Jessica Josephson1, Justine M Turner2, Catherine J Field3, Pamela R Wizzard1, Patrick N Nation4, Consolato Sergi4, Ronald O Ball3, Paul B Pencharz5, Paul W Wales6. 1. Department of Pediatrics, University of Alberta, Edmonton, Canada. 2. Department of Pediatrics, University of Alberta, Edmonton, Canada Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada Justine.Turner@albertahealthservices.ca. 3. Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada. 4. Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada. 5. Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Departments of Pediatrics and Nutritional Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 6. Department of Pediatrics, University of Alberta, Edmonton, Canada Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Departments of Pediatrics and Nutritional Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Group for Improvement of Intestinal Function and Treatment, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Parenteral nutrition (PN)-associated liver disease (PNALD) remains a significant cause of morbidity and mortality for neonates dependent on PN. Total fat emulsion dose and composition, particularly the large amount of ω-6 long-chain polyunsaturated fatty acids in plant oils, have been proposed as risk factors for PNALD. We hypothesized restriction of the dose of emulsion would prevent PNALD, regardless of the composition, but growth could be compromised. METHODS: Using a neonatal piglet model, we compared conventional soy oil emulsion (Intralipid), dosed high (SO10, n = 8: 10 g/kg/d) and low (SO5, n = 6: 5 g/kg/d), with fish oil (Omegaven), dosed low (FO5, n = 8: 5 g/kg/d). Piglets were given isonitrogenous PN for 14 days. The normal range for all parameters was determined by measurement in equivalent aged sow-reared piglets. RESULTS: Bile flow was lower with high-dose Intralipid, outside the normal range, while higher for the other groups (SO10, 5.4 µg/g; SO5, 8.6 µg/g; FO5, 13.4 µg/g; P = .010; normal range, 6.5-12.2 µg/g). Total body weight was low in all treatment groups (SO10, 4.4 kg; SO5, 4.5 kg; FO5, 5.0 kg; P = .038; normal range, 5.2-7.3 kg). Brain weight was not different between groups (SO10, 40.3 g; SO5, 36.0 g; FO5, 36.6 g; P = .122; normal range, 41.8-51.4 g). Corrected for body weight, brain weight was lowest in the fish oil group (SO10, 9.3 g/kg; SO5, 8.0 g/kg; FO5, 7.3 g/kg; P < .001; normal range, 5.9-9.0 g/kg). CONCLUSION: Low-dose fat emulsions reduce the risk of developing PNALD. Further investigation of the risk to brain development in neonates exposed to dose restriction, particularly with fish oil, is required.
BACKGROUND: Parenteral nutrition (PN)-associated liver disease (PNALD) remains a significant cause of morbidity and mortality for neonates dependent on PN. Total fat emulsion dose and composition, particularly the large amount of ω-6 long-chain polyunsaturated fatty acids in plant oils, have been proposed as risk factors for PNALD. We hypothesized restriction of the dose of emulsion would prevent PNALD, regardless of the composition, but growth could be compromised. METHODS: Using a neonatal piglet model, we compared conventional soy oil emulsion (Intralipid), dosed high (SO10, n = 8: 10 g/kg/d) and low (SO5, n = 6: 5 g/kg/d), with fish oil (Omegaven), dosed low (FO5, n = 8: 5 g/kg/d). Piglets were given isonitrogenous PN for 14 days. The normal range for all parameters was determined by measurement in equivalent aged sow-reared piglets. RESULTS: Bile flow was lower with high-dose Intralipid, outside the normal range, while higher for the other groups (SO10, 5.4 µg/g; SO5, 8.6 µg/g; FO5, 13.4 µg/g; P = .010; normal range, 6.5-12.2 µg/g). Total body weight was low in all treatment groups (SO10, 4.4 kg; SO5, 4.5 kg; FO5, 5.0 kg; P = .038; normal range, 5.2-7.3 kg). Brain weight was not different between groups (SO10, 40.3 g; SO5, 36.0 g; FO5, 36.6 g; P = .122; normal range, 41.8-51.4 g). Corrected for body weight, brain weight was lowest in the fish oil group (SO10, 9.3 g/kg; SO5, 8.0 g/kg; FO5, 7.3 g/kg; P < .001; normal range, 5.9-9.0 g/kg). CONCLUSION: Low-dose fat emulsions reduce the risk of developing PNALD. Further investigation of the risk to brain development in neonates exposed to dose restriction, particularly with fish oil, is required.
Authors: Margaret L Ong; Isabell B Purdy; Orly L Levit; Daniel T Robinson; Tristan Grogan; Martiniano Flores; Kara L Calkins Journal: JPEN J Parenter Enteral Nutr Date: 2017-12-19 Impact factor: 4.016
Authors: Kara L Calkins; Andrea DeBarber; Robert D Steiner; Martiniano J Flores; Tristan R Grogan; Susanne M Henning; Laurie Reyen; Robert S Venick Journal: JPEN J Parenter Enteral Nutr Date: 2017-12-18 Impact factor: 3.896