Phytosterolaemia associated with parenteral nutrition administration in adult patients

Abstract

Vegetable lipid emulsions (LE) contain non-declared phytosterols (PS). We aimed to determine PS content depending on the brand and LE batch, and in adult hospitalised patients treated with parenteral nutrition (PN), to establish the association between plasma and administered PS. Part I was the LE study: totals and fractions of PS in three to four non-consecutive batches from six LE were analysed. Part II was the patient study: patients with at least 7 previous days of PN with 0·8 g/kg per d of an olive/soyabean (O/S) LE were randomised (day 0) 1:1 to O/S or 100 % fish oil (FO) at a dose of 0·4 g/kg per d for 7 d (day 7). Plasma PS, its fractions, total cholesterol on days 0 and 7, their clearance and their association with PS administered by LE were studied. In part I, LE study: differences were found in the total PS, their fractions and cholesterol among different LE brands and batches. Exclusive soyabean LE had the highest content of PS (422·36 (sd 130·46) μg/ml). In part II, patient study: nineteen patients were included. In the O/S group, PS levels were maintained (1·11 (sd 6·98) μg/ml) from day 0 to 7, while in the FO group, significant decreases were seen in total PS (−6·21 (sd 4·73) μg/ml) and their fractions, except for campesterol and stigmasterol. Plasma PS on day 7 were significantly associated with PS administered (R2 0·443). PS content in different LE brands had great variability. PS administered during PN resulted in accumulation and could be prevented with the exclusive administration of FO LE.

Phytosterols Alleviate Hyperlipidemia by Regulating Gut Microbiota and Cholesterol Metabolism in Mice

“…However, it mainly has side effects such as elevated transaminases and myopathy, including myalgia, myositis, Oxidative Medicine and Cellular Longevity and transverse muscle melting, which predispose to poor prognosis [6,28]. PS are widely used in medical research because of their widespread presence in nature and their powerful properties [29]. Multiple studies have shown that PS significantly reduce blood cholesterol concentrations which has important clinical value in the management of obesity, HLP, and diabetes [30][31][32].…”

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study

“…The administration of high doses of intravenous lipids, that are high in n-6 PUFAs and phytosterols (like the ones based on soybean oils), can contribute to the development of parenteral nutrition-associated liver disease [23]. ILEs based exclusively on fish oil reduce plasmatic phytosterol levels and are associated with an improvement in liver profile [24,25]. In our study, regarding analytical data, we did not find any differences in liver profile, neither in the percentage of patients with an increase in liver enzymes nor in the number of patients with liver complications.…”