Effect of Parenteral Serum Plant Sterols on Liver Enzymes and Cholesterol Metabolism in a Patient With Short Bowel Syndrome

Abstract

Hepatobiliary complications are common during parenteral nutrition. Lipid moiety in commercially available solutions contains plant sterols. It is not known whether plant sterols in parenteral nutrition interfere with hepatic function in adults. We detected how different amounts of plant sterols in parenteral nutrition solution affected serum plant sterol concentrations and liver enzymes during a 1.5-year follow-up in a patient with short bowel syndrome. Serum lipid, plant sterol, and liver enzyme levels were measured regularly during the transition from Intralipid (100% soy-based intravenous fat emulsion) to ClinOleic (an olive oil-based intravenous fat emulsion with 80% olive oil, 20% soy oil and lower plant sterols); the lipid supply was also gradually increased from 20 to 35 g/d. Plant sterols in parenteral nutrition solution and serum were measured with gas-liquid chromatography. During infusion of soy-based intravenous fat emulsion (30 g/d, total plant sterols 87 mg/d), the concentrations of sitosterol, campesterol, and stigmasterol were 4361, 1387, and 378 microg/dL, respectively, and serum liver enzyme values were >or= 2.5 times above upper limit of normal. After changing to olive oil-based intravenous fat emulsion (20-35 g/d, plant sterols 37-65 mg/d), concentrations decreased to 2148 to 2251 microg/dL for sitosterol, 569-297 microg/dL for campesterol, and 95-55 microg/dL for stigmasterol. Concomitantly, liver enzyme values decreased to 1.4 to 1.8 times above upper limit of normal at the end of follow-up. The nutrition status of the patient improved. The amount of plant sterols in lipid emulsion affects serum liver enzyme levels more than the amount of lipid.

Soy sterols in the regulation of thyroid functions, glucose homeostasis and hepatic lipid peroxidation in mice

“…However, the rate of reduction was different at different concentrations of soy sterols (62.5% and 34.72%, respectively, in 5 mg/kg and 10 mg/kg of the sterol, respectively), which indicated a better inhibition at the lower dosed group. While few investigations were there on the cholesterol lowering effects of soy sterols (AbuMweis & Jones, 2008;Hallikainen et al, 2008), practically nothing was known on their regulatory efficacy on thyroid functions. For the first time the present findings indicate the impact of soy sterols in lowering the concentration of serum T 3 , the biologically most active thyroid hormone (Ganong, 2005).…”

“…Soy beans or its products also decrease the thyroid function and are thought to act as goitrogen (Doerge & Chang, 2002;Doerge & Sheehan, 2002;Ishizuki, Hirooka, Murata, & Togashi, 1991). Despite these beneficial effects of soy bean, little is known on the biological effects of its sterol components (AbuMweis & Jones, 2008;Hallikainen et al, 2008). Therefore, in the present investigation an attempt was made to isolate soy sterols (a well characterized mixture of beta-sitosterol, campesterol and stigma sterol) and to reveal its therapeutic potential in the alteration of serum glucose, thyroid hormones and insulin and in the activity of hepatic glucose-6-phospatase (G-6-Pase), an important thyroid hormone dependent parameter (Andersen, Friis, & Ottesen, 1977;Larsen & Ingbar, 1992;Muller & Seitz, 1984;Sandler, Robinson, & Rabin, 1983).…”

Intestinal Failure–Associated Liver Disease

“…Blood PS concentrations are closely associated with cholestasis in children and adults with IFALD (84)(85)(86)(87). PS have been shown to reduce bile acid secretion and inhibit excretion of bile.…”

Recent advances in the management of intestinal failure-associated liver disease

“…Reducing lipid infusion has become standard practice in preventing IFALD based on retrospective cohort studies [4,5]. New forms of intravenous lipid emulsion have now become available including oleic acid-based [40][41][42], structured lipids of nonphysiological medium-chain triglyceride and longchain triglyceride mixed triacylglycerols [43] and omega-3-enriched fish oil-based sources [44,45,46 ,47 ,48, 49,50 ]. Reversal of cholestatic IFALD has been noted in case reports in which the lipid source has been changed from soy-based to either olive oil-based or fish oil-based sources [41,42,44,45].…”

“…New forms of intravenous lipid emulsion have now become available including oleic acid-based [40][41][42], structured lipids of nonphysiological medium-chain triglyceride and longchain triglyceride mixed triacylglycerols [43] and omega-3-enriched fish oil-based sources [44,45,46 ,47 ,48, 49,50 ]. Reversal of cholestatic IFALD has been noted in case reports in which the lipid source has been changed from soy-based to either olive oil-based or fish oil-based sources [41,42,44,45]. A study of 18 infants treated with fish oil-based lipid was compared with a historical cohort and therefore open to bias [47 ]; however, the comparative resolution of cholestasis in the treatment group was dramatic and occurred despite lack of significant enteral intake ( Fig.…”