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Hepatocellular integrity in patients requiring parenteral nutrition: comparison of structured MCT/LCT vs. a standard MCT/LCT emulsion and a LCT emulsion*

Published online by Cambridge University Press:  01 July 2008

S. N. Piper ,
K. D. Röhm ,
J. Boldt ,
B. Odermatt ,
W. H. Maleck  and
S. W. Suttner
S. N. Piper*
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
K. D. Röhm
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
J. Boldt
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
B. Odermatt
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
W. H. Maleck
Affiliation:
Spital Menziken, Department of Anaesthesia, Menziken, Switzerland
S. W. Suttner
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
*
Correspondence to: Swen N. Piper, Department of Anaesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. E-mail: [email protected]; Tel: +49 621 503 3000; Fax: +49 621 503 3024
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Summary

Background and objective

The aetiology of parenteral nutrition-associated hepatic injury remains unresolved. The aim of the study was to evaluate the effects of structured triglycerides in parenteral nutrition compared either to a physical medium-chain triglycerides (MCT)/long-chain triglcerides (LCT) mixture or to a LCT emulsion on hepatic integrity.

Methods

In a randomized, double-blinded trial, we studied 45 patients undergoing abdominal surgery, who were expected to receive parenteral nutrition for 5 days. Patients were allocated to one of three nutrition regimens: Group A (n = 15) received structured triglycerides, Group B (n = 15) a MCT/LCT and Group C (n = 15) a LCT lipid emulsion. Before the start of parenteral nutrition (T0), 24 h (T1), 48 h (T2), 72 h (T3) and 120 h (T4) after start of infusion the following parameters were measured: Alpha-glutathione S-transferase (α-GST), alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose and serum triglycerides.

Results

At T3 and T4, α-GST levels were significantly higher in Group B (T3: 9.4 ± 9.9; T4: 14.6 ± 19.5 μg L−1) and Group C (T3: 14.2 ± 20.8; T4: 22.4 ± 39.3 μg L−1) compared with the patients receiving structured triglycerides (T3: 1.9 ± 1.8; T4: 3.2 ± 2.7 μg L−1). Whereas the mean α-GST-levels in structured triglycerides group always remained in the normal range, this was not the case in both other groups at T3 and T4. There were no significant differences concerning ALT, AST and glucose levels. At T3 and T4, triglyceride levels were significantly lower in Group A than in Groups B and C.

Conclusions

Hepatic integrity was well retained with the administration of structured triglycerides, whereas both MCT/LCT emulsion and LCT emulsion caused subclinical hepatic injury.

Keywords

TRIGLYCERIDES, long chain, medium chainFAT EMULSIONS INTRAVENOUSPARENTERAL NUTRITIONGLUTATHIONE S-TRANSFERASE ALPHALIVER
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 7 , July 2008 , pp. 557 - 565
Copyright
Copyright © European Society of Anaesthesiology 2008

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Footnotes

*

Presented in part at the 26th International Symposium on Intensive Care and Emergency Medicine, Brussels, 21–24 March 2006 and at the 8th German Interdisciplinary Congress on Intensive Care (DIVI 2006), Hamburg 08–11 November 2006.

