocrinol Nutr. 2015;62:285–289." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; LCTs: long-chain triglycerides; MCTs: medium-chain triglycerides; MSF: MCTs/soybean/fish; SMOF: soybean/MCTs/olive/fish." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Trade name \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Intralipid® \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Lipofundina® MCTs/LCTs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Clinoleic® 20% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Structolipid® \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Lipoplus® \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">SMOFLipid® \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Omegaven® \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of emulsion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Soybean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Physical mixture MCTs/LCTs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Olive/soybean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chemical mixture MCTs/LCTs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Soybean/MCT/W3-MSF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Soybean/MCTs/olive/W3-SMOF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fish \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Generation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3rd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3rd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3rd \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top">Oil origin (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Soybean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Coconut \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Olive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fish \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">W3 concentration (g/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">W6:W3 ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.7:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1:8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Linoleic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44–62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">α Linolenic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4–11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">α Tocoferol (mg/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85±20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">190±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150–296 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">EPA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">DHA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Phytosterols (mg/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">348 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">327±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1664101.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of lipid emulsions." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Doc 1. [chapter 11]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications and monitoring – guidelines on parenteral nutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.H. Hartl" 1 => "K.W. Jauch" 2 => "K. Parhofer" 3 => "P. Rittler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3205/000067" "Revista" => array:4 [ "tituloSerie" => "Ger Med Sci" "fecha" => "2009" "volumen" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19718276" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complicaciones hepáticas asociadas al uso de nutrición parenteral" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Moreno Villares" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Nutr Hosp" "fecha" => "2008" "volumen" => "23" "numero" => "Suppl 2" "paginaInicial" => "25" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18714408" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parenteral nutrition-associated liver disease in adult and pediatric patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V.J. Kumpf" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0115426506021003279" "Revista" => array:6 [ "tituloSerie" => "Nutr Clin Pract" "fecha" => "2006" "volumen" => "21" "paginaInicial" => "279" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16772545" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver dysfunction associated with artificial nutrition in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Grau" 1 => "A. Bonet" 2 => "M. Rubio" 3 => "D. Mateo" 4 => "M. Farre" 5 => "J.A. Acosta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc5670" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2007" "volumen" => "11" "paginaInicial" => "R10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17254321" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782411004720" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of liver dysfunction under artificial nutrition: a reason to modify nutrition therapy in the intensive care unit?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Stehle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc5679" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2007" "volumen" => "11" "paginaInicial" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17316464" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Managing liver dysfunction in parenteral nutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Lloyd" 1 => "S.M. Gabe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S002966510700585X" "Revista" => array:7 [ "tituloSerie" => "Proc Nutr Soc" "fecha" => "2007" "volumen" => "66" "paginaInicial" => "530" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17961274" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782415001304" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESPEN guidelines on parenteral nutrition: home parenteral nutrition (HPN) in adult patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Staun" 1 => "L. Pironi" 2 => "F. Bozzetti" 3 => "J. Baxter" 4 => "A. Forbes" 5 => "F. Joly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clnu.2009.04.001" "Revista" => array:6 [ "tituloSerie" => "Clin Nutr" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "467" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19464089" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New parenteral lipid emulsions for clinical use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.L. Waitzberg" 1 => "R.S. Torrinhas" 2 => "T.M. Jacintho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0148607106030004351" "Revista" => array:6 [ "tituloSerie" => "JPEN J Parenter Enteral Nutr" "fecha" => "2006" "volumen" => "30" "paginaInicial" => "351" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16804134" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fish oil-based lipid emulsions prevent and reverse parenteral nutrition associated liver disease: the Boston experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V.E. De Meijer" 1 => "K.M. Gura" 2 => "H.D. Le" 3 => "J.A. Meisel" 4 => "M. Puder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0148607109332773" "Revista" => array:6 [ "tituloSerie" => "JPEN J Parenter Enteral Nutr" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "541" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19571170" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phytosterolemia in parenteral nutrition patients: implications for liver disease development" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Llop" 1 => "N. Virgili" 2 => "J.M. Moreno-Villares" 3 => "P. Garcia-Peris" 4 => "T. Serrano" 5 => "M. Forga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nut.2008.06.017" "Revista" => array:8 [ "tituloSerie" => "Nutrition" "fecha" => "2008" "volumen" => "24" "numero" => "11-12" "paginaInicial" => "1145" "paginaFinal" => "1152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18656327" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002937812003997" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolution of parenteral lipid emulsions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.L. Waitzberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Nutr Suppl" "fecha" => "2005" "volumen" => "1" "paginaInicial" => "5" "paginaFinal" => "7" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immune modulation by parenteral lipid emulsions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.J. Wanten" 1 => "P.C. Calder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2007" "volumen" => "85" "paginaInicial" => "1171" "paginaFinal" => "1184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17490951" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002937812001317" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hot topics in parenteral nutrition. Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.C. Calder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0029665109001268" "Revista" => array:6 [ "tituloSerie" => "Proc Nutr Soc" "fecha" => "2009" "volumen" => "68" "paginaInicial" => "252" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19426581" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The metabolic consequences of infusing emulsions containing medium chain triglycerides for parenteral nutrition: a comparative study with conventional lipid" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.R. Dennison" 1 => "M. Ball" 2 => "P.J. Crowe" 3 => "K. White" 4 => "L. Hands" 5 => "R.M. Watkins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann R Coll Surg Engl" "fecha" => "1986" "volumen" => "68" "paginaInicial" => "119" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3089123" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Olive oil in parenteral nutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Sala-Vila" 1 => "V.M. Barbosa" 2 => "P.C. Calder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCO.0b013e32802bf787" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Clin Nutr Metab Care" "fecha" => "2007" "volumen" => "10" "paginaInicial" => "165" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17285004" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Structured triglyceride emulsions in parenteral nutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Chambrier" 1 => "M. Lauverjat" 2 => "P. Bouletreau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0115426506021004342" "Revista" => array:6 [ "tituloSerie" => "Nutr Clin Pract" "fecha" => "2006" "volumen" => "21" "paginaInicial" => "342" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16870802" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatocellular integrity in patients requiring parenteral nutrition: comparison of structured MCT/LCT vs. a standard MCT/LCT emulsion and a LCT emulsion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.N. Piper" 1 => "K.D. Rohm" 2 => "J. Boldt" 3 => "B. Odermatt" 4 => "W.H. Maleck" 5 => "S.W. Suttner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0265021508004055" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2008" "volumen" => "25" "paginaInicial" => "557" "paginaFinal" => "565" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18413006" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Omega-3 fatty acids improve the diagnosis-related clinical outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.R. Heller" 1 => "S. Rossler" 2 => "R.J. Litz" 3 => "S.N. Stehr" 4 => "S.C. Heller" 5 => "R. Koch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000206309.83570.45" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2006" "volumen" => "34" "paginaInicial" => "972" "paginaFinal" => "979" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16484909" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fish oil lipid emulsions and immune response: what clinicians need to know" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.L. Waitzberg" 1 => "R.S. Torrinhas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0884533609339071" "Revista" => array:6 [ "tituloSerie" => "Nutr Clin Pract" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "487" "paginaFinal" => "499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19605803" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parenteral fish oil lipid emulsions in the critically ill: a systematic review and metaanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Manzanares" 1 => "R. Dhaliwal" 2 => "B. Jurewitsch" 3 => "R.D. Stapleton" 4 => "K.N. Jeejeeboy" 5 => "D.K. Heyland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JPEN" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "20" "paginaFinal" => "28" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of a fish oil-based lipid emulsion to treat essential fatty acid deficiency in a soy allergic patient receiving parenteral nutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.M. Gura" 1 => "S.K. Parsons" 2 => "L.J. Bechard" 3 => "T. Henderson" 4 => "M. Dorsey" 5 => "W. Phipatanakul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clnu.2005.05.020" "Revista" => array:6 [ "tituloSerie" => "Clin Nutr" "fecha" => "2005" "volumen" => "24" "paginaInicial" => "839" "paginaFinal" => "847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16029913" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversal of parenteral nutritiona associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.M. Gura" 1 => "C.P. Duggan" 2 => "S.B. Collier" 3 => "R.W. Jennings" 4 => "J. Folkman" 5 => "B.R. 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Parenteral nutrition-associated liver disease and lipid emulsions

