Lipids in parenteral nutrition – expert consensus statements: Translating guidelines into clinical practice

Abstract

Lipids are integral to parenteral nutrition (PN) in all settings where PN is required, serving as a source of energy and essential fatty acids. In addition, lipids modulate a variety of biological functions, including inflammatory and immune responses. Moreover, fish oil (FO), which contains omega-3 fatty acids, has become an important component of modern lipid emulsions. The Lipids in PN Summit involved a panel of international experts with extensive clinical experience in PN use. They assessed the current state of knowledge and developed expert consensus statements regarding the use of lipid emulsions in patients requiring PN. This summit built upon outcomes from an earlier summit, and focused on adult patients in three distinct clinical settings: intensive care units, hospital wards, and the home environment/long-term PN. The summit workflow included identification and appraisal of scientific and clinical literature, the exchange of practical clinical experience, and the formulation of consensus statements. The latter aim to assist healthcare professionals in their decision-making processes in daily practice by providing practical guidance related to providing lipid emulsions as part of PN. This article briefly summarizes the biological effects of lipids used in PN, and then focuses on the rationale for their use in three distinct adult PN settings. Expert consensus statements are also provided, helping to bridge gaps between evidence and clinical practice, and thus complementing formal PN guideline recommendations. There is accumulating evidence suggesting that PN including FO confers clinically meaningful advantages compared with PN without FO, and has a favorable risk–benefit ratio.