Liver function and plasma antioxidant status in intensive care unit patients requiring total parenteral nutrition: comparison of 2 fat emulsions.
BACKGROUND
Efficacy and safety of an alpha-tocopherol-enriched emulsion incorporating soybean, coconut, olive, and fish oils (SMOF) are compared in terms of biologic parameters to those of soybean oil-based emulsion (LIPOVEN).


METHODS
Twenty stressed patients were randomly assigned in a double-blind study to receive at least a 5-day course of total parenteral nutrition. Plasma activities of liver enzymes, C-reactive protein, antioxidant capacity, alpha-tocopherol, retinol, and low density lipoprotein (LDL)-alpha-tocopherol levels were determined. LDL-lipid oxidation is measured after incubation of the LDL in the presence of a prooxidant.


RESULTS
The plasma activities of liver enzymes and the phospholipids/apo A1 ratio were increased in both groups. However, in the SMOF group the increases were lower than in the LIPOVEN group and non-significant for the CRP plasma level and the alanineamino-transferase activity. Before parenteral nutrition, the plasma antioxidant status was markedly reduced in both groups. After parenteral nutrition discontinuation, the antioxidant capacity and the amount of LDL-derived oxidation by-products formed were comparable in both groups. There was a significant improvement in plasma lipophilic antioxidant vitamins and LDL-alpha-tocopherol levels only in the SMOF group.


CONCLUSIONS
The lower increase of plasma liver enzymes and phospholipids/apo A1 ratio in the SMOF group suggest a better liver function than in the LIPOVEN group. This beneficial effect results in a higher liver mobilization and plasma levels of lipophilic antioxidants. They could, together with higher delivery of omega-3 fatty acids to peripheral tissues, contribute positively to survival rate of stressed patients.
Antébi
H
H
Unité de Formation et de Recherches Medicale Paris-Ile-de-France-Ouest, University René Descartes, France.
Mansoor
O
O
Ferrier
C
C
Tétégan
M
M
Morvan
C
C
Rangaraj
J
J
Alcindor
L G
LG
D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D000975:Antioxidants / Q000378:metabolism*; D016632:Apolipoprotein A-I / Q000378:metabolism; D002097:C-Reactive Protein / Q000032:analysis; D003422:Critical Care / Q000379:methods; D004311:Double-Blind Method; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000737:chemistry*; D005260:Female; D005395:Fish Oils; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D000069463:Olive Oil; D010289:Parenteral Nutrition, Total / Q000379:methods*; D010743:Phospholipids / Q000378:metabolism; D010938:Plant Oils; D011182:Postoperative Care; D011446:Prospective Studies; D012449:Safety; D013024:Soybean Oil; D017392:Thiobarbituric Acid Reactive Substances / Q000032:analysis; D016896:Treatment Outcome; D024502:alpha-Tocopherol / Q000008:administration & dosage / Q000097:blood
D000975:Antioxidants; D016632:Apolipoprotein A-I; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D000069463:Olive Oil; D010743:Phospholipids; D010938:Plant Oils; D017392:Thiobarbituric Acid Reactive Substances; D013024:Soybean Oil; D002097:C-Reactive Protein; D000410:Alanine Transaminase; D024502:alpha-Tocopherol