Hepatopatía asociada a nutrición parenteral y emulsiones lipídicas

Ana Zugasti Murilloa,

Corresponding author

ana.zugasti.murillo@cfnavarra.es

Corresponding author.

, Estrella Petrina Jáureguia, Javier Elizondo Armendárizb

a Sección de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra, Pamplona, Spain

b Servicio de Farmacia, Complejo Hospitalario de Navarra, Pamplona, Spain

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    "cabecera" => "<span class="elsevierStyleTextfn">Short review</span>"
    "titulo" => "Parenteral nutrition-associated liver disease and lipid emulsions"
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        "titulo" => "Hepatopat&#237;a asociada a nutrici&#243;n parenteral y emulsiones lip&#237;dicas"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The first safe lipid emulsion&#44; still on the market&#44; was developed in 1961 and consisted of soybean oil and egg lecithin&#46; From that date&#44; lipid emulsions became a feature of parenteral nutrition &#40;PN&#41;&#46; One decade later&#44; these emulsions were combined with all the other nutrients to obtain the well known &#8220;all-in-one&#8221; admixtures currently used&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The latest generation of these emulsions includes formulas enriched with fish oil&#44; based on omega-3 fatty acids &#40;W3FA&#41;&#44; and with a lower concentration of omega-6 fatty acids &#40;W6FA&#41;&#44; the main component of the original emulsions&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The traditional management of PN-associated liver disease &#40;PNALD&#41; includes the cyclic administration of PN for as short a time as possible&#44; the early detection and treatment of catheter sepsis&#44; the start of enteral nutrition as early as possible&#44; the administration of ursodeoxycholic acid to decrease bile viscosity and antibiotics to prevent bacterial overgrowth&#44; and an adequate provision of macronutrients and macronutrients in PN&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Data in the literature suggest that nutritional supplementation with fish oil may modify the inflammatory response&#44; and some authors have reported positive results with the use of lipid emulsions with a high W3FA content in the treatment of PNALD in both children and adults&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Liver changes associated with parenteral nutrition</span><p id="par0025" class="elsevierStylePara elsevierViewall">The administration of PN has been associated with liver changes such as steatosis&#44; steatohepatitis&#44; fibrosis&#44; cirrhosis&#44; and biliary changes such as cholestasis&#44; cholelithiasis&#44; and cholecystitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a> These changes may occur in 25&#8211;100&#37; of adult patients who receive PN&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a> In Spanish studies&#44; the prevalence of such changes has been reported as 30&#37; in critically ill patients with PN&#44; and as 36&#37; in patients on home PN&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> If liver involvement progresses&#44; it may lead to cirrhosis and liver and bowel transplant may be required&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis is mainly based on bilirubin and liver enzyme levels&#44; although the cut-off points for these markers may change depending on the hospital or in different studies&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Moreover&#44; the correlation between changes in these laboratory tests and histopathological findings in liver biopsies is low&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a> The etiology of changes has not been fully elucidated&#44; and is thought to be multifactorial&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;6</span></a> Changes have been related to factors associated with both PN itself&#44; such as therapy duration&#44; calorie overload&#44; carbohydrate overload&#44; amino acid overload or deficiency&#44; carnitine&#44; choline&#44; or taurine deficiency&#44; excess manganese and copper administration&#44; and continuous infusion&#44; and to patient-associated factors such as underlying disease&#44; sepsis&#44; intestinal bacterial overgrowth&#44; the presence of short bowel syndrome&#44; a lack of enteral stimulation&#44; or hyperinsulinism&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As regards lipids in PN&#44; four factors have been related to liver dysfunction&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lipid dose</span>&#58; both a deficiency and an excess provision of essential fatty acids may cause liver damage&#46; A lipid dose &#62;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day is associated with a marked increase in liver changes and a 2&#8211;5 times greater risk of experiencing some severe change in the liver&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;6</span></a> and has been included in current European guidelines as the value that should not be exceeded&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> At least 2&#8211;4&#37; of total calories should be administered as lineoleic acid to prevent deficiency&#46; The ratio of calories provided by carbohydrates and lipids also appears to be important&#44; and should not exceed 60&#58;40 in home patients according to various recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> The mechanism by which toxicity related to lipid dose occurs is not clear&#44; but it could be changes in liver macrophages&#44; phospholipid elimination in bile&#44; or a blockade of liver capacity to mobilize lipids&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lipid composition&#58;</span> lipid emulsions based on soybean oil&#44; with high W6FA contents&#44; have been associated with greater liver toxicity&#44; particularly when they are used over a long period of time&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a> To decrease this toxicity&#44; the alternatives proposed have included lipid emulsions with lower W6FA contents&#44; such as those consisting of mixtures of medium &#40;MCT&#41; and long-chain triglycerides &#40;LCT&#41;&#44; those based on olive oil&#44; those containing W3FA&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;6&#44;8</span></a> or even the provision of W3FA as the only lipid&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Phytosterolemia</span>&#58; lipid emulsions are mostly of plant origin and contain substantial amounts of phytosterols&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;6&#44;10</span></a> These phytosterols have been related to liver toxicity in PN because they are considered to be able to alter cholesterol and bile acid production and to contribute to cholestasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;10</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">&#945;-Tocoferol</span>&#58; this may act as a potent antioxidant in cases of steatosis&#44; protecting the liver from oxidative damage&#46; W3FA-enriched formulas have greater amounts of &#945;-tocoferol than those derived from soybean&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Types of lipid emulsions &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">To date&#44; there have