Liver Dysfunction and Energy Source: Results of a Randomized Clinical Trial

Abstract

Controversy still exists regarding the role of the carbohydrate:fat ratio on liver function abnormalities associated with the administration of total parenteral nutrition (TPN). We designed a prospective clinical trail comparing standard carbohydrate-based TPN (8.5% amino acids, 50% dextrose, 7.5% of total calories from lipids) with an isocaloric lipid-based TPN (8.5% amino acids, 30% dextrose, 40% of total calories from lipids) in 43 patients exclusively receiving TPN > or = 2 weeks. Energy needs were calculated as basal energy expenditure x 1.5. The mean daily calorie intake for patients who obtained carbohydrate-based TPN (CHO) was 2227 kcal, whereas the lipid-based TPN (LIP-CHO) group achieved a mean of 2310 kcal. Patients with preexisting liver disease were excluded. There was no significant difference in age or diagnosis between the groups. We monitored total bilirubin, direct bilirubin, alkaline phosphatase, gamma-glutamyl transferase, lactic dehydrogenase, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase. Initial liver-associated tests did not vary significantly between groups. Group mean values after 2 weeks of TPN were significantly different for total bilirubin (1.5 mg/dL in the CHO group compared with 0.7 in the LIP-CHO group, p < .05) and direct bilirubin (0.8 mg/dL in the CHO group compared with 0.3 mg/dL in the mixed substrate group, p < .05). Differences in mean values between groups were also noted for serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and lactic dehydrogenase. In conclusion, this prospective trial reveals that the use of a balanced energy source TPN solution prevents the abnormalities in liver-associated tests commonly associated with TPN.(ABSTRACT TRUNCATED AT 250 WORDS)

Liver dysfunction associated with artificial nutrition in critically ill patients

“…Another factor that could contribute to the low incidence of LD found in our group is related to the composition of the TPN. There are studies that emphasize the effect of overfeeding on the hepatic metabolism [ 45 - 47 ] or suggest that a lipid mixture containing MCTs (MCT/LCT) could decrease the risk of steatosis or liver cholestasis [ 48 ]. Our results do not confirm this protective effect of the MCT/LCT lipid admixture.…”

Liver Disease Secondary to Intestinal Failure

“…It is also important to maintain a balance in macronutrient composition in the TPN prescription. Hepatic steatosis occurs in over 50% of patients receiving dextrose infusion, as compared with 17% receiving a combined dextrose-lipid mixture [60]. In adults, it is recommended to provide glucose and lipids in a proportion of about 70% : 30% of nonprotein calories to reduce the risk of liver complications related to TPN.…”

Intestinal transplantation: an update

“…The composition of the TPN solution influences hepatic changes [30,33], although there is no consensus as to which combination of nutrients is optimal. Certain elements in TPN may be toxic [34] while other elements that are lacking in TPN may be protective [35].…”