Phytosterolemia in parenteral nutrition patients: implications for liver disease development.
OBJECTIVE
Phytosterols present in parenteral nutrition (PN) lipid emulsions have been linked to phytosterolemia and cholestatic liver disease, although no direct relation has been established. We investigated the relation among plasma phytosterol (PY) infused, total plasma PY levels, and possible links to PN-associated liver disease.


METHODS
Twenty-seven adult patients on home PN were enrolled in the study. PYs were measured in plasma and lipid emulsions by gas chromatography. Liver function tests and blood counts were assessed to identify hepatic impairment, and biopsies were performed in eight patients.


RESULTS
Mean total plasma PY level was higher in patients than in controls (55.4 +/- 6.2 versus 14.8 +/- 2.3 microg/mL). Simple linear regression models showed a correlation among total plasma PY, liver function tests, and platelet counts, which was stronger for total bilirubin (r(2) = 0.53, P = 0.0001) and aspartate aminotransferase (r(2) = 0.50, P = 0.0001) and weaker for platelet counts (r(2) = 0.158, P = 0.04); between infused lipid and liver function tests, the correlation was significant for total bilirubin (r(2) = 0.19, P = 0.038) and aspartate aminotransferase (r(2) = 0.164, P = 0.049). In multiple linear regression analysis, a decreased oral diet (b = -52.3, P = 0.001) and infused PY (b = 2.54, P = 0.093) were risk factors for high plasma PY levels (r(2) = 0.54). Biopsies showed moderate to severe liver impairment in five patients.


CONCLUSIONS
Liver damage may be linked to high plasma PY levels and strengthened by lack of an oral diet in patients on home PN.
Llop
Josep M
JM
Department of Pharmacy and Endocrinology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain. josep.llop@csub.scs.es
Virgili
Núria
N
Moreno-Villares
José M
JM
García-Peris
Pilar
P
Serrano
Teresa
T
Forga
Maria
M
Solanich
Joan
J
Pita
Ana M
AM
D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000032:analysis; D002849:Chromatography, Gas; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000737:chemistry*; D005260:Female; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000201:enzymology / Q000502:physiology*; D008107:Liver Diseases / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D010840:Phytosterols / Q000097:blood*; D010976:Platelet Count; D055815:Young Adult
D005217:Fat Emulsions, Intravenous; D010840:Phytosterols; D001219:Aspartate Aminotransferases; D001663:Bilirubin