Hepatocellular integrity after parenteral nutrition: comparison of a fish-oil-containing lipid emulsion with an olive-soybean oil-based lipid emulsion

BACKGROUND AND OBJECTIVEParenteral nutrition including lipids might be associated with liver disease. The cause leading to parenteral nutrition-related liver dysfunction remains largely unknown but is likely to be multifactorial. The study was performed to assess the effects of a lipid emulsion based on soybean oil, medium-chain triglycerides, olive and fish oil (SMOFlipid20%) compared with a lipid emulsion based on olive and soybean oil on hepatic integrity. METHODSIn a prospective, randomized, double-blinded trial, 44 postoperative patients with an indication for parenteral nutrition were allocated to one of two regimensgroup A (n = 22) received SMOFlipid, group B (n = 22) a lipid emulsion based on olive and soybean oil for 5 days. Aspartate aminotransferase, alanin-aminotransferase, and serum alpha-glutathion S-transferase were measured before the start of parenteral nutrition (d0), at day 2 (d2), and day 5 (d5) after the start of parenteral nutrition. The significance level was defined at a P value of less than 0.05. RESULTSThere was no significant difference at d0, but at d2 and d5, significantly lower aspartate aminotransferase (d2group A27 ± 13 vs. group B47 ± 36 U l; d5A31 ± 14 vs. B56 ± 45 U l), alanin-aminotransferase (d2A20 ± 12 vs. B42 ± 39 U l; d5A26 ± 15 vs. B49 ± 44 U l), and α-glutathion S-transferase levels (d2A5 ± 6 vs. B17 ± 21 U l; d5A6 ± 7 vs. B24 ± 27 μg l) were found in soybean oil, medium-chain triglycerides, olive and fish oil group compared with the control group. CONCLUSIONHepatic integrity was well retained with the administration of SMOFlipid whereas in patients receiving a lipid emulsion based on olive and soybean oil liver enzymes were elevated indicating a lower liver tolerability.