INTRODUCTION: Our study aim was to assess how the macronutrient intake during total parenteral nutrition (TPN) modulates plasma total free fatty acids (FFAs) levels and individual fatty acids in critically ill patients. METHOD: Adult patients aged 18-80, admitted to the intensive care unit (ICU), who were indicated for TPN, with an expected duration of more than three days, were included in the study. Isoenergetic and isonitrogenous TPN solutions were given with a major non-protein energy source, which was glucose (group G) or glucose and lipid emulsions (Smof lipid; group L). Blood samples were collected on days 0, 1, 3, 6, 9, 14, and 28. RESULTS: A significant decrease (p < 0.001) in total FFAs occurred in both groups with a bigger decrease in group G (p < 0.001) from day 0 (0.41 ± 0.19 mmol∙L-1) to day 28 (0.10 ± 0.07 mmol∙L-1). Increased palmitooleic acid and decreased linoleic and docosahexaenoic acids, with a trend of increased mead acid to arachidonic acid ratio, on day 28 were observed in group G in comparison with group L. Group G had an insignificant increase in leptin with no differences in the concentrations of vitamin E, triacylglycerides, and plasminogen activator inhibitor-1. CONCLUSION: Decreased plasma FFA in critically ill patients who receive TPN may result from increased insulin sensitivity with a better effect in group G, owing to higher insulin and glucose dosing and no lipid emulsions. It is advisable to include a lipid emulsion at the latest from three weeks of TPN to prevent essential fatty acid deficiency.

3rd Department of Internal Medicine Metabolic Care and Gerontology University Hospital and Faculty of Medicine in Hradec Kralove Charles University Prague Sokolska 581 50005 Hradec Kralove Czech Republic

4th Department of Internal Medicine Hematology University Hospital Hradec Kralove Sokolska 581 50005 Hradec Kralove Czech Republic

Department of Clinical Biochemistry and Diagnostics University Hospital and Faculty of Medicine in Hradec Kralove Charles University Prague Sokolska 581 50005 Hradec Kralove Czech Republic

Department of Military Internal Medicine and Military Hygiene Faculty of Military Health Sciences University of Defence in Brno Trebesska 1575 50001 Hradec Kralove Czech Republic

Department of Physiology Faculty of Medicine in Hradec Kralove Charles University Prague Simkova 870 50003 Hradec Kralove Czech Republic

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