Impact of intravenous lipid emulsions on liver function tests: Contribution of parenteral fish oil

Badia-Tahull, M.B.; Llop-Talaverón, J.; Leiva‐Badosa, Elisabet

doi:10.1016/j.nut.2015.04.005

Cited by 17 publications

(8 citation statements)

References 52 publications

(24 reference statements)

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“…At the end of the study, like other authors describe [ 1 , 4 , 5 ], GGT and AP doubled their normal value in 47 and 10.5% of the patients, respectively. The short period studied (8.43 ± 6.64 days) would explain the low incidence in the alteration of ALT and TB, as per our previous studies [ 10 , 13 ] and other reference publications [ 14 – 17 ]. Such increases of GGT and AP emerge as early indicators of hepatic dysfunction [ 15 ], whilst ALT and TB are linked to hepatocellular damage and intrahepatic cholestasis [ 15 – 17 ].…”

Section: Discussionsupporting

confidence: 66%

“…Some studies related this alteration to high doses of LE [ 4 , 5 ] and others to the emulsions’ vegetable origin [ 6 – 8 ]. Our group has studied the impact of vegetal LE on the alteration of LTs, as well as the protective effect of fish oil, and our findings support the hypothesis of an association between liver damage and use of vegetal LE [ 9 , 10 ] due, in part, to plasma phytosterol concentration. This association is relatively well established in premature infants and adults with long-term PN, as well as those on home PN (HPN) [ 11 ].…”

Section: Introductionsupporting

confidence: 79%

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Risk factors of hepatic function alterations in hospitalized adult patients treated with short-term parenteral nutrition receiving the same lipid composition at the same dose

et al. 2018

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BackgroundHigh doses and vegetable origin of lipid emulsions (LE) are prominent factors for liver test (LT) alterations in patients treated with parenteral nutrition (PN). This study aims to determine incidence of LT alterations, and risk factors related to these alterations in patients with short term PN with homogenous LE.MethodsAdult non-critically ill hospitalized patients, with normal LTs at the beginning of PN, receiving 0.8 g/kg/day of an olive/soybean LE were included. A paired Student t-test was applied to compare final with initial LT values. LT variation (end vs start of PN) according to type of surgery and infection was studied by means of an analysis of the variance. Univariate and multivariate analyses were constructed to relate the variations of each of the 4 LTs with the adjustment variables.ResultsOne hundred eighty one patients (66.57 ± 12.89 years; 72.4% men), 66.8% suffered from cancer. Final LT values increased from initial values for gamma-glutamyltransferase (GGT) 2.69 ± 2.49 μkat/L vs 0.55 ± 0.36 μkat/L, alkaline phosphatase (AP) 1.97 ± 1.49 μkat/L vs 1.04 ± 0.33 μkat/L, and alanine aminotransferase (ALT) 0.57 ± 0.92 μkat/L vs 0.32 ± 0.26 μkat/L. GGT and AP variations were associated with days of PN; GGT, AP and total bilirubin with surgical patients, AP variations with infection, and GGT with cancer. Multivariate analysis: elevation of GGT, AP and ALT was related to infection, days of PN and surgery.ConclusionsFactors that increased the risk of LTs elevation during short term PN treatment were duration of PN, surgery, cancer, and infection associated with oxidative stress.

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Section: Discussionsupporting

confidence: 66%

Section: Introductionsupporting

confidence: 79%

Risk factors of hepatic function alterations in hospitalized adult patients treated with short-term parenteral nutrition receiving the same lipid composition at the same dose

et al. 2018

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“…0.25–0.3 g/kg/d). In a retrospective study from Spain, increasing the amount of FO in PN by means of a combination of a mixed ILE with FO and a pure FO ILE resulted in a higher and significant decrease ( p < 0.05) in GGT, AP, and triglycerides after an average PN period of 16–17 days compared to patients receiving standard ILE [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

High Dose Intravenous Fish Oil Reduces Inflammation—A Retrospective Tale from Two Centers

Kłęk¹,

Mańkowska-Wierzbicka

Ścisło

et al. 2020

Nutrients

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Aim: Patients on parenteral nutrition (PN) are prone to inflammation. This may aggravate an existing proinflammatory state and become a critical factor in the development of liver dysfunction (LD). Intravenous fish oil may attenuate this inflammatory state, but data on its use in adults are scarce. The aim of this study was to investigate the effects of adding a pure fish oil intravenous lipid emulsion (ILE) into short- and long-term PN in patients either at risk of, or with existing, inflammation. Methods: A retrospective analysis of 61 patients (32 female, 29 male, mean age 51.5 ± 12.6 years) who received all-in-one PN, including amino acids, glucose, and lipids supplemented with pure fish oil ILE, was performed. Pure fish oil ILE (Omegaven®, Fresenius Kabi, Bad Homburg, Germany) was used along with the standard ILE to reach a fish oil dose of 0.4–0.5 g fish oil/kg/d. Diagnoses were chronic intestinal failure (CIF, n = 20), Crohn’s disease (CD, n = 22), and ulcerative colitis (UC, n = 19). The observation period was 12 months for CIF and 21 days for UC and CD. Results: A reduction in inflammation was noticeable in all patients and became statistically significant in CD (hsCRP p < 0.0001, ESR p = 0.0034, procalcitonin p = 0.0014, Il-6 p = 0.001) and UC groups (hsCRP and ESR p < 0.0001, Il-6 p = 0.0001, TNF-α p = 0.0113). In the CIF group, the total bilirubin concentration (p = 0.2157) and aspartate transaminase SGOT (p = 0.1785) did not vary over time. Conclusions: PN with pure fish oil ILE reduces some inflammatory parameters in IBD and maintains liver function parameters in CIF patients. Fish oil might become a valuable ingredient in both short- and long-term PN in patients at risk of liver dysfunction.

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“…Lipid composition of TPN could also play a significant role in liver enzyme alteration associated with PN, and n-3 PUFA ILEs have been shown to minimize this disturbance in hospitalized adult patients by reducing liver complications [21,22]. The administration of high doses of intravenous lipids, that are high in n-6 PUFAs and phytosterols (like the ones based on soybean oils), can contribute to the development of parenteral nutrition-associated liver disease [23].…”

Section: Lipid Control and Liver Enzymesmentioning

confidence: 99%

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study

et al. 2020

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There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.

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Impact of intravenous lipid emulsions on liver function tests: Contribution of parenteral fish oil

Cited by 17 publications

References 52 publications

Risk factors of hepatic function alterations in hospitalized adult patients treated with short-term parenteral nutrition receiving the same lipid composition at the same dose

Risk factors of hepatic function alterations in hospitalized adult patients treated with short-term parenteral nutrition receiving the same lipid composition at the same dose

High Dose Intravenous Fish Oil Reduces Inflammation—A Retrospective Tale from Two Centers

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study

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