been three generations of intravenous lipid emulsions&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> The fatty acid profile of these emulsions has evolved with our increased understanding of their metabolism and their importance in the regulation of processes triggered by aggression and immunity &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The first generation &#40;based on soybean or safflower oil&#44; Intralipid<span class="elsevierStyleSup">&#174;</span>&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">These were the first lipid emulsions to be marketed &#40;1961&#41;&#46; Derived from soybean oil&#44; they contain long-chain triglycerides &#40;&#91;LCTs&#93; 16&#8211;18 carbon atoms&#41; only&#46; They were originally intended to provide essential fatty acids to prevent their deficiency&#44; and were subsequently accepted as a concentrated source of energy&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> They contain a high proportion of W6FA&#44; approximately 50&#8211;60&#37;&#44; mainly as linoleic acid&#44; an essential fatty acid&#46; Cumulative observations of the adverse effects derived from the high proportion of W6FA in these initial lipid emulsions indicated the need to develop new emulsions having a much lower content of this type of fat&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">The second generation &#40;developed to decrease the provision of W6FA in the first generation products&#59; a mixture with medium- and long-chain triglycerides&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Emulsions containing 50&#37; of MCTs have been in clinical use since 1984&#46; MCTs have 6&#8211;12 carbon atoms and are mainly found in coconut oil&#46; They oxidate easily and enter mitochondria without the need for carnitine&#46; MCTs are therefore more rapidly available for tissues than LCT emulsions and are considered immunologically neutral&#46; As they are saturated fatty acids&#44; they are resistant to lipid peroxidation&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> do not participate in eicosanoid synthesis&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> are not stored as triglycerides&#44; and have a ketogenic effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;13&#44;14</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Lipid emulsions based on a mixture of soybean oil and medium-chain triglycerides &#40;Lipofundina<span class="elsevierStyleSup">&#174;</span>&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Chronologically&#44; this emulsion appeared after the first-generation emulsions&#46; It is a mixture of 50&#37; soybean oil and 50&#37; coconut or palm oil that contains a very high proportion of MCTs&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Lipid emulsions based on soybean and olive oil &#40;Clinoleic<span class="elsevierStyleSup">&#174;</span>&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Another solution for decreasing W6FA content was to base the emulsion on olive oil &#40;80&#37;&#41;&#44; with EFA provision being completed with soybean oil &#40;20&#37;&#41;&#46; This emulsion contains oleic acid as the main component&#44; a monounsaturated acid of the omega-9 family &#40;W9FA&#41;&#44; and has some benefits such as resistance to lipid peroxidation&#44; an effect that is considered neutral and poorly toxic on the immune system&#44; and a decreased generation of pro-inflammatory cell mediators&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;12&#44;13</span></a> It has also been postulated that some phenolic compounds contained in olive oil could provide additional advantages as being antioxidant and anti-inflammatory&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Lipid emulsions based on a chemical mixture of soybean oil and medium-chain triglycerides&#46; Structured lipids &#40;Structolipid<span class="elsevierStyleSup">&#174;</span>&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">These are emulsions consisting of synthetic lipids obtained through the hydrolysis of soybean and coconut oils&#44; equivalent to 64&#37; of soybean oil and 34&#37; of coconut oil&#44; and subsequent random reesterification&#46; The result is a fat that contains LCTs and MCTs in the same glycerol and in a resulting equimolecular proportion&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;12&#44;16</span></a> It appears that fewer changes occur in the liver<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> and immune system<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> as compared with physical mixture or soybean emulsions&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">The third generation</span><p id="par0095" class="elsevierStylePara elsevierViewall">This refers to the incorporation of W3FA into emulsions of a prior generation&#44; decreasing W6FA provision&#44; to positively modulate inflammation and immunosuppression&#46; This generation is clearly aimed at achieving a pharmaconutrient effect&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">W3FA doses &#62;0&#46;05<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day have been reported to provide benefits&#44; with optimal doses of 0&#46;14&#8211;0&#46;30<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> However&#44; further studies confirming these results are needed&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">These emulsions are considered to be safe&#44; and no significant adverse effects have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;13&#44;19</span></a> They have even improved or reversed the toxicity of PN for the liver&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Two emulsions containing fish oil are currently being marketed in Spain&#58;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">A lipid emulsion based on soybean oil&#44; medium-chain triglycerides&#44; and fish oil&#58; MSF emulsion &#40;Lipoplus<span class="elsevierStyleSup">&#174;</span>&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">This is an emulsion based on the second generation of the physical mixture of soybean oil and MCTs in which part of the soybean oil is replaced by fish oil to achieve final concentrations of 40&#37;&#44; 50&#37;&#44; and 10&#37; respectively&#46; This emulsion has been found to increase contents in eicosapentaenoic acid &#40;EPA&#41; and docosahexaenoic acid &#40;DHA&#41; in plasma phospholipids and erythrocyte membranes&#44; and to the modulated production of pro-inflammatory leukotrienes<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> with no negative impact on gas exchange or hemodynamics&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">A lipid emulsion based on soybean oil&#44; medium-chain triglycerides&#44; olive oil&#44; and fish oil&#58; SMOF emulsion &#40;SMOFlipid<span class="elsevierStyleSup">&#174;</span>&#41;</span><p id="par0120" class="elsevierStylePara elsevierViewall">This is based on a physical mixture of soybean oil&#44; MCTs&#44; and olive and fish oils at 30&#37;&#44; 30&#37;&#44; 25&#37;&#44; and 15&#37; respectively&#46; This is a new concept of emulsion that combines the conditions of an &#8220;ideal&#8221; emulsion in the light of our current knowledge&#44; with a balanced and more physiological fatty acid composition&#44; and a &#969;-6&#47;&#969;-3 ratio within the optimum range&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;19</span></a> This emulsion is metabolized 40&#37; faster than soybean oil-based emulsions&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Increased plasma levels of W3FA&#44; together with decreased W6FA levels&#44; reduce levels of pro-inflammatory mediators&#44; have a neutral impact on inflammatory and immune variables&#44; and have been shown in several studies to decrease both hospital stay and mortality and the number of days of mechanical ventilation in critically ill patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;12&#44;13&#44;20</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Omegaven<span class="elsevierStyleSup"><span class="elsevierStyleItalic">&#174;</span></span> &#40;not marketed in Spain&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">This is a 100&#37; ultra-refined fish oil emulsion available on the market since 1998&#46; It is recommended that it be administered together with other lipid emulsions at a maximum dose of 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#46; The first case in which this product was used alone in a patient with soybean allergy to prevent EFA deficiency was reported in 2005&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Emulsions of omega-3 fatty acids alone and the improvement of parenteral nutrition-associated liver disease</span><p id="par0135" class="elsevierStylePara elsevierViewall">Several articles reporting PNALD improvement with the use of Omegaven<span class="elsevierStyleSup">&#174;</span> &#40;as a supplement of another lipid emulsion or as a single formula&#41; in both children<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">22&#8211;25</span></a> and adults have been published in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#8211;30</span></a> In adult patients&#44; liver function improvement has been seen in a short period &#40;4&#8211;8 weeks&#41;&#44; but no data are available beyond 16 weeks of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The patient reported by Jurewitsch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> initially received a mixture of soybean emulsion together with Omegaven<span class="elsevierStyleSup">&#174;</span> &#40;0&#46;25<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#41; for four weeks&#46; In view of the stabilization of bilirubin levels&#44; Omegaven<span class="elsevierStyleSup">&#174;</span> alone was continued at the same dose as maintenance therapy&#44; resulting in the normalization of bilirubin levels at 16 weeks&#44; decreased hepatomegaly&#44; and the disappearance of cholestasis in a biopsy performed five months after treatment start&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a> reported a series of 15 adults &#40;9 females and 6 males&#41; in which an emulsion of soybean oil and MCTs was replaced by Omegaven<span class="elsevierStyleSup">&#174;</span> &#40;0&#46;15&#8211;2<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#44; maximum 10<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41; for two months&#46; Eighty percent of the subjects experienced a normalization of esterified bilirubin levels within four weeks&#44; as well as decreased cholestasis and inflammation at biopsies&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Burns et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> replaced an emulsion based on soybean oil only by Omegaven<span class="elsevierStyleSup">&#174;</span> &#40;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg 5 days weekly&#41; in a patient&#44; resulting in laboratory data improvement at five weeks and a normalization of bilirubin levels at eight weeks&#46; These results persisted at 29 weeks&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Venecourt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> reported a patient receiving an emulsion of soybean and olive oil whose bilirubin levels decreased &#40;at 8 weeks&#41; and whose transaminase levels normalized &#40;at 10 weeks&#41; after switching to Omegaven<span class="elsevierStyleSup">&#174;</span> &#40;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg 6 days weekly&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The most recent series&#44; reported by Pastor-Clerigues et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> provided data on the anti-inflammatory and antifibrotic effect of Omegaven<span class="elsevierStyleSup">&#174;</span> administered to two patients for four months &#40;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg 5 days weekly&#41;&#46; Liver function impairment recurred on the replacement of this emulsion by a mixture of soybean oil&#44; MCTs&#44; and olive and fish oils&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">Patients diagnosed with PNALD have a high mortality rate as a result of liver cirrhosis&#47;failure if PN discontinuation or liver and bowel transplant is not possible&#46; An understanding of all the mechanisms involved in the development of this disease and the availability of effective and safe treatments are therefore especially important&#46; In recent years there has been an increasing interest in treatment and prevention using W3FA-enriched lipid formulas&#46; Although the exact mechanism is unknown&#44; it could lie in a decreased hepatic apoptosis due to the effect of EPA and DHA contained in these types of formulas&#44; along with an essential anti-inflammatory role&#44; and to decreased W6FA provision&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Elsewhere<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> in this issue of the journal we report the case of a patient who was treated with W3FA alone for 50 weeks&#44; the longest treatment with Omegaven<span class="elsevierStyleSup">&#174;</span> reported in Spain&#46; We believe that this case may lead to a new approach to the treatment of patients with PNALD&#46; The improvement in the laboratory results was important&#44; but the change in portal flow direction detected in the imaging tests was even more significant as indirect evidence of portal hypertension improvement&#46; No deficiencies in essential fatty acids were found during the follow-up period&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Larger series and longer follow-up periods will provide more information about the ideal proportions of W3FA and W6FA and the dose that should be given in PN to cover nutritional requirements and prevent hepatic complications&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors state that they have no conflicts of interest&#46;</p></span></span>"
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            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec950267"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Liver changes associated with parenteral nutrition"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Types of lipid emulsions &#40;Table 1&#41;"
