Abstract
Parenteral nutrition lipid emulsions made from various plant oils contain steroidal compounds, called phytosterols. During parenteral administration of lipid emulsions, phytosterols can reach levels in the blood that are many fold higher than during enteral administration. The elevated phytosterol levels have been associated with the development of liver dysfunction and the rare development of liver failure. There is limited information available in the literature related to phytosterol concentrations in lipid emulsions. The objective of the current study was to validate an assay for steroidal compounds found in lipid emulsions and to compare their concentrations in the most commonly used parenteral nutrition lipid emulsions: Liposyn® II, Liposyn® III, Lipofundin® MCT, Lipofundin® N, Structolipid®, Intralipid®, Ivelip® and ClinOleic®. Our data demonstrates that concentrations of the various steroidal compounds varied greatly between the eight lipid emulsions, with the olive oil-based lipid emulsion containing the lowest levels of phytosterols and cholesterol, and the highest concentration of squalene. The clinical impression of greater incidences of liver dysfunction with soybean versus MCT/LCT and olive/soy lipid emulsions may be reflective of the levels of phytosterols in these emulsions. This information may help guide future studies and clinical care of patients with lipid emulsion-associated liver dysfunction.
Highlights
Lipid emulsions used for parenteral administration to humans during nutritional support are water-based emulsions made primarily from soybean oil, coconut or palm oil, olive oil and egg yolk phospholipids
One of the major complications encountered in patients that are dependent upon parenteral nutrition for survival is the development of parenteral nutrition-associated liver dysfunction (PNALD) [1,2,3,4,5]
Using the optimized gas liquid chromatographic (GC) conditions described in the methods section, good resolution of all ten sterols, squalene, and the internal standard were obtained
Summary
Lipid emulsions used for parenteral administration to humans during nutritional support are water-based emulsions made primarily from soybean oil, coconut or palm oil, olive oil and egg yolk phospholipids. These lipid emulsions serve as an important source of energy and essential fatty acids. The exact etiology of PNALD is unclear, but likely results from multifactorial etiologies that include high intake of lipids, high doses of linoleic acid (found in soybean oil), high intakes of phytosterols, extreme short gastrointestinal tracts, lack of use of enteral nutrition, disruption of the enterohepatic circulation, and recurrent sepsis [1,2,3,4,5,6]
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