Biomarkers of oxidation, inflammation and intestinal permeability in persons with diabetes mellitus with parenteral nutrition: A multicenter randomized trial

Clin Nutr. 2025 Jan:44:155-164. doi: 10.1016/j.clnu.2024.11.044. Epub 2024 Dec 3.

Abstract

Background and aims: Parenteral nutrition (PN) composition could play a role in the management of systemic inflammatory response and intestinal barrier disruption. We aimed to evaluate changes in biomarkers of inflammation, oxidative status and intestinal permeability in patients with type 2 diabetes mellitus (T2DM) who received different PN lipid formulas.

Methods: This was a prospective study, including 94 patients with T2DM who received omega (n)-3 polyunsaturated fatty acids (PUFA)-enriched PN, a mixture of medium and long chain triglycerides (MCT/LCT) PN, or an olive oil-based PN. Serum levels of biomarkers of oxidative status, intestinal permeability and inflammation biomarkers were determined at day 1 and day 5 after PN initiation. Registered under ClinicalTrials.gov Identifier no. NCT02706119.

Results: At day 5 after the onset of PN, the MCT/LCT group had a significant reduction of 2 proinflammatory cytokines [interleukin (IL)-15, IL-17A], elevation of the anti-inflammatory cytokine IL-13 and increase of zonulin and indoxylsulfate. The olive oil group showed a statistically significant reduction of 5 proinflammatory cytokines [IL-1β, IL-17A, IL-6, cytokine-leukemia inhibitory factor (LIF) and tumor necrosis factor alpha (TNF-α)] and reduced concentrations of the anti-inflammatory cytokine IL-1RA, while the n-3 PUFA-enriched group presented a statistically significant reduction of 8 proinflammatory cytokines (interferon-gamma, IL-1β, IL-15, IL-17A, IL-6, LIF, monocyte chemoattractant protein 1, and TNF-α). In the between-group comparisons, indoxylsulfate significantly increased in the MCT/LCT group compared to the n-3 PUFA-enriched group, while 8-isoprostane and indoxylsulfate significantly increased in the MCT/LCT group compared to the other groups and superoxide dismutase significantly decreased in the MCT/LCT group compared to the other groups.

Conclusion: In patients with T2DM, PN lipid composition exerts a profound impact on proinflammatory, prooxidative and intestinal permeability biomarkers.

Keywords: Inflammation; Intestinal permeability; Oxidative status; Parenteral nutrition.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Biomarkers* / blood
  • Cytokines* / blood
  • Diabetes Mellitus, Type 2* / blood
  • Diabetes Mellitus, Type 2* / therapy
  • Fatty Acids, Omega-3* / administration & dosage
  • Fatty Acids, Omega-3* / blood
  • Female
  • Haptoglobins
  • Humans
  • Inflammation* / blood
  • Intestinal Barrier Function
  • Intestinal Mucosa / metabolism
  • Male
  • Middle Aged
  • Olive Oil* / administration & dosage
  • Oxidative Stress / drug effects
  • Parenteral Nutrition* / methods
  • Permeability*
  • Prospective Studies
  • Protein Precursors
  • Triglycerides* / blood

Substances

  • Biomarkers
  • Cytokines
  • Fatty Acids, Omega-3
  • Olive Oil
  • Triglycerides
  • zonulin
  • Haptoglobins
  • Protein Precursors

Associated data

  • ClinicalTrials.gov/NCT02706119