          "secciones" => array:9 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "The first generation &#40;based on soybean or safflower oil&#44; Intralipid&#41;"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "The second generation &#40;developed to decrease the provision of W6FA in the first generation products&#59; a mixture with medium- and long-chain triglycerides&#41;"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Lipid emulsions based on a mixture of soybean oil and medium-chain triglycerides &#40;Lipofundina&#41;"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Lipid emulsions based on soybean and olive oil &#40;Clinoleic&#41;"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Lipid emulsions based on a chemical mixture of soybean oil and medium-chain triglycerides&#46; Structured lipids &#40;Structolipid&#41;"
            ]
            5 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "The third generation"
            ]
            6 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "A lipid emulsion based on soybean oil&#44; medium-chain triglycerides&#44; and fish oil&#58; MSF emulsion &#40;Lipoplus&#41;"
            ]
            7 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "A lipid emulsion based on soybean oil&#44; medium-chain triglycerides&#44; olive oil&#44; and fish oil&#58; SMOF emulsion &#40;SMOFlipid&#41;"
            ]
            8 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Omegaven &#40;not marketed in Spain&#41;"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Emulsions of omega-3 fatty acids alone and the improvement of parenteral nutrition-associated liver disease"
        ]
        8 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-11-24"
    "fechaAceptado" => "2015-03-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec950268"
          "palabras" => array:3 [
            0 => "Parenteral nutrition-associated liver disease"
            1 => "Fish oil-based lipid emulsion"
            2 => "Omegaven"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec950267"
          "palabras" => array:3 [
            0 => "Hepatopat&#237;a asociada a nutrici&#243;n parenteral"
            1 => "Emulsi&#243;n lip&#237;dica &#225;cidos grasos omega-3"
            2 => "Omegaven"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Parenteral nutrition-associated liver disease &#40;PNALD&#41; is a particularly important problem in patients who need this type of nutritional support for a long time&#46; Prevalence of the condition is highly variable depending on the series&#44; and its clinical presentation is different in adults and children&#46; The etiology of PNALD is not well defined&#44; and participation of several factors at the same time has been suggested&#46; When a bilirubin level &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl is detected for a long time&#44; other causes of liver disease should be ruled out and risk factors should be minimized&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The composition of lipid emulsions used in parenteral nutrition is one of the factors related to PNALD&#46; This article reviews the different types of lipid emulsions and the potential benefits of emulsions enriched with omega-3 fatty acids&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La afectaci&#243;n de la funci&#243;n hep&#225;tica asociada con la nutrici&#243;n parenteral es un problema especialmente importante en los pacientes que precisan este tipo de soporte nutricional durante un tiempo prolongado&#46; La prevalencia es muy variable seg&#250;n las series&#44; y se presenta cl&#237;nicamente de forma distinta en adultos y en ni&#241;os&#46; Su etiolog&#237;a no est&#225; bien definida y se contempla la participaci&#243;n de varios factores al mismo tiempo&#46; Cuando se detecta un nivel de bilirrubina &#62; 2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl durante un per&#237;odo prolongado se deben descartar otras causas de hepatopat&#237;a y minimizar los factores de riesgo&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La composici&#243;n de las emulsiones lip&#237;dicas empleadas en la nutrici&#243;n parenteral es uno de los factores relacionados con la alteraci&#243;n de la funci&#243;n hep&#225;tica&#46; En este art&#237;culo se revisan los distintos tipos de emulsiones lip&#237;dicas&#44; as&#237; como los posibles beneficios de las f&#243;rmulas enriquecidas con &#225;cidos grasos omega-3&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Zugasti Murillo A&#44; Petrina J&#225;uregui E&#44; Elizondo Armend&#225;riz J&#46; Hepatopat&#237;a asociada a nutrici&#243;n parenteral y emulsiones lip&#237;dicas&#46; Endocrinol Nutr&#46; 2015&#59;62&#58;285&#8211;289&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">DHA&#58; docosahexaenoic acid&#59; EPA&#58; eicosapentaenoic acid&#59; LCTs&#58; long-chain triglycerides&#59; MCTs&#58; medium-chain triglycerides&#59; MSF&#58; MCTs&#47;soybean&#47;fish&#59; SMOF&#58; soybean&#47;MCTs&#47;olive&#47;fish&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Trade name&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Intralipid<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Lipofundina<span class="elsevierStyleSup">&#174;</span><br>MCTs&#47;LCTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Clinoleic<span class="elsevierStyleSup">&#174;</span> 20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Structolipid<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Lipoplus<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">SMOFLipid<span class="elsevierStyleInf">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Omegaven<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of emulsion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Soybean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Physical mixture<br>MCTs&#47;LCTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Olive&#47;soybean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chemical mixture<br>MCTs&#47;LCTs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Soybean&#47;MCT&#47;W3-MSF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Soybean&#47;MCTs&#47;olive&#47;W3-SMOF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fish&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Generation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3rd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3rd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3rd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">Oil origin &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Soybean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coconut&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Olive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fish&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">W3 concentration &#40;g&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">W6&#58;W3 ratio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;5&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#58;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Linoleic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#8211;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#945; Linolenic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#8211;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#945; Tocoferol &#40;mg&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;9&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "bib0160"
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                0 => array:3 [
