Optimizing intravenous supply of functional lipid components.

Abstract

The aims of nutritional support administered to acutely ill patients have markedly evolved with time, from supplying huge amounts of calories and nitrogen (in an attempt to abolish the catabolic response and to guarantee weight gain) to providing a limited and balanced intake of macroand micronutrients in order to maintain or restore an adequate composition of different body compartments [1]. Currently, the focus is to improve the function of those organs, which are critical for the survival of acutely ill patients by quickly supplying conditionally essential substrates. Again, priorities have changed from protecting skeletal muscle to maintaining or improving immune defenses, intestinal integrity and barrier function, as well as cardiac work. Still, little attention has so far been paid to protecting other important functions, namely those performed by the endothelium including tissue microperfusion. It has also taken some time to realize that acute phase conditions are associated with marked changes in the priorities for substrate requirements, and that the pharmacological effects of given nutrients could be used to optimize metabolic support and ultimately clinical outcome. This requires an improved knowledge of the metabolic pathways involved in the delivery of active agents, as well as of the action of such agents in key tissues and organs. In this chapter, we will consider ways of optimizing the delivery of essential fatty acids from the n-3 family to the endothelium in an attempt to maintain or optimize its functions.