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

Background and objective Parenteral 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. Methods In a prospective, randomized, double-blinded trial, 44 postoperative patients with an indication for parenteral nutrition were allocated to one of two regimens: group 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. Results There was no significant difference at d0, but at d2 and d5, significantly lower aspartate aminotransferase (d2: group A: 27 +/- 13 vs. group B: 47 +/- 36 Ul(-1); d5:A:31 +/- 14 vs. B:56 +/- 45 Ul(-1)), alanin-aminotransferase (d2: A:20 +/- 12 vs. B:42 +/- 39 Ul(-1); d5:A:26 +/- 15 vs. B:49 +/- 44 Ul(-1)), and alpha-glutathion S-transferase levels (d2: A: 5 +/- 6 vs. B: 17 +/- 21 Ul(-1); d5: A: 6 +/- 7 vs. B: 24 +/- 27 mu g l(-1)) were found in soybean oil, medium-chain triglycerides, olive and fish oil group compared with the control group. Conclusion Hepatic 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. Eur J Anaesthesiol 26:1076-1082 (C) 2009 European Society of Anaesthesiology.