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Effects of Long-term Parenteral Nutrition on Serum Lipids, Plant Sterols, Cholesterol Metabolism, and Liver Histology in Pediatric Intestinal Failure

Kurvinen, Annika*; Nissinen, Markku J.; Gylling, Helena; Miettinen, Tatu A.; Lampela, Hanna*; Koivusalo, Antti I.*; Rintala, Risto J.*; Pakarinen, Mikko P.*

Journal of Pediatric Gastroenterology & Nutrition: October 2011 - Volume 53 - Issue 4 - p 440–446
doi: 10.1097/MPG.0b013e3182212130
Original Articles: Hepatology and Nutrition

Background and Objective: Plant sterols (PS) in parenteral nutrition (PN) may contribute to intestinal failure–associated liver disease. We investigated interrelations between serum PS, liver function and histology, cholesterol metabolism, and characteristics of PN.

Patients and Methods: Eleven patients with intestinal failure (mean age 6.3 years) receiving long-term PN were studied prospectively (mean 254 days) and underwent repeated measurements of serum lipids, noncholesterol sterols, including PS, and liver enzymes. PS contents of PN were analyzed. Liver biopsy was obtained in 8 patients. Twenty healthy children (mean age 5.7 years) served as controls.

Results: Median percentage of parenteral energy of total daily energy (PN%) was 48%, including 0.9 g · kg−1 · day−1 of lipids. Respective amounts of PN sitosterol, campesterol, avenasterol, and stigmasterol were 683, 71, 57, and 45 μg · kg−1 · day−1. Median serum concentrations of sitosterol (48 vs 7.5 μmol/L, P < 0.001), avenasterol (2.9 vs 1.9, P < 0.01), stigmasterol (1.9 vs 1.2, P < 0.005), but not that of campesterol (9.8 vs 12, P = 0.22), were increased among patients in relation to controls, and correlated with PN% (r = 0.81–0.88, P < 0.005), but not with PN fat. Serum cholesterol precursors were higher in patients than in controls. Serum liver enzymes remained close to normal range. Glutamyl transferase correlated with serum PS (r = 0.61–0.62, P < 0.05). Liver fibrosis in 5 patients reflected increased serum PS (r = 0.55–0.60, P = 0.16–0.12).

Conclusions: Serum PS moderately increase during olive oil–based PN, and correlate positively with PN% and glutamyl transferase. Despite well-preserved liver function, histology often revealed significant liver damage.

*Section of Pediatric Surgery, Hospital for Children and Adolescents

Department of Medicine, Division of Gastroenterology

Department of Medicine, Division of Internal Medicine, University of Helsinki, Helsinki, Finland.

Address correspondence and reprint requests to Annika Kurvinen, Section of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, PO Box 281, 00029 HUS, Helsinki, Finland (e-mail: annika.kurvinen@helsinki.fi).

Received 10 December, 2010

Accepted 20 April, 2011

This study was supported by grants from the Päivikki and Sakari Sohlberg Foundation and the Finnish Foundation of Pediatric Research.

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN