Effects of cyclic parenteral nutrition on parenteral-associated liver dysfunction parameters

Abstract

IntroductionOne of the most common complications of parenteral nutrition (PN) is liver dysfunction (LD). Therapeutic approaches for LD include, among others, administering cyclic parenteral nutrition (cPN), allowing some hours for metabolic rest. The purpose of this study was to evaluate the effectiveness of cPN in treating PN-associated LD.Materials and methodsA retrospective observational study was carried out at the Costa del Sol Hospital in Spain between 2013 and 2014. The study involved inpatients ≥18 years old prescribed with cPN due to the development of PN-associated LD. The hepatic biochemical parameters measured at baseline and after completion of cPN included aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and total bilirubin (TB). Quantitative values (age, biochemical parameters) were compared using matched Student’s t-test; the mean change in qualitative variables (sex, indication of PN, hepatic comorbidities, presence of insulin in cPN, infection during cPN, management of LD prior to cPN administrarion) was estimated using Mann-Whitney U test, and bivariate correlation between quantitative variables was determined by Spearman’s coefficient of correlation.ResultsThirty-seven patients met inclusion criteria. All hepatic function parameters except ALP improved after the administration of cPN, with statistically significant differences (p < 0.05) in AST GGT and TB.ConclusioncPN improves PN-associated LD by restoring abnormal AST, GGT, and BT levels to normal, and reducing ALT levels close to normal. The results obtained suggest that the administration of cPN is effective in reverting PN-associated LD.

Short‐Bowel Syndrome: Epidemiology, Hospitalization Trends, In‐Hospital Mortality, and Healthcare Utilization

“…68,101 Several guidelines from nutrition societies are established for the prevention and management of IFALD, including frequent monitoring of liver function, cycled feeding, and limiting the dose of soybean oil-based lipid infusions, which can help clinicians in decision-making and can potentially decrease excess mortality. [101][102][103][104] We found that mortality in patients who have SBS secondary to inflammatory bowel disease is relatively lower, which is consistent with reported higher survival rates in this patient population in recent multicenter studies. 105 We found that severe malnutrition also increased the risk of mortality, which highlights the importance of early protein-energy optimization of these patients to decrease this excess mortality risk.…”

“…In addition to the duration of PN, other factors associated with a higher risk of IFALD are shorter length of the remaining bowel, 98 small intestinal bacterial overgrowth, 99,100 and overfeeding of glucose and lipid, 101 as well as underfeeding, which could result in nutrient deficiencies, such as essential fatty‐acid, choline, and vitamin E deficiencies 68,101 . Several guidelines from nutrition societies are established for the prevention and management of IFALD, including frequent monitoring of liver function, cycled feeding, and limiting the dose of soybean oil–based lipid infusions, which can help clinicians in decision‐making and can potentially decrease excess mortality 101–104 . We found that mortality in patients who have SBS secondary to inflammatory bowel disease is relatively lower, which is consistent with reported higher survival rates in this patient population in recent multicenter studies 105 .…”

The Effect of Vitamin E and Metallothionein on the Antioxidant Capacities of Cadmium-Damaged Liver in Grass Carp Ctenopharyngodon idellus

“…AST and ALT, two highly conservative indicators in liver, are commonly located in hepatic cytoplasm and would release into the circulation when hepatocytes necrotize [ 28 – 30 ]. In order to detect the protective effect of VE and MT on the liver, the activities of the two enzymes in different groups were examined.…”

New Insights Into Intestinal Failure–Associated Liver Disease in Children

“…Interruption of PN delivery for at least several hours per day, known as cyclic PN, has also been found to decrease cholestasis prevalence and have favorable metabolic effects, despite the risk of hypoglycemia, in patients aged <3 years. ( 55,56 )…”