住院患者接受肠外营养期间甘油三酯耐受性、体重指数与脂肪蓄积之间的关系

　　背景：虽然已经明确高甘油三酯血症与静脉输注脂肪乳剂（IVFE）患者的不良预后相关，但关于其发生率和原因知之甚少。

　　资料与方法：该研究对体重指数（BMI）和甘油三酯耐受之间是否存在相关性进行了调查，我们对287名接受肠外营养的成人进行了回顾性分析以明确极低BMI（VLBMI，＜16kg/m²）患者是否比低BMI（LBMI，16～18.4kg/m²）患者、正常体重患者（NBMI，18.5～24.9kg/m²），以及超重/肥胖患者（HBMI，≥25kg/m²）对IVFE的耐受性更好。

　　结果：在IVFE期间，尽管VLBMI患者的脂质输注率更高，但与非VLBMI患者（124mg/dL）相比，VLBMI患者甘油三酯浓度的中位数（107mg/dL）明显较低（P=0.016）。在整个队列中，甘油三酯和BMI之间存在显著的相关性（R=0.2375，P＜0.0001），虽然HBMI患者摄入相对较低的脂质和能量，但该人群患高甘油三酯血症发生率仍然最高。在进行了腹部CT扫描的VLBMI患者（n=36）中，其腹部脂肪组织的体积存在25～100倍的差异。在该群体中，甘油三酯浓度与内脏脂肪相关，而与腹部皮下脂肪无关。

　　结论：总之，在IVFE期间，VLBMI患者的甘油三酯浓度比其他患者低，但该组的甘油三酯和体脂存在相对个体差异。提示需谨慎应用IVFE，尤其在HBMI患者中。

JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):922-8.

Relationship Between Triglyceride Tolerance, Body Mass Index, and Fat Depots in Hospitalized Patients Receiving Parenteral Nutrition.

Frazee EN, Nystrom EM, McMahon MM, Williamson EE, Miles JM.

Mayo Clinic, Rochester, Minnesota.

BACKGROUND: Hypertriglyceridemia has been associated with adverse outcomes in patients receiving intravenous fat emulsions (IVFEs), but little is known about its prevalence and causes.

MATERIALS AND METHODS: The study investigated whether a relationship exists between body mass index (BMI) and triglyceride tolerance in parenterally fed patients. We conducted a retrospective analysis of 287 adults receiving parenteral nutrition to determine whether patients with very low BMI (VLBMI, <16 kg/m(2)) tolerate IVFEs better than do patients with low BMI (LBMI, 16-18.4 kg/m(2)), normal-weight patients (NBMI, 18.5-24.9 kg/m(2)), and overweight/obese patients (HBMI, ≥25 kg/m(2)).

RESULTS: The median triglyceride concentration during IVFE was significantly lower in VLBMI patients at 107 mg/dL compared with 124 mg/dL in non-VLBMI patients (P = .016), despite higher lipid infusion rates in the VLBMI group. There was a significant association between triglycerides and BMI in the aggregate cohort (R = 0.2375, P < .0001), with the highest frequency of hypertriglyceridemia occurring in HBMI patients despite relatively lower lipid and energy supply. In a subset of VLBMI patients (n = 36) who had an abdominal computed tomography scan, there was 25- to 100-fold variability in the size of the abdominal adipose tissue depots. In this subgroup, triglyceride concentrations correlated with visceral fat but not subcutaneous abdominal fat.

CONCLUSIONS: In summary, patients with VLBMI have lower triglyceride concentrations during IVFEs than do other individuals, but there is considerable variability in triglycerides and body fat in this group. Caution should be employed with the use of IVFEs, especially in HBMI patients.

KEYWORDS: adult; life cycle; lipids; nutrition; obesity; parenteral nutrition; research and diseases

PMID: 24920321

DOI: 10.1177/0148607114538059