Journal of Pediatric Gastroenterology and Nutrition 44(2):p 237-244, February 2007.
Martina Kohl, Thilo Wedel, Andreas Entenmann, Julia Stuttmann, Meike Bendiks, Steffan Loff, Stefan Köster, Stefan Ortfeld, Inge Bos
DOI: 10.1097/01.mpg.0000252193.99331.03
Abstract
OBJECTIVES: Long-term total parenteral nutrition (TPN) in children is often complicated by the development of cholestasis, liver fibrosis, and liver failure. High doses of intravenous lipids may be involved in the pathogenesis of hepatobiliary dysfunction. The purpose of this study was to determine whether the use of 2 newly developed lipid emulsions could reduce liver damage.
MATERIALS AND METHODS: Three groups of prepubescent rabbits received TPN including a lipid emulsion either based on soybean oil, olive oil, or soybean oil with n-3 fatty acids added. Enterally fed animals served as controls. After 21 d the animals were killed. Serum samples were obtained at the beginning and end of the study period. Specimens were processed for histological evaluation using a specific score to assess the severity of liver damage.
RESULTS: Biochemical parameters did not predict the extent of liver damage. Hydropic degeneration as an indicator of toxic liver injury was the predominant histological alteration regardless of the type of lipids infused. The extent of fibrosis did not significantly differ among treatment groups except for animals infused with n-3 fatty acids exhibiting increased fibrotic transformation as compared with controls.
CONCLUSION: In our animal model, the use of a lipid emulsion with a reduced amount of polyunsaturated fatty acids was not superior to a lipid emulsion based on soybean oil. Long-term application of n-3 fatty acids was associated with more extensive fibrosis. Therefore, intravenous n-3 fatty acids containing lipid preparations (fish oil) should not be used in patients for long-term TPN.
Keywords: Total parenteral nutrition; Hepatobiliary dysfunction; Intravenous lipid emulsion; n-3 fatty acids
© 2007 Lippincott Williams & Wilkins, Inc.