title: Parenteral fish-oil-based lipid emulsion improves fatty acid profiles and lipids in parenteral nutrition-dependent children.
abstract: BACKGROUND
  Total parenteral nutrition (PN), including fat administered as a soybean oil-based lipid emulsion (SOLE), is a life-saving therapy but may be complicated by PN-induced cholestasis and dyslipidemia. A fish-oil-based lipid emulsion (FOLE) as a component of PN can reverse PN-cholestasis and has been shown to improve lipid profiles.
  
  
  OBJECTIVE
  The objective was to describe changes in the fatty acid and lipid profiles of children with PN-cholestasis who were treated with a FOLE.
  
  
  METHODS
  Lipid and fatty acid profiles of 79 pediatric patients who developed PN-cholestasis while receiving standard PN with a SOLE were examined before and after the switch to a FOLE. All patients received PN with the FOLE at a dose of 1 g · kg(-1) · d(-1) for ≥1 mo.
  
  
  RESULTS
  The median (interquartile range) age at the start of the FOLE treatment was 91 (56-188) d. After a median (interquartile range) of 18.3 (9.4-41.4) wk of receiving the FOLE, the subjects' median total and direct bilirubin improved from 7.9 and 5.4 mg/dL to 0.5 and 0.2 mg/dL, respectively (P < 0.0001). Serum triglyceride, total cholesterol, LDL, and VLDL concentrations significantly decreased by 51.7%, 17.4%, 23.7%, and 47.9%, respectively.
  
  
  CONCLUSIONS
  The switch from a SOLE to a FOLE in PN-dependent children with cholestasis and dyslipidemia was associated with a dramatic improvement in serum triglyceride and VLDL concentrations, a significant increase in serum omega-3 (n-3) fatty acids (EPA and DHA), and a decrease in serum omega-6 fatty acids (arachidonic acid). A FOLE may be the preferred lipid emulsion in patients with PN-cholestasis, dyslipidemia, or both. This trial is registered at clinicaltrials.gov as NCT00910104.
authors.affiliation: Department of Surgery, Vascular Biology Program, Children's Hospital Boston, MA, USA.
authors.forename: Hau D
authors.initials: HD
authors.lastname: Le
authors.forename: Vincent E
authors.initials: VE
authors.lastname: de Meijer
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Robinson
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Potemkin
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Arsenault
authors.forename: Erica M
authors.initials: EM
authors.lastname: Fallon
authors.forename: Alpin
authors.initials: A
authors.lastname: Malkan
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Bistrian
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
authors.forename: Mark
authors.initials: M
authors.lastname: Puder
mesh_terms: D001663:Bilirubin / Q000097:blood*; D002779:Cholestasis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D004041:Dietary Fats / Q000008:administration & dosage*; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D005395:Fish Oils / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008055:Lipids / Q000097:blood*; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D012778:Short Bowel Syndrome / Q000628:therapy; D013024:Soybean Oil / Q000009:adverse effects
chemical_list: D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D008055:Lipids; D013024:Soybean Oil; D001663:Bilirubin