Parenteral Lipid Emulsions and the Liver Function

NCT ID: NCT03044639

Last Updated: 2017-02-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

64 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-04-01

Study Completion Date

2016-12-31

Brief Summary

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The randomized, double-blind, multi-centric study performed in four parallel groups to compare all lipid emulsions, which can be used as a part of PN. Patients with home parenteral nutrition due to stable intestinal failure, were randomly assigned to receive parenteral nutrition with one the following lipid emulsions:

* Long-chained triglycerides (LCT group)
* Medium/ long-chained triglycerides MCT/LCT (50:50, MCT/LCT group))
* Olive oil/ LCT (80:20, OO group))
* SMOFlipid (Omega-3/ olive oil/ MCT/ LCT, SMOF group)

Detailed Description

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Intravenous lipid emulsion (IVLE) is the essential component of parenteral nutrition (PN), because it is a very efficient source of energy and essential fatty acids (FA).The prevalence of abnormal liver function tests during PN varies from 15 to 85%, according to most authors.\[19-21\] The severity of IFALD depends also on underlying disease, especially ongoing sepsis and pre-existing liver disease. A study comparing all lipid emulsions, which can be used as a part of PN, has never been done. The aim of the study was to compare the clinical value of the four most popular intravenous lipid emulsions in regards to the liver function in long term intestinal failure patients.Patients with home parenteral nutrition due to stable intestinal failure, were randomly assigned to receive parenteral nutrition with one the following lipid emulsions:

* Long-chained triglycerides (LCT group)
* Medium/ long-chained triglycerides MCT/LCT (50:50, MCT/LCT group))
* Olive oil/ LCT (80:20, OO group))
* SMOFlipid (Omega-3/ olive oil/ MCT/ LCT, SMOF group) Randomization was performed after assessment and check for in-/exclusion criteria if the patient has met all study eligibility requirements.

The test emulsion became a part of regular PN admixture, which was used to feed patient at home. The study was performed for 12 months.

Conditions

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Liver Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized, double-blind, multi-centric study performed in four parallel groups
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Investigators
No information on the lipid emulsion's type provided neither to the patient nor the leading physician

Study Groups

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Provision of LCT emulsions in PN

Intervention: Lipid Emulsions, Intravenous. Daily provision of LCT-based lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Group Type EXPERIMENTAL

Lipid Emulsions, Intravenous

Intervention Type DRUG

The every day provision of lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Provision of MCT/LCT emulsions in PN

Intervention: Lipid Emulsions, Intravenous. Daily provision of MCT/LCT lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Group Type EXPERIMENTAL

Lipid Emulsions, Intravenous

Intervention Type DRUG

The every day provision of lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Provision of Olive oil emulsions in PN

Intervention: Lipid Emulsions, Intravenous. Daily provision of Olive-oil/ LCT lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Group Type EXPERIMENTAL

Lipid Emulsions, Intravenous

Intervention Type DRUG

The every day provision of lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Provision of SMOF lipid emulsions in PN

Intervention: Lipid Emulsions, Intravenous. Daily provision of SMOF lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Group Type EXPERIMENTAL

Lipid Emulsions, Intravenous

Intervention Type DRUG

The every day provision of lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Interventions

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Lipid Emulsions, Intravenous

The every day provision of lipid emulsion as a part of parenteral nutrition along with dextrose, amino acids, electrolytes, trace elements, vitamins and water in the dose of 0.8-1.0 g/kg/day.

Intervention Type DRUG

Other Intervention Names

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parenteral lipid provision

Eligibility Criteria

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Inclusion Criteria

1. chronic intestinal failure (CIF) receiving HPN including lipids
2. metabolic stability on HPN for more than three months (metabolic stability = the absence of pathological laboratory resulting in the change of PN regime for at least one month)
3. 1.0 g lipids/kg body weight per day as a part of PN

Exclusion Criteria

1. Existing liver failure: an elevation of SGOT, SGTP, total bilirubin, GGTP, alkaline phosphatase of more than 1.5 times x normal value
2. Patients in whom PN was interrupted for longer than 4 continuous weeks in the preceding 6 months
3. Patients with history of cancer and anti-cancer treatment within the last 5 years
4. Severe hyperlipidemia
5. Severe coagulopathy
6. Severe renal insufficiency
7. Acute thromboembolic events
8. Positive test for HIV, Hepatitis B or C (from medical history)
9. Known or suspected drug or alcohol abuse
10. Participation in another interventional clinical trial in parallel or within three months prior to the start of this clinical trial
11. For women with childbearing potential (i.e. females who are not chemically or surgically sterile or females who are not postmenopausal) or women of childbearing potential tested positive on standard pregnancy test (urine dipstick) or/ and lactation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stanley Dudrick's Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

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Stanislaw Klek

Head of the Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Stanislaw Klek, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Stanley Dudrick's Memorial Hospital

Locations

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Stanley Dudrick's Memorial Hospital

Skawina, , Poland

Site Status

Countries

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Poland

References

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Calder PC. Hot topics in parenteral nutrition. Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults. Proc Nutr Soc. 2009 Aug;68(3):252-60. doi: 10.1017/S0029665109001268. Epub 2009 May 11.

Reference Type BACKGROUND
PMID: 19426581 (View on PubMed)

Calder PC, Jensen GL, Koletzko BV, Singer P, Wanten GJ. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med. 2010 May;36(5):735-49. doi: 10.1007/s00134-009-1744-5. Epub 2010 Jan 14.

Reference Type BACKGROUND
PMID: 20072779 (View on PubMed)

Klek S, Szczepanek K, Scislo L, Walewska E, Pietka M, Pisarska M, Pedziwiatr M. Intravenous lipid emulsions and liver function in adult chronic intestinal failure patients: results from a randomized clinical trial. Nutrition. 2018 Nov;55-56:45-50. doi: 10.1016/j.nut.2018.03.008. Epub 2018 Mar 22.

Reference Type DERIVED
PMID: 29960156 (View on PubMed)

Other Identifiers

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IVLE

Identifier Type: -

Identifier Source: org_study_id

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