What is the optimal lipid emulsion for preventing intestinal failure-associated liver disease following parenteral feeding in a rat model of short-bowel syndrome?

Seiro Machigashira,Mitsuru Muto,Satoshi Ieiri,Koji Yamada,Waka Yamada,Toshio Harumatsu,Keisuke Yano,Tatsuru Kaji,Shun Onishi,Makoto Matsukubo

doi:10.1007/s00383-020-04802-0

Seiro Machigashira, Mitsuru Muto + Show 8 more

Open Access

https://doi.org/10.1007/s00383-020-04802-0

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Abstract

PurposeComposite lipid emulsion (CLE) has been used for intestinal failure-associated liver disease (IFALD) to compensate for the disadvantages of soybean oil lipid emulsion (SOLE) or fish oil lipid emulsion (FOLE). However, the influence of its administration is unclear. We evaluated the effects of these emulsions on IFALD using a rat model of the short-bowel syndrome.MethodsWe performed jugular vein catheterization and 90% small bowel resection in Sprague–Dawley rats and divided them into four groups: control (C group), regular chow with intravenous administration of saline; and total parenteral nutrition co-infused with SOLE (SOLE group), CLE (CLE group) or FOLE (FOLE group).ResultsHistologically, obvious hepatic steatosis was observed in the SOLE and CLE groups but not the FOLE group. The liver injury grade of the steatosis and ballooning in the FOLE group was significantly better than in the SOLE group (p < 0.05). The TNF-α levels in the liver in the FOLE group were significantly lower than in the SOLE group (p < 0.05). Essential fatty acid deficiency (EFAD) was not observed in any group.ConclusionFish oil lipid emulsion attenuated hepatic steatosis without EFAD, while CLE induced moderate hepatic steatosis. The administration of CLE requires careful observation to prevent PN-induced hepatic steatosis.

Highlights

The survival prognosis of patients with intestinal failures, such as short-bowel syndrome (SBS), intestinal motility disorder, and inflammatory bowel disease, has dramatically improved due to the development of total parenteral nutrition (TPN)
The serum total cholesterol (T-CHO) levels were significantly higher in the soybean oil lipid emulsion (SOLE) group than in the fish oil lipid emulsion (FOLE) group (p < 0.05)
Hepatic steatosis of intestinal failure-associated liver disease (IFALD), known as non-alcoholic fatty liver disease (NAFLD), was observed after the administration of SOLE and Composite lipid emulsion (CLE) using a parenterally fed rat model with SBS, which is an authentic IFALD model, as these surgical and nutritional conditions closely resemble those of clinical cases of SBS

Summary

Introduction

The survival prognosis of patients with intestinal failures, such as short-bowel syndrome (SBS), intestinal motility disorder, and inflammatory bowel disease, has dramatically improved due to the development of total parenteral nutrition (TPN). Many patients with intestinal failure require longterm PN, which can cause complications, such as catheter-related blood stream infection (CRBSI) and intestinal failure-associated liver disease (IFALD). Et al stated that IFALD is characterized by a progressive pathology of cholestasis and steatosis inducing hepatic fibrosis and leading to liver cirrhosis [1]. Cholestasis occurs in 15–80% of IFALD neonates and infants, and steatosis, . Pediatric Surgery International (2021) 37:247–256 known as non-alcoholic fatty liver disease (NAFLD), occurs in 40–60% of IFALD adults. Several studies have implicated soybean oil lipid emulsion (SOLE) in the occurrence of hepatic cholestasis and steatosis of IFALD for two reasons. SOLE is rich in ω-6 polyunsaturated fatty acids (PUFAs), such as linoleic acid. Phytosterols contained in SOLE may exacerbate the development of cholestasis through the inhibition of bile acid transporters

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