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Hepatocellular integrity in patients requiring parenteral nutrition: comparison of structured MCT/LCT vs. a standard MCT/LCT emulsion and a LCT emulsion*

Published online by Cambridge University Press:  01 July 2008

S. N. Piper ,
K. D. Röhm ,
J. Boldt ,
B. Odermatt ,
W. H. Maleck  and
S. W. Suttner
S. N. Piper*
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
K. D. Röhm
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
J. Boldt
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
B. Odermatt
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
W. H. Maleck
Affiliation:
Spital Menziken, Department of Anaesthesia, Menziken, Switzerland
S. W. Suttner
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
*
Correspondence to: Swen N. Piper, Department of Anaesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. E-mail: swen.n.piper@t-online.de; Tel: +49 621 503 3000; Fax: +49 621 503 3024
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Summary

Background and objective

The aetiology of parenteral nutrition-associated hepatic injury remains unresolved. The aim of the study was to evaluate the effects of structured triglycerides in parenteral nutrition compared either to a physical medium-chain triglycerides (MCT)/long-chain triglcerides (LCT) mixture or to a LCT emulsion on hepatic integrity.

Methods

In a randomized, double-blinded trial, we studied 45 patients undergoing abdominal surgery, who were expected to receive parenteral nutrition for 5 days. Patients were allocated to one of three nutrition regimens: Group A (n = 15) received structured triglycerides, Group B (n = 15) a MCT/LCT and Group C (n = 15) a LCT lipid emulsion. Before the start of parenteral nutrition (T0), 24 h (T1), 48 h (T2), 72 h (T3) and 120 h (T4) after start of infusion the following parameters were measured: Alpha-glutathione S-transferase (α-GST), alanine aminotransferase (ALT), aspartate aminotransferase (AST), glucose and serum triglycerides.

Results

At T3 and T4, α-GST levels were significantly higher in Group B (T3: 9.4 ± 9.9; T4: 14.6 ± 19.5 μg L−1) and Group C (T3: 14.2 ± 20.8; T4: 22.4 ± 39.3 μg L−1) compared with the patients receiving structured triglycerides (T3: 1.9 ± 1.8; T4: 3.2 ± 2.7 μg L−1). Whereas the mean α-GST-levels in structured triglycerides group always remained in the normal range, this was not the case in both other groups at T3 and T4. There were no significant differences concerning ALT, AST and glucose levels. At T3 and T4, triglyceride levels were significantly lower in Group A than in Groups B and C.

Conclusions

Hepatic integrity was well retained with the administration of structured triglycerides, whereas both MCT/LCT emulsion and LCT emulsion caused subclinical hepatic injury.

Keywords

TRIGLYCERIDES, long chain, medium chainFAT EMULSIONS INTRAVENOUSPARENTERAL NUTRITIONGLUTATHIONE S-TRANSFERASE ALPHALIVER
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 7 , July 2008 , pp. 557 - 565
Copyright
Copyright © European Society of Anaesthesiology 2008

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Footnotes

*

Presented in part at the 26th International Symposium on Intensive Care and Emergency Medicine, Brussels, 21–24 March 2006 and at the 8th German Interdisciplinary Congress on Intensive Care (DIVI 2006), Hamburg 08–11 November 2006.

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