                  "comentario" => "Doc 1&#46; &#91;chapter 11&#93;"
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                    0 => array:2 [
                      "titulo" => "Complications and monitoring &#8211; guidelines on parenteral nutrition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;H&#46; Hartl"
                            1 => "K&#46;W&#46; Jauch"
                            2 => "K&#46; Parhofer"
                            3 => "P&#46; Rittler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3205/000067"
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                        "tituloSerie" => "Ger Med Sci"
                        "fecha" => "2009"
                        "volumen" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19718276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complicaciones hep&#225;ticas asociadas al uso de nutrici&#243;n parenteral"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Moreno Villares"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Nutr Hosp"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "25"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18714408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parenteral nutrition-associated liver disease in adult and pediatric patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46;J&#46; Kumpf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0115426506021003279"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Clin Pract"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "279"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16772545"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0175"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Liver dysfunction associated with artificial nutrition in critically ill patients"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Grau"
                            1 => "A&#46; Bonet"
                            2 => "M&#46; Rubio"
                            3 => "D&#46; Mateo"
                            4 => "M&#46; Farre"
                            5 => "J&#46;A&#46; Acosta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc5670"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2007"
                        "volumen" => "11"
                        "paginaInicial" => "R10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17254321"
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              "identificador" => "bib0180"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of liver dysfunction under artificial nutrition&#58; a reason to modify nutrition therapy in the intensive care unit&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Stehle"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1186/cc5679"
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                        "tituloSerie" => "Crit Care"
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                        "volumen" => "11"
                        "paginaInicial" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17316464"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0185"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Managing liver dysfunction in parenteral nutrition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;A&#46; Lloyd"
                            1 => "S&#46;M&#46; Gabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S002966510700585X"
                      "Revista" => array:7 [
                        "tituloSerie" => "Proc Nutr Soc"
                        "fecha" => "2007"
                        "volumen" => "66"
                        "paginaInicial" => "530"
                        "paginaFinal" => "538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17961274"
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                          ]
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            6 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESPEN guidelines on parenteral nutrition&#58; home parenteral nutrition &#40;HPN&#41; in adult patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Staun"
                            1 => "L&#46; Pironi"
                            2 => "F&#46; Bozzetti"
                            3 => "J&#46; Baxter"
                            4 => "A&#46; Forbes"
                            5 => "F&#46; Joly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2009.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nutr"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "467"
                        "paginaFinal" => "479"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19464089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New parenteral lipid emulsions for clinical use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;L&#46; Waitzberg"
                            1 => "R&#46;S&#46; Torrinhas"
                            2 => "T&#46;M&#46; Jacintho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0148607106030004351"
                      "Revista" => array:6 [
                        "tituloSerie" => "JPEN J Parenter Enteral Nutr"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "351"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16804134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fish oil-based lipid emulsions prevent and reverse parenteral nutrition associated liver disease&#58; the Boston experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46;E&#46; De Meijer"
                            1 => "K&#46;M&#46; Gura"
                            2 => "H&#46;D&#46; Le"
                            3 => "J&#46;A&#46; Meisel"
                            4 => "M&#46; Puder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0148607109332773"
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                        "tituloSerie" => "JPEN J Parenter Enteral Nutr"
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                        "volumen" => "33"
                        "paginaInicial" => "541"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19571170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Phytosterolemia in parenteral nutrition patients&#58; implications for liver disease development"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Llop"
                            1 => "N&#46; Virgili"
                            2 => "J&#46;M&#46; Moreno-Villares"
                            3 => "P&#46; Garcia-Peris"
                            4 => "T&#46; Serrano"
                            5 => "M&#46; Forga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nut.2008.06.017"
                      "Revista" => array:8 [
                        "tituloSerie" => "Nutrition"
                        "fecha" => "2008"
                        "volumen" => "24"
                        "numero" => "11-12"
                        "paginaInicial" => "1145"
                        "paginaFinal" => "1152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18656327"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0002937812003997"
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                          "issn" => "00029378"
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                  ]
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              ]
