The results showed that the levels of postoperative albumin and prealbumin in the STG group were higher than in the MCT/LCT group. 1. Introduction Fat emulsion is an indispensable component of total parenteral nutrient (PN) preparations. Fat emulsions provide essential fatty acids and play an important role as an energy source. Furthermore, lipids are involved in the structure and function of cell membranes and receptors, gene expression modification, and inflammatory and immune Troglitazone response modification [1]. The liver is the main place where the metabolism of fat emulsions takes place. The use of total PN by patients undergoing long-term fasting can affect liver function, causing a series of problems such as cholestasis. However, the etiology Troglitazone of PN-associated hepatic injury remains unresolved. The use of fat emulsion for nutritional support among patients who have undergone liver surgery has caused controversy. However, in recent years, with the continuous development of fat emulsion technology and the Troglitazone deepening understanding of the mechanisms of hepatic metabolism, a new generation of fat emulsions has been created for patients who have undergone liver surgery. Structured triglyceride- (STG-) based lipid emulsions are composed of medium-chain fatty acids (MCFA) and long-chain fatty acids (LCFA) attached to the same glycerol skeleton. The production process involves heating the starting materials (medium-chain triglycerides [MCTs] and long-chain triglycerides [LCTs]) in the presence of enzyme catalysts to bring about restructuring. In this process, the triglyceride fatty acyl chains become randomized. The advantage of this process is the avoidance of the metabolism of physically mixed MCTs and LCTs, which interfere with each other. Many studies [2C4] have been performed to evaluate the effects of STG emulsions compared to physical MCT/LCT mixtures or LCT emulsions on hepatic integrity. In experimental settings, it has been repeatedly demonstrated that PN involving STG-based lipid emulsions is more beneficial than physical LCT/MCT mixtures. However, findings from studies involving surgical patients and those in intensive care units (ICUs) have yielded inconsistent outcomes. Chambrier and colleagues found no significant differences in hepatic function between patients who received STG emulsions or physical MCT/LCT mixtures, though only the differences in transaminases were assessed. To identify the optimal fat emulsion preparation, the effects on liver function impairment have to be clinically assessed, in addition to the ability of the fat emulsion to meet the patients’ energy demands. The present meta-analysis was carried out to identify potential differences in nutritionally and clinically relevant endpoints among patients who have undergone gastrointestinal surgery and/or critically ill patients. Consequently, we systematically identified and reviewed the relevant evidence comparing STG-based lipid emulsions with physical MCT/LCT mixtures in patients with liver cancer who had undergone hepatectomy and we conducted a meta-analysis to identify potential differences between the two types of PN in terms Rabbit Polyclonal to OR11H1 of liver function, protein metabolism, and immune function. 2. Methods We searched both electronically and manually for journal articles published from January 2007 to March 2017. We searched PubMed, the Cochrane Library, Web of Science, EMBASE, and the Chinese Biomedicine Database using the following search terms: (structured triglyceride OR structured triacylglycerol OR structured lipid OR STG) AND (long-chain triglyceride OR long-chain triacylglycerol OR long-chain lipid OR medium-chain triglyceride OR medium-chain triacylglycerol OR medium-chain lipid OR MCT OR LCT OR MCT/LCT) AND (randomized controlled trial OR RCT). No language restriction was applied and the search was performed by two independent researchers (Figure 1). Open in a separate window Figure 1 2.1. Inclusion Criteria The included studies met the following criteria: (1) the study compared STG emulsion with MCT/LCT mixture; (2) the study population consisted of patients with benign or malignant liver tumors who had undergone elective liver surgery; (3) the study was the latest publication (if the same data had been published multiple times); and (4) the study was a randomized controlled trial (RCT). 2.2. Exclusion Criteria The following studies were excluded: (1) the PN type or the details of the surgical method were not reported; (2) the patients had not undergone liver surgery or had severe chronic liver disease (and were staying in an ICU); (3) there was no comparison of STG emulsion with MCT/LCT mixture; (4) the study outcomes did not include postoperative liver or immune function indicators; (5) the study was a report of data used in a later study; (6) low-quality studies: the quality of RCTs was evaluated based on the Jadad scale system: if the total score was 4, the RCT was deemed to be of low quality; (7) abstracts, case reports, letters, comments, and reviews without original data, and studies that presented insufficient data were not included; and (8) studies that were not RCTs were not included. 2.3. Literature Screening All reports found during the.