Steroidal Compounds in Commercial Parenteral Lipid Emulsions

Abstract

Parenteral nutrition lipid emulsions made from various plant oils contain steroidal compounds, called phytosterols. During parenteral administration of lipid emulsions, phytosterols can reach levels in the blood that are many fold higher than during enteral administration. The elevated phytosterol levels have been associated with the development of liver dysfunction and the rare development of liver failure. There is limited information available in the literature related to phytosterol concentrations in lipid emulsions. The objective of the current study was to validate an assay for steroidal compounds found in lipid emulsions and to compare their concentrations in the most commonly used parenteral nutrition lipid emulsions: Liposyn® II, Liposyn® III, Lipofundin® MCT, Lipofundin® N, Structolipid®, Intralipid®, Ivelip® and ClinOleic®. Our data demonstrates that concentrations of the various steroidal compounds varied greatly between the eight lipid emulsions, with the olive oil-based lipid emulsion containing the lowest levels of phytosterols and cholesterol, and the highest concentration of squalene. The clinical impression of greater incidences of liver dysfunction with soybean versus MCT/LCT and olive/soy lipid emulsions may be reflective of the levels of phytosterols in these emulsions. This information may help guide future studies and clinical care of patients with lipid emulsion-associated liver dysfunction.

Supplemental Parenteral Vitamin E Into Conventional Soybean Lipid Emulsion Does Not Prevent Parenteral Nutrition–Associated Liver Disease in Full‐Term Neonatal Piglets

“…Conventional soy‐based lipid emulsions are predominant in ω‐6 PUFAs, implicated for proinflammatory eicosanoid production 6 . They are also abundant in phytosterols, which may be a factor in PNALD as they have been shown to alter bile acid transport and metabolic function 14 , 15 . Finally, they are low in vitamin E, a major lipid‐soluble antioxidant.…”

Multi-omic profiles of hepatic metabolism in TPN-fed preterm pigs administered new generation lipid emulsions

“…This is especially important for preterm infants who are born at a stage of gestation before the normal placental transfer and deposition of DHA in fetal tissues are completed. This loss of fetal DHA transfer due to preterm birth may be difficult to restore by current nutritional practices and result in a "DHA gap of prematurity" (6,9). The challenge of restoring this DHA gap in premature infants is further complicated when ENT feedings are delayed and lipid intake is exclusively via parenteral lipid emulsions.…”

The Use of Fish Oil Lipid Emulsion in the Treatment of Intestinal Failure Associated Liver Disease (IFALD)

“…For example, phytosterols found in SO are thought to have a deleterious effect on hepatic function [89]. Phytosterols are plant-derived lipids structurally similar to cholesterol; however, enteral absorption is limited to 5%–10%, approximately 1/10 that of cholesterol [90,91,92].…”