It should be considered that the composition of the OO-based
parenteral nutrition in this study differs from the normal diet of
the healthy Dutch population. OO-based PN consists of 64% mono-
unsaturated fatty acids (FAs), 22% polyunsaturated FAs and 14%
saturated FA, while according to the Dutch National Food
Consumption Surveythe dietof theadult Dutch population consists
of 53% unsaturated FA, 38% saturated FA, 3% trans FA and 6% other
FA. 3,29 It is known that saturated FAs and triglycerides can modu-
late immune function depending on their carbon chain-length
in vitro. 30 However, it is unclear what the consequences of these
different intakes of FAs are for cell membrane composition and the
function of immune cells in patients on OO-based PN.
Another difference between the groups in this study is the
hepatic function; HPN patients have significantly increased serum
liver enzyme levels compared to healthy controls. Liver dysfunction
occurs frequently in long-term HPN patients. 1 The difference in
hemoglobin of 0.6 mmol/l between HPN patients and controls is
not clinically relevant and is considered to be the effect of the
underlying disease of HPN patients.
Limitations of the present study should be also considered. The
incidence of severe intestinal failure that necessitates HPN treat-
ment is low, only 4e6 million per year in patients with benign
primary diseases in Europe. Since HPN patients with an active
immune-mediated disease were excluded, this resulted in a small
group of patients that could be included in this study. 1 This limited
power might therefore preclude the detection of very subtle
changes in innate immune functions. However, our detailed anal-
ysis clearly rules out significant differences between these HPN
patients and healthy controls.
In conclusion, this study shows that innate immune function in
patients with severe intestinal failure can be preserved during
home treatment with OO-based parenteral nutrition. Therefore,
a compromised innate immune function does not seem to be the
explanation for the increased risk for infectious complications in
these HPN patients.