Comparison of liver function with two new/mixed intravenous lipid emulsions in children with intestinal failure
Background/objective: The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e....
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| Published in | European journal of clinical nutrition Vol. 68; no. 10; pp. 1161 - 1167 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
Nature Publishing Group UK
01.10.2014
Nature Publishing Group |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Background/objective:
The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF).
Subjects/methods:
Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. Results of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used.
Results:
One hundred and twenty-seven children aged 0–16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (
P
<0.008 on SMOF;
P
<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (
P
⩽0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs.
Conclusion:
Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. |
|---|---|
| AbstractList | Background/objective:
The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF).
Subjects/methods:
Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. Results of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used.
Results:
One hundred and twenty-seven children aged 0–16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (
P
<0.008 on SMOF;
P
<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (
P
⩽0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs.
Conclusion:
Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF). Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. RESULTS of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used. One hundred and twenty-seven children aged 0-16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P<0.008 on SMOF; P<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs. Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF).BACKGROUND/OBJECTIVEThe high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF).Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. RESULTS of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used.SUBJECTS/METHODSNeonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. RESULTS of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used.One hundred and twenty-seven children aged 0-16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P<0.008 on SMOF; P<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P⩽0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs.RESULTSOne hundred and twenty-seven children aged 0-16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P<0.008 on SMOF; P<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P⩽0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs.Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation.CONCLUSIONAddition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. BACKGROUND/OBJECTIVE: The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF). SUBJECTS/METHODS: Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 µmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. Results of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used. RESULTS: One hundred and twenty-seven children aged 0-16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P < 0.008 on SMOF; P < 0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P ≤ 0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs. CONCLUSION: Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. European Journal of Clinical Nutrition (2014) 68, 1161-1167; doi: 10.1038/ejcn.2014.118; published online 25 June 2014 SUBJECTS/METHODS: Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 µmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. Results of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used. European Journal of Clinical Nutrition (2014) 68, 1161-1167; doi: 10.1038/ejcn.2014.118; published online 25 June 2014 The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF). Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. RESULTS of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used. One hundred and twenty-seven children aged 0-16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P<0.008 on SMOF; P<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P⩽0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs. Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. Background/objective:The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF).Subjects/methods:Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT) 1.5x upper limit of normal and/or total bilirubin >50 μmol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. Results of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used.Results:One hundred and twenty-seven children aged 0–16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P<0.008 on SMOF; P<0.05 on Lipofundin), with additional significant reduction in γ-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P⩽0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs.Conclusion:Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation. |
| Audience | Professional Academic |
| Author | Pichler, J Macdonald, S Simchowitz, V Hill, S |
| Author_xml | – sequence: 1 givenname: J surname: Pichler fullname: Pichler, J email: Judith.pichler@meduniwien.ac.at organization: Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Paediatric and Adolescent Medicine, Medical University of Vienna – sequence: 2 givenname: V surname: Simchowitz fullname: Simchowitz, V organization: Department of Pharmacy, Great Ormond Street Hospital for Children NHS Foundation Trust – sequence: 3 givenname: S surname: Macdonald fullname: Macdonald, S organization: Department of Dietetics, Great Ormond Street Hospital for Children NHS Foundation Trust – sequence: 4 givenname: S surname: Hill fullname: Hill, S organization: Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust |
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| Keywords | Human Liver function intestinal failure Emulsion Intravenous administration Digestive diseases Intestinal disease Lipids Metabolic diseases Child Comparative study |
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| PublicationTitle | European journal of clinical nutrition |
| PublicationTitleAbbrev | Eur J Clin Nutr |
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| Publisher | Nature Publishing Group UK Nature Publishing Group |
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The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous... The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs).... BACKGROUND/OBJECTIVE: The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous... SUBJECTS/METHODS: Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine... Background/objective:The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous... |
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| SubjectTerms | 692/699 692/700 Adolescent Alanine Alkaline phosphatase Bilirubin Bilirubin - blood Biochemistry Biological and medical sciences Blood Catheters Child Child, Preschool Children Children & youth Cholesterol Clinical Nutrition Colorectal diseases Comparative analysis Diseases Drug Combinations Emulsions Emulsions - administration & dosage Epidemiology Fat Emulsions, Intravenous - administration & dosage Fat Emulsions, Intravenous - therapeutic use Feeding. Feeding behavior Female Fish oils Fish Oils - administration & dosage Fundamental and applied biological sciences. Psychology Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal diseases Health aspects Health services Humans Infant Infant, Newborn Infants Internal Medicine Intestinal Diseases - drug therapy Intestinal Diseases - physiopathology Intravenous administration Lipid metabolism Lipids Liver Liver - drug effects Liver - physiopathology Liver diseases Male Medical instruments Medical research Medical sciences Medicine Medicine & Public Health Medicine, Experimental Metabolic Diseases Neonates Nutrition Olive Oil original-article Other diseases. Semiology Parenteral Nutrition Phospholipids - administration & dosage Physiological aspects Plant Oils - administration & dosage Public Health Retrospective Studies Sorbitol - administration & dosage Soybean Oil - administration & dosage Soybeans Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Triglycerides Triglycerides - administration & dosage Vertebrates: anatomy and physiology, studies on body, several organs or systems |
| Title | Comparison of liver function with two new/mixed intravenous lipid emulsions in children with intestinal failure |
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