Does a fish-oil-containing lipid emulsion improve liver function in comparison with a soybean oil lipid emulsion?

Introduction

Liver function disturbances have been of concern in parenteral nutrition. The aim of the post hoc analyses of two pooled studies was to compare liver function parameters using fish-oil-containing vs soybean oil lipid emulsions.

Methods

Two prospective, controlled, randomized, parallel-group, double-blind, multicenter studies compared SMOFlipid 20%, a fishoil-containing lipid emulsion (SMOF: soybean oil 60 g, medium-chain triglycerides 60 g, olive oil 50 g, fish oil 30 g per l), vs standard soybean oil emulsion (SO, 200 g soybean oil/l). The studies were as follows: A: postsurgical adult patients, 5 days total parenteral nutrition, 100 SMOF vs 103 SO patients; B: adult patients receiving parenteral nutrition for 28 days, 22 SMOF vs 32 SO patients. Patients with data at baseline and study end were selected. The data were pooled and differences of laboratory data at 1 week minus baseline and study end minus baseline were calculated. Analyses of variance were applied using differences between 1 week/study end values and baseline values of bilirubin (BIL), AST and ALT as dependent variables and treatment group as independent variable. Covariates used: baseline values for BIL, AST, ALT and mean daily dose of fat per kg body weight.

Results

Baseline values were not significantly different between the two treatment groups. The mean daily intake of fat/kg bw after 1 week and study end was the same between both treatment groups. One-week - baseline values of liver parameters (mean; SMOF group: BIL -5.1* μmol/l, AST -5.4** U/l, ALT 0.6*** U/l; SO group: BIL -2.0* μmol/l, AST 0.6** U/l, ALT 11.1*** U/l) were significantly different between treatment groups (P: 0.035*, 0.001**, 0.001***). Extending the analysis until 28 days did not alter the results.

Conclusions

Infusion of SMOFlipid 20% compared with a soybean oil standard lipid emulsion exerts a significant decrease in the values of BIL and AST. It also significantly attenuates the rise seen in ALT. These results indicate that SMOFlipid 20% is promising in preventing parenteral nutrition-induced liver disturbances.