2025 Southeastern Residency Conference

Title: Comparison of Clinical Outcomes in Hospitalized Patients Receiving Olive Oil-Based versus Soybean Oil-Based Lipid Emulsions with Parenteral Nutrition
Authors: 
Tilyn Digiacomo
Chris Wilson
Breanna Carter
Background: Intravenous lipid emulsions are an integral component of parenteral nutrition for the provision of essential fatty acids, linoleic acid and alpha-linolenic acid. Given the pro-inflammatory properties of linoleic acid, the advantage of linoleic-sparing formulations has been debated. Olive oil-based lipid emulsions contain one-third the amount of linoleic acid compared to its soybean oil-based counterpart, making its use potentially advantageous in critical illness, infection, and liver injury. Despite its vital role in parenteral nutrition, recommendations regarding the optimal lipid emulsion formulation are lacking. This study aims to compare clinical outcomes in patients receiving olive oil-based versus soybean oil-based lipid emulsions as a component of parenteral nutrition.
Methods: This was a single-center, retrospective, cohort study that included adult patients hospitalized at a large academic medical center. Patients had to be 18 years of age or older with confirmed receipt of either olive oil-based or soybean oil-based lipid emulsion as a component of parenteral nutrition. Patients were excluded from the study if they were receiving parenteral nutrition prior to hospitalization, duration of parenteral nutrition was less than three days, patients received both lipid emulsions, cirrhosis was noted on imaging or past medical history, baseline serum bilirubin was greater than 2 mg/dL, or baseline serum triglycerides were greater than 400 mg/dL. The primary endpoint of this study was parenteral nutrition-associated liver disease, defined as total bilirubin greater than 2 mg/dL or any of the following greater than 1.5 times the upper limit of normal in accordance with institution-specific values: aspartate aminotransferase, alanine transaminase, or alkaline phosphatase. Secondary outcomes include the incidence of hospital-acquired bloodstream infection, hypertriglyceridemia, and length of stay. Nominal data was analyzed utilizing Chi-square or Fisher’s exact test. Continuous data was analyzed utilizing Wilcoxon Rank Sum or Student’s t-test.
Results: In total, 200 patients were included in the final analysis with 100 patients in each group. The majority of patients were receiving parenteral nutrition for ileus or small bowel obstruction for a median duration of 8 to 9 days, respectively. Baseline demographics, including intensive care unit admission and mortality, were similar between groups. Parenteral nutrition-associated liver disease occurred in 35 patients in the olive oil-based group compared to 28 in the soybean oil-based group (35% vs. 28%; P = 0.29). There was no difference in hypertriglyceridemia, hospital-acquired bloodstream infection, or length of stay observed between lipid emulsions.
Conclusion: Among hospitalized patients receiving parenteral nutrition, there was no difference in the rate of parenteral nutrition-associated liver disease when comparing olive oil-based versus soybean oil-based lipid emulsions. Moreover, no difference in hypertriglyceridemia, length of stay, or hospital-acquired bloodstream infections were observed between groups. Study findings may be explained by confounding medications, critical illness, or shorter durations of parenteral nutrition. Future research should aim to examine similar outcomes among longer durations of parenteral nutrition.