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            10 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of parenteral lipid emulsions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;L&#46; Waitzberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Nutr Suppl"
                        "fecha" => "2005"
                        "volumen" => "1"
                        "paginaInicial" => "5"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immune modulation by parenteral lipid emulsions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;J&#46; Wanten"
                            1 => "P&#46;C&#46; Calder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "2007"
                        "volumen" => "85"
                        "paginaInicial" => "1171"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17490951"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0002937812001317"
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                          "issn" => "00029378"
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                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hot topics in parenteral nutrition&#46; Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;C&#46; Calder"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0029665109001268"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Nutr Soc"
                        "fecha" => "2009"
                        "volumen" => "68"
                        "paginaInicial" => "252"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19426581"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The metabolic consequences of infusing emulsions containing medium chain triglycerides for parenteral nutrition&#58; a comparative study with conventional lipid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            3 => "K&#46; White"
                            4 => "L&#46; Hands"
                            5 => "R&#46;M&#46; Watkins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann R Coll Surg Engl"
                        "fecha" => "1986"
                        "volumen" => "68"
                        "paginaInicial" => "119"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3089123"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Olive oil in parenteral nutrition"
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                        0 => array:2 [
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                      "titulo" => "Structured triglyceride emulsions in parenteral nutrition"
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                          0 => array:2 [
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                      "titulo" => "Hepatocellular integrity in patients requiring parenteral nutrition&#58; comparison of structured MCT&#47;LCT vs&#46; a standard MCT&#47;LCT emulsion and a LCT emulsion"
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                            3 => "B&#46; Odermatt"
                            4 => "W&#46;H&#46; Maleck"
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                      "titulo" => "Omega-3 fatty acids improve the diagnosis-related clinical outcome"
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                        "paginaFinal" => "979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16484909"
                            "web" => "Medline"
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                    ]
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                ]
              ]
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                      "titulo" => "Fish oil lipid emulsions and immune response&#58; what clinicians need to know"
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                          "autores" => array:2 [
                            0 => "D&#46;L&#46; Waitzberg"
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                    ]
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                        "tituloSerie" => "Nutr Clin Pract"
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                        "volumen" => "24"
                        "paginaInicial" => "487"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19605803"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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                      "titulo" => "Parenteral fish oil lipid emulsions in the critically ill&#58; a systematic review and metaanalysis"
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                          "etal" => false
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                            2 => "B&#46; Jurewitsch"
                            3 => "R&#46;D&#46; Stapleton"
                            4 => "K&#46;N&#46; Jeejeeboy"
                            5 => "D&#46;K&#46; Heyland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "paginaInicial" => "20"
                        "paginaFinal" => "28"
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                    ]
                  ]
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                    0 => array:2 [
                      "titulo" => "Use of a fish oil-based lipid emulsion to treat essential fatty acid deficiency in a soy allergic patient receiving parenteral nutrition"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "L&#46;J&#46; Bechard"
                            3 => "T&#46; Henderson"
                            4 => "M&#46; Dorsey"
                            5 => "W&#46; Phipatanakul"
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                        "paginaFinal" => "847"
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                            3 => "R&#46;W&#46; Jennings"
                            4 => "J&#46; Folkman"
                            5 => "B&#46;R&#46; Bistrian"
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                      ]
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                        "paginaInicial" => "e197"
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                        "link" => array:1 [
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                      "titulo" => "Parenteral fish oil monotherapy in the management of patients with parenteral nutrition associated liver disease"
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                        "volumen" => "145"
                        "paginaInicial" => "547"
                        "paginaFinal" => "551"
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                          "etal" => false
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                            3 => "M&#46; Puder"
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                    0 => array:2 [
                      "titulo" => "Omega 3 enriched lipid emulsion for liver salvage in parenteral nutrition induced cholestasis in the adult patient"
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                          "etal" => false
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                            4 => "J&#46; Li"
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Article information

