Impact of fish oil-based lipid emulsion on serum triglyceride, bilirubin, and albumin levels in children with parenteral nutrition-associated liver disease

Abstract

Parenteral nutrition is known to cause liver injury in babies. The aim of this study is to investigate the effects of different lipid emulsions on parenteral nutrition-associated cholestasis in infants. In addition, there may be a relationship between the lipid emulsion and triglyceride levels. Furthermore, triglyceride levels may correlate with direct bilirubin and albumin, as markers of liver impairment and nutritional status. Patients with parenteral nutrition-associated cholestasis who were treated with a fish oil-based lipid emulsion (n = 18) were prospectively followed for triglyceride, direct bilirubin, and albumin levels and compared with patients who were maintained on a soy-based lipid emulsion (n = 59). Triglyceride levels decreased in the fish oil cohort from a mean of 140 mg/dL at wk 0 to 40 mg/dL at wk 20 but remained unchanged at approximately 140 mg/dL in the soybean cohort. Triglyceride levels of patients treated with fish oil declined over time, while those receiving soybean oil did not. Also, changes in triglyceride levels over time were directly correlated with direct bilirubin and inversely related to albumin levels. These findings may indicate an added benefit of reduced triglyceride levels for patients treated with fish oil and this effect coincides with markers for improved liver function and nutritional status.

Figure 1

Observed weekly mean (fish oil = dots, soybean oil = stars) and mean trajectory over weeks, estimated in a random effects model (fish oil = solid line, soybean oil = dashed line) by the type of IV fat emulsion. Means represent geometric means or exponential {mean[ln (test)]}.* Notes: P represents P-value for testing difference in mean trajectory of triglyceride (TG) over weeks between fish oil and soybean oil in the following random effects model- 4.89 + 0.23 fish oil (vs. soybean oil) + 0.004 week – 0.08 fish oil × week.

Figure 2

Individual trajectory of triglyceride (TG) after beginning fish oil until week 19.

Figure 3

Pairwise associations of observed weekly mean trajectories of direct bilirubin (solid line) and triglyceride (TG) (line with points), representing the association between direct bilirubin and TG in the fish oil cohort. Numbers included in the weekly mean estimation for each laboratory test are shown.

Figure 4

Pairwise associations of observed weekly mean trajectories of direct bilirubin (solid line) and triglyceride (TG) (line with points), representing the association between direct bilirubin and TG in the soybean oil cohort. Numbers included in the weekly mean estimation for each laboratory test are shown.

Figure 5

Pairwise associations of observed weekly mean trajectories of direct bilirubin (solid line) and albumin (dashed line), representing the association between direct bilirubin and albumin in the fish oil cohort.

Figure 6

Pairwise associations of observed weekly mean trajectories of triglyceride (TG) (line with points) and albumin (dashed line), representing the association between TG and albumin in the fish oil cohort. Numbers included in the weekly mean estimation for each laboratory test are shown.

Figure 7

Distribution of individual Pearson correlation coefficients for pairwise association of triglyceride (TG), direct bilirubin, and albumin in the fish oil cohort and TG and albumin in the soybean oil cohort. The solid bar within the box represents the median value, upper boundary- 75^th percentile, lower boundary- 25^th percentile; whiskers extend from the 10^th–90^th percentiles. Correlation of TG with direct bilirubin in the soybean oil cohort excluded 6 subjects who had 1 or less pair of observations and 12 subjects who had 2 pairs of observations (9 with correlation + 1 and 3 with correlation −1).