Effects of lipid-supplemented total parenteral nutrition on fatty liver disease in a premature neonatal piglet model.
BACKGROUND
Routine total parenteral nutrition (TPN) in neonatal care can result in hepatic dysfunction in 40-60% of patients, most commonly as fatty liver, but little work has been conducted on the underlying mechanisms causing hepatic dysfunction.


OBJECTIVE
To use a piglet model for the premature human neonate on TPN, supplemented with lipid emulsions, to investigate hepatic responses.


METHODS
Piglets were delivered 2 days prematurely. Six control piglets were fed enterally (E), whilst twelve animals were maintained on TPN. TPN piglets received the standard TPN solution plus the lipid emulsion as either ClinOleic(R) (C, n = 6) or Intralipid(R) (I, n = 6). Hepatic lipid content and the fatty acid composition of liver triacylglyercol (TAG) as well as hepatic lipase (HL) activity were determined. Lipoprotein lipase (LPL) activity was measured in the liver, muscle and adipose tissue. The plasma concentrations of choline, bilirubin, TAG and non-esterified fatty acids (NEFA) were also measured.


RESULTS
Liver lipid was significantly increased in piglets on TPN and the tissue fatty acid profiles reflected the lipid emulsion. HL and LPL activities were reduced in liver but LPL increased in adipose tissue during TPN. Plasma concentrations of choline, bilirubin, TAG and NEFA were similar across the treatments.


CONCLUSIONS
The results suggest fatty liver occurs in neonates receiving TPN and the source of the accumulated lipid appears to be the lipid emulsion used. The factors regulating lipase activity during TPN require further study. The piglet can be used as a model for neonatal TPN.
Department of Biomedical Sciences, Imperial College London, Wye Campus, Wye, UK.
Matthew J
MJ
Hyde
Encarnación
E
Amusquivar
John
J
Laws
Anne M
AM
Corson
Richard R
RR
Geering
Ian J
IJ
Lean
Guy
G
Putet
Peter F
PF
Dodds
Emilio
E
Herrera
Lynne
L
Clarke
D000818:Animals; D000831:Animals, Newborn / Q000378:metabolism*; D001663:Bilirubin / Q000097:blood; D002794:Choline / Q000097:blood; D019587:Dietary Supplements / Q000009:adverse effects*; D004195:Disease Models, Animal; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005234:Fatty Liver / Q000209:etiology* / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D050356:Lipid Metabolism / Q000502:physiology; D008055:Lipids / Q000009:adverse effects*; D008071:Lipoprotein Lipase / Q000378:metabolism; D008099:Liver / Q000378:metabolism*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D013552:Swine; D014280:Triglycerides / Q000378:metabolism
D005230:Fatty Acids, Nonesterified; D008055:Lipids; D014280:Triglycerides; D008071:Lipoprotein Lipase; D002794:Choline; D001663:Bilirubin