ISSN: 21735093
Original language: English

DOI:10.1016/j.endoen.2015.06.005

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2023 July	126	18	144
2023 June	119	19	138
2023 May	172	16	188
2023 April	135	9	144
2023 March	127	30	157
2023 February	136	12	148
2023 January	129	24	153
2022 December	128	13	141
2022 November	126	22	148
2022 October	142	27	169
2022 September	94	16	110
2022 August	79	15	94
2022 July	71	26	97
2022 June	119	19	138
2022 May	111	26	137
2022 April	92	33	125
2022 March	116	20	136
2022 February	68	12	80
2022 January	95	13	108
2021 December	61	23	84
2021 November	115	23	138
2021 October	114	40	154
2021 September	107	35	142
2021 August	106	19	125
2021 July	80	18	98
2021 June	78	30	108
2021 May	124	33	157
2021 April	308	38	346
2021 March	121	21	142
2021 February	93	20	113
2021 January	127	33	160
2020 December	84	27	111
2020 November	117	29	146
2020 October	78	13	91
2020 September	59	17	76
2020 August	165	28	193
2020 July	71	19	90
2020 June	63	22	85
2020 May	111	28	139
2020 April	72	21	93
2020 March	80	16	96
2020 February	61	10	71
2020 January	62	12	74
2019 December	64	5	69
2019 November	86	19	105
2019 October	142	16	158
2019 September	111	30	141
2019 August	84	18	102
2019 July	65	26	91
2019 June	138	26	164
2019 May	251	17	268
2019 April	94	2	96
2019 March	44	9	53
2019 February	34	8	42
2019 January	33	12	45
2018 December	36	8	44
2018 November	31	4	35
2018 October	43	11	54
2018 September	30	10	40
2018 August	17	10	27
2018 July	24	8	32
2018 June	21	2	23
2018 May	26	12	38
2018 April	24	7	31
2018 March	27	3	30
2018 February	19	1	20
2018 January	30	0	30
2017 December	26	3	29
2017 November	49	3	52
2017 October	92	9	101
2017 September	26	8	34
2017 August	60	12	72
2017 July	29	11	40
2017 June	56	14	70
2017 May	58	12	70
2017 April	30	2	32
2017 March	40	41	81
2017 February	65	4	69
2017 January	38	1	39
2016 December	36	5	41
2016 November	36	4	40
2016 October	50	9	59
2016 September	53	7	60
2016 August	51	7	58
2016 July	40	2	42
2016 June	46	12	58
2016 May	42	15	57
2016 April	54	34	88
2016 March	40	34	74
2016 February	41	22	63
2016 January	28	21	49
2015 December	26	11	37
2015 November	3	0	3
2015 September	1	0	1
2015 August	0	1	1
2015 July	0	2	2

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Now is Endocrinología, Diabetes y Nutrición (English ed.). More information

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Now is Endocrinología, Diabetes y Nutrición (English ed.). More information

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