Phytosterolemia and γ-glutamyl transferase in adults with parenteral nutrition: Fish versus vegetal lipids: A randomized clinical trial

Autor: Maria B. Badia-Tahull, Elisabet Leiva-Badosa, Ana Suárez-Lledó, Mónica Miró-Martín, Toni Lozano-Andreu, Leandre Farran-Teixidó, Raül Rigo-Bonnin, J. Llop-Talaveron, Núria Virgili-Casas
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Parenteral Nutrition
Endocrinology
Diabetes and Metabolism
Gastroenterology
chemistry.chemical_compound
0302 clinical medicine
Liver Function Tests
Interquartile range
Prospective Studies
Nutrition and Dietetics
biology
Phytosterols
Alanine Transaminase
gamma-Glutamyltransferase
Middle Aged
Fish oil
Treatment Outcome
Liver
Population study
Alkaline phosphatase
Female
Fat Emulsions
Intravenous
medicine.medical_specialty
Randomization
Bilirubin
Hypercholesterolemia
030209 endocrinology & metabolism
digestive system
Lipid Metabolism
Inborn Errors
03 medical and health sciences
Fish Oils
Double-Blind Method
Internal medicine
medicine
Humans
Plant Oils
Aged
030109 nutrition & dietetics
business.industry
Alkaline Phosphatase
digestive system diseases
Intestinal Diseases
Parenteral nutrition
chemistry
Alanine transaminase
Linear Models
biology.protein
business
Zdroj: Nutrition. 70:110587
ISSN: 0899-9007
DOI: 10.1016/j.nut.2019.110587
Popis: Objectives Fish oil (FO)–based lipid emulsions (LEs) have been reported to prevent hepatic dysfunction in patients treated with parenteral nutrition (PN). We studied patients with alterations of γ-glutamyl transferase (GGT) associated with the administration of PN containing olive/soybean (O/S)-based LE. The aim of this study was to determine whether the strategy of reducing the lipid dose by 50%, by changing to an FO-based LE, reduced plasma levels of phytosterols (PS) and GGT more effectively and safely, than the strategy of reducing lipid contribution by 50% while maintaining the same LE composition. Methods A randomized double-blind clinical trial was carried out in patients with normal initial GGT, who after a minimum of 1 wk of daily PN (0.8 g/kg of O/S-based LE) presented with GGT values twice the upper normal value. At the time of randomization 1:1, lipids were reduced to 0.4 g/kg daily. Group A maintained O/S LE and group B changed to FO LE. The primary endpoints were reduction of plasmatic PS and GGT on day 7 after randomization, performed in the study population per protocol by Student's t test and simple linear regression. Secondary outcomes included alkaline phosphatase (AP), alanine transaminase (ALT), and total bilirubin (BIL), and safety variables. Results Nineteen patients were included. On day 7 after randomization, GGT and AP values were higher in the O/S group (n = 10; GGT: median [Med], 4.99; interquartile range [IQR], 4.09; AP: Med, 2.59 μkat/L; IQR 1.74) than in the FO group (n = 9; GGT: Med, 2.26 μkat/L; IQR, 1.07; AP: Med, 1.2 μkat/L; IQR 1.44). Although there were no differences in ALT and BIL values, the ALT decrease was larger and more statistically significant in the FO group than in the O/S group (P = 0.009). Total PS (Med, 21.10 μg/mL; IQR, 5.50) in the O/S group was higher than in the FO group (Med, 13.4 μg/mL; IQR, 10.65; P = 0.002). Significant decreases in PS and their fractions were observed, with the exception of campesterol and stigmasterol. Conclusion Plasma accumulation of PS and high values of GGT, AP, and ALT can be prevented with the exclusive administration of FO-based LE.
Databáze: OpenAIRE
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