Composition of Fatty Acids in Lipid Emulsions and Clinical Outcomes in Non-Surgical Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials; Composition Des Acides Gras Dans Les Emulsions Lipidiques Et Resultats Cliniques Chez Les Patients Non Chirurgicaux En Etat Critique : Revue Systematique Et Meta-Analyse D'essais Controles Randomises Publisher



M Hajimohammadebrahimketabforoush MELIKA ; A Saghazadeh AMENE ; M Behfar MARYAM ; Aa Hamidieh Amir ALI ; Zv Shariatpanahi Zahra VAHDAT
Source: Nutrition Clinique et Metabolisme Published:2025

Abstract

Background & objectives: Increasing evidence has demonstrated that lipid emulsions are an essential part of nutrition therapy for critically-ill patients who are candidates for parenteral nutrition (PN). Meanwhile, determining the optimal lipid composition remains challenging, especially in non-surgical critically-ill patients. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing fatty acids in lipid emulsions and clinical outcomes in these patients. Methods: Based on our predefined search strategy, PubMed, Cochrane, and Web of Science were searched for RCTs published up to 18 October 2023. The interventions included fish oil (FO), olive oil (OO), medium-chain triglyceride (MCT), and soybean oil (SO) or their mixture and were compared with traditional emulsions mostly based on 100% SO. The clinical outcomes evaluated included infections, mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, ICU mortality, in-hospital mortality, and long-term mortality. Results: A total of 802 articles were retrieved in the first stage of our search. Based on our predefined inclusion criteria, 9 articles were eligible for entering this meta-analysis. The studies had a low to moderate risk of bias. Hospital LOS was the only statistically significant outcome with a lower value in the treatment groups compared with the controls (Hedges's g −0.45; 95% CI −0.69, −0.20; P = 0.00; I2 = 8.90%). Infection was identified as another statistically significant variable (Log odds-ratio 0.77; 95% CI 0.13, 1.42; P = 0.02; I2 = 0%); however, only 2 articles in this regard were included in the meta-analysis. Conclusion: The results of our meta-analysis highlighted a decrease in hospital LOS and infections. However, particularly regarding infections, more future studies are required. In accordance with previous meta-analyses, this findings highlight the superiority of mixed lipid emulsions consisting of FO/OO/MCT/SO, especially based on FO, over the traditional ones mostly based on SO, in non-surgical critically-ill patients who are candidates for PN. © 2025 Elsevier B.V., All rights reserved.