Effect of Parenteral Medium- and Long-Chain Triglycerides on Lymphocytes Subpopulations and Functions in Patients With Acquired Immunodeficiency Syndrome: A Prospective Study

• Published in: JPEN. Journal of parenteral and enteral nutrition 1998-03, Vol.22 (2), p.67-71
• Main Authors: Gelas, Patrick, Cotte, Laurent, Poitevin-Later, Françoise, Pichard, Claude, Leverve, Xavier, Barnoud, Didier, Leclercq, Pascale, Touraine-Moulin, Françoise, Trépo, Christian, Boulétreau, Paul
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - immunology; Acquired Immunodeficiency Syndrome - therapy; AIDS/HIV; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; Double-Blind Method; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Fat Emulsions, Intravenous - administration & dosage; Fat Emulsions, Intravenous - chemistry; Humans; Intensive care medicine; Lymphocyte Subsets - drug effects; Lymphocyte Subsets - immunology; Medical sciences; Nutrition Disorders - complications; Nutrition Disorders - immunology; Nutrition Disorders - therapy; Parenteral Nutrition, Total - methods; Prospective Studies; Time Factors; Triglycerides - administration & dosage; Triglycerides - chemistry; Triglycerides - pharmacology
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/014860719802200267

Background: Total parenteral nutrition (TPN) may offer significant clinical benefit in malnourished patients with acquired immunodeficiency syndrome (AIDS). However, the immunologic effect of parenteral lipids remains unknown in these severely immunodepressed patients. Methods: We undertook a prospective randomized double-blind multicenter study comparing the effects of two IV lipid emulsions used during TPN: long-chain triglycerides (LCT) or balanced emulsion of long- and medium-chain triglycerides (LCT/MCT). Thirty-three AIDS patients requiring TPN for wasting and reduced oral intake were allocated randomly to receive a ternary TPN mixture consisting of 1.5 g/kg/d proteins, 18 kcal/kg/d lipids, and 12 kcal/kg/d carbohydrates for 6 days. The following tests were performed at days 0 and 7: immunoglobulins, complement fractions, lymphocyte subpopulations count, and lymphocyte proliferation with mitogens. Results: Patients were all severely malnourished (weight loss: — 14.0 ± 1.3 kg). No clinical or biological differences were observed between the groups at baseline. At day 7, both groups reported a significant increase in weight. Patients in the LCT group exhibited a significant decrease in phytohemagglutinin A response (p = .04) compared with baseline. Patients in the LCT/ MCT group exhibited a lower level of IgM (p = .03) and a significant increase in C3 fraction (p = .03) compared with baseline. They also showed a tendency to have a higher CD4/CD8 lymphocyte ratio ( p = .07), whereas other immunological parameters remained unchanged. Conclusions: Parenteral ternary mixture containing LCT or LCT/MCT are clinically well tolerated in AIDS patients over 6 days. With 2 g/kg/d of lipids, LCT seems to induce significant abnormalities in lymphocyte function. Such abnormalities are not observed with LCT/MCT. (Journal of Parenteral and Enteral Nutrition 22:67-71, 1998)