References

[1]Holt, LE, Tidwell, HC, McNair Scott, TF. The intravenous administration of fat. A practical therapeutic procedure. J Pediatr 1935; 6: 151–160.CrossRefGoogle Scholar
[2]Zhou, Y, Wu, XT, Li, N et al. Structured triglyceride for parenteral nutrition: meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr 2006; 15: 406–411.Google ScholarPubMed
[3]Antébi, H, Mansoor, O, Ferrier, C et al. Liver function and plasma antioxidant status in intensive care unit patients requiring toral parenteral nutrition: Comparison of 2 fat emulsions. J Parenter Enteral Nutr 2004; 28: 142–148.CrossRefGoogle Scholar
[4]Grimm, H, Mertes, N, Goeters, C et al. Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients. Eur J Nutr 2006; 45: 55–60.CrossRefGoogle ScholarPubMed
[5]Adolph, M. Lipid emulsions in parenteral nutrition. Ann Nutr Metab 1999; 43: 1–13.CrossRefGoogle ScholarPubMed
[6]Jarstrand, C, Berghem, L, Lahnborg, G. Human granulocyte and reticuloendothelial system function during Intralipid infusion. J Parenter Enter Nutr 1978; 2: 663–670.CrossRefGoogle ScholarPubMed
[7]Seidner, DL, Mascioli, EA, Istfan, NW et al. Effects of long-chain triglyceride emulsions on reticuloendothelial system function in humans. J Parenter Enter Nutr 1989; 13: 614–619.CrossRefGoogle ScholarPubMed
[8]Palmblad, J. Intravenous lipid emulsions and host defense: a critical review. Clin Nutr 1991; 10: 303–308.CrossRefGoogle ScholarPubMed
[9]Heyland, DK, MacDonald, S, Keefe, L, Drover, JW. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 1998; 280: 2013–2019.CrossRefGoogle ScholarPubMed
[10]Chambrier, C, Guiraud, M, Gibault, JP, Labrosse, H, Boulétreau, P. Medium- and long-chain triacylglycerols in postoperative patients. Structured lipids versus a physical mixture. Nutrition 1999; 15: 274–277.CrossRefGoogle ScholarPubMed
[11]Ball, MJ. Parenteral nutrition in the critically ill: use of a medium chain triglyceride emulsion. Intensive Care Med 1993; 19: 89–95.CrossRefGoogle ScholarPubMed
[12]Jiang, ZM, Zhang, SY, Wang, XR, Yang, NF, Zhu, Y, Wilmore, D. A comparison of medium-chain and long-chain triglycerides in surgical patients. Ann Surg 1993; 217: 175–184.CrossRefGoogle ScholarPubMed
[13]Jeevanandam, M, Holaday, NJ, Voss, T, Buier, R, Petersen, SR. Efficacy of a mixture of medium-chain triglyceride (75%) and long-chain triglyceride (25%) fat emulsions in the nutritional management of multiple-trauma patients. Nutrition 1995; 11: 275–284.Google Scholar
[14]Lin, MT, Yeh, SL, Kuo, ML et al. Effects of medium-chain triglyceride in parenteral nutrition on rats undergoing gastrectomy. Clin Nutr 2002; 21: 39–43.CrossRefGoogle ScholarPubMed
[15]Martín-Pena, G, Culebras, JM, De la Hoz-Perales, L, Barro-Ordovás, JP, Catalá-Pizarro, R, Ruíz-Galiana, J. Effects of 2 lipid emulsions (LCT versus MCT/LCT) on the fatty acid composition of plasma phospholipid: a double-blind randomized trial. J Parenter Enteral Nutr 2002; 26: 30–41.CrossRefGoogle ScholarPubMed
[16]Nordenström, J, Thörne, A, Olivecrona, T. Metabolic effects of infusion of a structured-triglyceride emulsion in healthy subjects. Nutrition 1995; 11: 269–274.Google ScholarPubMed
[17]Kruimel, JW, Naber, TH, Van der Vliet, JA, Carneheim, C, Katan, MB, Jasnsen, JB. Parenteral structured triglyceride emulsion improves nitrogen balance and is cleared faster from the blood in moderately catabolic patients. J Parenter Enteral Nutr 2001; 25: 237–244.CrossRefGoogle ScholarPubMed
[18]Röhm, KD, Suttner, SW, Boldt, J, Schöllhorn, TAH, Piper, SN. Insignificant effect of desflurane-fentanyl-thiopental on hepatocellular integrity – a comparison with total intravenous anaesthesia using propofol-remifentanil. Eur J Anaesthesiol 2005; 22: 209–214.Google ScholarPubMed
[19]Beckett, GJ, Hayes, JD. Glutathione S-transferases: biomedical applications. Adv Clin Chem 1993; 30: 281–380.CrossRefGoogle ScholarPubMed
[20]Piper, SN, Haisch, G, Kumle, B et al. Effects of esmolol- and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery. Anaesthesiol Intensivmed Notfallmed Schmerzther 2003; 38: 781–786.Google ScholarPubMed
[21]Moher, D, Schulz, KF, Altman, DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001; 134: 657–662.CrossRefGoogle Scholar
[22]Beckett, GJ, Hayes, JD. Plasma glutathione S-transferase measurements and liver disease in man. J Clin Biochem Nutr 1987; 2: 1–24.CrossRefGoogle Scholar
[23]Yoo, JSH, Hong, JY, Ning, SM, Yang, CS. Roles of dietary corn oil in the regulation of cytochromes P450 and glutathione S-transferases in rat liver. J Nutr 1990; 120: 1718–1726.CrossRefGoogle ScholarPubMed
[24]Buchman, AL, Ament, ME, Sohel, M et al. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. J Parenter Enteral Nutr 2001; 25: 260–268.CrossRefGoogle ScholarPubMed
[25]Rubin, M, Moser, A, Vaserberg, N et al. Structured triacylglycerol emulsion, containing both medium- and long-chain fatty acids, in long-term home parenteral nutition: a double-blind randomized cross-over study. Nutrition 2000; 16: 95–100.CrossRefGoogle Scholar
[26]Porayko, MK. Liver dysfunction and parenteral nutritional therapies. Clin Liver Dis 1998; 2: 133–147.CrossRefGoogle ScholarPubMed
[27]Sandström, R, Hyltander, A, Körner, U, Lundholm, K. Structured triglycerides were well tolerated and induced increased whole body fat oxidation compared with long-chain triglycerides in postoperative patients. J Parenter Enteral Nutr 1995; 19: 381–386.CrossRefGoogle ScholarPubMed
[28]Nordenström, J, Thorne, A, Aberg, W, Carneheim, C, Olivecrona, T. The hypertriglyceridemic clamp technique. Studies using long-chain and structured triglyceride emulsions in healthy subjects. Metabolism 2006; 55: 1443–1445.CrossRefGoogle ScholarPubMed
[29]Mok, KT, Maiz, A, Yamazaki, K et al. Structured medium-chain and long-chain triglyceride emulsions are superior to physical mixtures in sparing body protein in the burned rat. Metabolism 1984; 33: 910–915.CrossRefGoogle ScholarPubMed
[30]Maiz, A, Yamazaki, K, Sobrado, J et al. Protein metabolism during total parenteral nutrition (TPN) in injured rats using medium-chain triglycerides. Metabolism 1984; 33: 901–909.CrossRefGoogle ScholarPubMed
[31]Kim, H, Son, E, Kim, J et al. Association of hyperglycemia and markers of hepatic dysfunction with dextrose infusion rates in Korean patients receiving total parenteral nutrition. Am J Health Syst Pharm 2003; 60: 1760–1766.CrossRefGoogle ScholarPubMed
[32]Simoens, C, Deckelbaum, RJ, Carpentier, YA. Metabolism of defined structured triglyceride particles compared to mixtures of medium and long chain triglycerides intravenously infused in dogs. Clin Nutr 2004; 23: 665–672.CrossRefGoogle ScholarPubMed
[33]Hultin, M, Müllertz, A, Zundel, MA et al. Metabolism of emulsions containing medium- and long-chain triglycerides or interesterified triglycerides. J Lipid Res 1994; 35: 1850–1860.CrossRefGoogle ScholarPubMed