phytosterols and Infant--Premature--Diseases

Parenteral nutrition and intravenous lipid emulsions are essential for promoting optimal nutrition in the neonatal intensive care unit. However, long-term use of a pure soybean lipid emulsion is associated with a liver disease known as intestinal failure associated liver disease. Over the past several years, the science of lipid emulsions has evolved with a focus on nutritional optimization and disease prevention. This review's purpose is to provide a general overview of the three main components of lipid emulsions, phytosterols, the antioxidant Vitamin E, and polyunsaturated fatty acids, and their contribution to health.

Topics: Dietary Fats; Fat Emulsions, Intravenous; Gastrointestinal Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Intestinal Absorption; Intestines; Liver Diseases; Parenteral Nutrition; Phytosterols; Randomized Controlled Trials as Topic; Risk Assessment; Soybean Oil; Vitamin E

Elevated plasma phytosterol concentrations are an untoward effect of parenteral nutrition (PN) with vegetable oil-based lipid emulsions (LEs). Phytosterols are elevated in neonatal cholestasis, but the relation remains controversial.. The objective was to study the effect of 5 LEs on plasma phytosterols in preterm infants.. One hundred forty-four consecutive admitted preterm infants (birth weight: 500-1249 g) were studied. Patients were randomly assigned to receive 1 of 5 different LEs: S [100% soybean oil (SO)], MS [50% medium-chain triglycerides (MCTs) and 50% SO], MSF (50% MCTs, 40% SO, and 10% fish oil (FO)], OS (80% olive oil and 20% SO), or MOSF (30% MCTs, 25% olive oil, 30% SO, and 15% FO). Phytosterols in the LEs and in plasma (on postnatal day 7 and day 14) were measured by gas chromatography-mass spectrometry.. Patients in the S group had significantly higher total phytosterol intakes than did the other study groups. On PN days 7 and 14, plasma phytosterol concentrations were highest in the S group and lowest in the MOSF group. Despite similar β-sitosterol intakes between the MS and MSF groups, plasma concentrations were significantly lower in the MSF than in the MS group. Only 3 patients (2.1%) developed cholestasis: 1 in the MS, 1 in the MSF, and 1 in the MOSF group. No cases of cholestasis were observed in the S and OS groups.. In uncomplicated preterm infants receiving routine PN, we found a correlation between phytosterol intake and plasma phytosterol concentrations; however, cholestasis was rare and no difference in liver function at 6 wk was observed.

Topics: Birth Weight; Cholestasis; Emulsions; Fat Emulsions, Intravenous; Female; Fish Oils; Gas Chromatography-Mass Spectrometry; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Liver; Male; Olive Oil; Parenteral Nutrition; Phytosterols; Plant Oils; Sitosterols; Soybean Oil; Triglycerides