2015
DOI: 10.1177/0148607115595978
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Phytosterols, Lipid Administration, and Liver Disease During Parenteral Nutrition

Abstract: Phytosterols are plant-derived sterols that are structurally and functionally analogous to cholesterol in vertebrate animals. Phytosterols are found in many foods and are part of the normal human diet. However, absorption of phytosterols from the diet is minimal. Most lipid emulsions used for parenteral nutrition are based on vegetable oils. As a result, phytosterol administration occurs during intravenous administration of lipid. Levels of phytosterols in the blood and tissues may reach high levels during par… Show more

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Cited by 67 publications
(43 citation statements)
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References 119 publications
(201 reference statements)
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“…As liver capacity to metabolize PS is limited, 11 intravenously administered soy oil–based and olive oil–based PN emulsions substantially increase serum PS concentrations. Elevated serum PS levels during PN are associated with biochemical cholestasis, increased plasma liver enzyme levels, and IFALD‐related liver histopathology, whereas reducing PN lipid dose decreases serum PS levels and improves liver dysfunction 6 9 , 12 15 . The finding that substituting soy oil–based PN with fish oil–based emulsion devoid of PS can reverse liver injury further supports the role of PS in IFALD development 1 , 16 .…”
Section: Introductionmentioning
confidence: 78%
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“…As liver capacity to metabolize PS is limited, 11 intravenously administered soy oil–based and olive oil–based PN emulsions substantially increase serum PS concentrations. Elevated serum PS levels during PN are associated with biochemical cholestasis, increased plasma liver enzyme levels, and IFALD‐related liver histopathology, whereas reducing PN lipid dose decreases serum PS levels and improves liver dysfunction 6 9 , 12 15 . The finding that substituting soy oil–based PN with fish oil–based emulsion devoid of PS can reverse liver injury further supports the role of PS in IFALD development 1 , 16 .…”
Section: Introductionmentioning
confidence: 78%
“…Delivery of fish oil–based PN associates with reversal of IFALD 1 , 16 . Although this has been proposed to be mediated by its fatty acid composition and antioxidative characteristics, 26 another possible explanation is the absence of PS in fish oil, supported by studies showing that adding stigmasterol to fish oil and administrating fish oil with soy oil can result in similar serum PS levels and hepatotoxicity than soy oil alone 4 , 9 , 13 , 16 , 27 . Another potential benefit of fish oil is its higher cholesterol content versus soy and olive oil 21 .…”
Section: Discussionmentioning
confidence: 99%
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“…The lipids in PN-containing plant sterols and their increased serum concentrations have been linked repeatedly with biochemical and histologic liver injury in children and adults. [18][19][20][21][22] Children with IF display an overabundance of lipopolysaccharide-producing Proteobacteria in their intestinal microbiota in association with histologic liver fibrosis and steatosis, intestinal inflammation, and increased serum levels of IL-6 and TNFa, 6,11,23 while other clinical studies indicate that short bowel syndrome promotes intestinal permeability and continuous systematic exposure to lipopolysaccharides. [24][25][26] In the present study, the combination of intestinal compromise (IF) and PN was associated with markedly increased hepatic gene expression of IL-1a, IL-1b, EGF, integrin-b6, and MMP-9, although liver TGF and TNF gene expression remained statistically insignificant.…”
Section: Discussionmentioning
confidence: 99%
“…On the other hand, lipids are complex structures with different length of the fatty acid chain, with various degrees of saturation, and with individual pro-or anti-inflammatory properties [42]. Plant lipids contain significant amounts of phytosterols, which are not absorbed by the enteral route but which may be toxic when given parenterally [43]. Furthermore, lipids need emulsification and are relatively poorly absorbed in the short bowel situation.…”
Section: Dietary Fatmentioning
confidence: 99%