title: Treatment of hypertriglyceridemia in patients receiving parenteral nutrition.
abstract: BACKGROUND
  This study aims to evaluate whether withdrawal of a soy oil-based lipid emulsion from the parenteral nutrition (PN) regimen in humans is associated with improved triglyceride and liver enzyme concentrations.
  
  
  METHODS
  In this retrospective study, patients with hypertriglyceridemia (>4.50 mmol/L) while receiving PN were retrieved from a prospective complication registration database. Patients received Intralipid 20% as part of an all-in-one system containing all necessary macro- and micronutrients, electrolytes, trace elements, and vitamins.
  
  
  RESULTS
  Forty patients with hypertriglyceridemia were included. Lipid emulsions were withdrawn from the all-in-one mixture for a median of 5 (range, 1-23) days, after which triglyceride concentrations decreased significantly (mean difference -2.5 ± 0.30 mmol/L, P < .001). Aspartate aminotransaminase and leukocyte count decreased significantly (mean difference -35 ± 17 U/L, P = .049 and -3.8 ± 1.7*10E9/L, P = .028, respectively), whereas albumin level increased significantly (mean difference 2.1 ± 0.9 g/L, P = .027). Alanine aminotransaminase showed a nonsignificant reduction (mean difference -30 ± 22 U/L, P = .194). In 11 patients, the lipid emulsion was reintroduced, after which triglyceride levels showed a significant increase (mean difference 1.5 ± 0.30 mmol/L, P = .001).
  
  
  CONCLUSIONS
  Short-term withdrawal of the lipid fraction in the PN mixture is associated with a significant reduction of plasma triglyceride concentration. Reintroduction was related to an increase of triglyceride concentration. In addition, liver enzyme abnormalities and leukocyte count reduced, whereas albumin levels increased, suggesting that even short withdrawal of the lipid emulsion diminished hepatocellular damage and systemic inflammation.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, The Netherlands. r.visschers@ah.unimaas.nl
authors.forename: Ruben G J
authors.initials: RG
authors.lastname: Visschers
authors.forename: Steven W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: Jolanda M L G
authors.initials: JM
authors.lastname: Gehlen
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Peter B
authors.initials: PB
authors.lastname: Soeters
authors.forename: Wim G
authors.initials: WG
authors.lastname: van Gemert
mesh_terms: D000418:Albumins / Q000032:analysis; D004655:Emulsions / Q000008:administration & dosage / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000628:therapy*; D016014:Linear Models; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D010743:Phospholipids / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013024:Soybean Oil / Q000008:administration & dosage / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
chemical_list: D000418:Albumins; D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D010743:Phospholipids; D014280:Triglycerides; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil