Parenteral Plant Sterols Accumulate in the Liver Reflecting Their Increased Serum Levels and Portal Inflammation in Children With Intestinal Failure

Abstract

Among children with IF, parenteral PSs accumulate in the liver, reflect their increased serum levels, and relate with biochemical liver injury, portal inflammation, and liver fibrosis, thus supporting their role in promoting liver damage.

Intravenous Fish Oil and Pediatric Intestinal Failure–Associated Liver Disease: Changes in Plasma Phytosterols, Cytokines, and Bile Acids and Erythrocyte Fatty Acids

“…While these changes represent a change in the composition of the lipid product, we believe this study provides information regarding the pathomechanism of IFALD and the contribution of fat emulsions to this disease. We speculate that FO’s reduced phytosterol load, in combination with a decrease in inflammation, which is partially driven by an increased ω‐3 fatty acid provision, improves biliary flow in IFALD children …”

“…Intravenous (IV) lipids have been associated with IFALD . The only Food and Drug Administration (FDA)–approved fat emulsion in the United States for children is soy based.…”

“…We have published that approximately 75% of children with IFALD who receive a 6‐month course of IV fish oil (FO) experienced cholestasis reversal in comparison to 6% of children who received soybean oil (SO) . Only a few human studies have attempted to elucidate FO’s mechanism for cholestasis reversal . SO contains high concentrations of pro‐inflammatory ω‐6 fatty acids and phytosterols—both of which cause hepatic inflammation and biliary obstruction .…”

Use of Lipids in Adult Patients Requiring Parenteral Nutrition in the Home Setting

“…Another cohort of 24 adult patients with SBS also noted higher phytosterol levels in patients receiving PN, as well as a correlation between phytosterol levels and alkaline phosphatase levels that was limited in significance, possibly owing to a small sample size . Furthermore, among children with IF, parenteral phytosterols tend to accumulate in the liver, reflecting their increased serum levels, and are associated with biochemical liver injury, portal inflammation, and liver fibrosis …”

“…31 Furthermore, among children with IF, parenteral phytosterols tend to accumulate in the liver, reflecting their increased serum levels, and are associated with biochemical liver injury, portal inflammation, and liver fibrosis. 34 A number of strategies, including use of cyclic PN, avoidance of hepatotoxic agents, and avoidance and timely management of sepsis, are employed to prevent or minimize the risk of developing IFALD. 9,21 One additional strategy has been to minimize the dose of ILE, especially SO ILE.…”