title: Parenteral plant sterols and intestinal failure-associated liver disease in neonates.
abstract: OBJECTIVE
  We prospectively evaluated incidence of prolonged (>28 days) parenteral nutrition (PN), associated complications, and significance of parenteral plant sterols (PS) in neonatal intestinal failure-associated liver disease (IFALD) compared with children.
  
  
  METHODS
  We recruited 28 neonates (mean age 50 days, range 28-126) and 11 children (6.9 y, 2.1-16.6) in all of Finland. Patients underwent repeated measurements of serum cholesterol, noncholesterol sterols, including PS, cholestanol and cholesterol precursors, and liver biochemistry during and 1 month after discontinuation of PN. Healthy matched neonates (n=10) and children (n=22) served as controls.
  
  
  RESULTS
  IFALD occurred more frequently among neonates (63%) than children (27%; P<0.05). Ratios of serum PS, including stigmasterol, sitosterol, avenasterol, and campesterol, and total PS were increased among neonates compared with healthy controls and children on PN by 2- to 22- and 2- to 5-fold (P<0.005), respectively. Neonates with IFALD had significantly higher ratios of serum PS and cholestanol compared with neonates without IFALD (P<0.05). Total duration of PN associated with serum cholestanol, stigmasterol, avenasterol, alanine aminotransferase, and aspartate aminotransferase (r=0.472-0.636, P<0.05). Cholestanol and individual serum PS, excluding campesterol, reflected direct bilirubin (r=0.529-0.688, P<0.05). IFALD persisted after discontinuation of PN in 25% of neonates with 4.2- and 2.2-times higher ratios of serum stigmasterol and cholestanol compared with neonates without IFALD (P<0.05).
  
  
  CONCLUSIONS
  Frequent occurrence of IFALD among neonates on PN displays an association to duration of PN and markedly increased serum PS, especially stigmasterol, in comparison to healthy neonates and children on PN. Striking accumulation of parenteral PS may contribute to IFALD among neonates.
authors.affiliation: Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland. annika.kurvinen@helsinki.fi
authors.forename: Annika
authors.initials: A
authors.lastname: Kurvinen
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Nissinen
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
authors.forename: Päivi
authors.initials: P
authors.lastname: Korhonen
authors.forename: Tarja
authors.initials: T
authors.lastname: Ruuska
authors.forename: Mari
authors.initials: M
authors.lastname: Taimisto
authors.forename: Marko
authors.initials: M
authors.lastname: Kalliomäki
authors.forename: Liisa
authors.initials: L
authors.lastname: Lehtonen
authors.forename: Ulla
authors.initials: U
authors.lastname: Sankilampi
authors.forename: Pekka
authors.initials: P
authors.lastname: Arikoski
authors.forename: Timo
authors.initials: T
authors.lastname: Saarela
authors.forename: Tatu A
authors.initials: TA
authors.lastname: Miettinen
authors.forename: Helena
authors.initials: H
authors.lastname: Gylling
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004083:Cholestanol / Q000097:blood*; D002784:Cholesterol / Q000031:analogs & derivatives / Q000097:blood; D004041:Dietary Fats / Q000009:adverse effects / Q000097:blood; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000737:chemistry; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000097:blood / Q000150:complications* / Q000628:therapy; D008107:Liver Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D000069463:Olive Oil; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D010840:Phytosterols / Q000097:blood*; D010938:Plant Oils / Q000009:adverse effects* / Q000737:chemistry; D015995:Prevalence; D011446:Prospective Studies; D013024:Soybean Oil / Q000009:adverse effects / Q000737:chemistry; D013265:Stigmasterol / Q000097:blood
chemical_list: D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D000069463:Olive Oil; D010840:Phytosterols; D010938:Plant Oils; C021273:campesterol; D013024:Soybean Oil; D004083:Cholestanol; D002784:Cholesterol; D013265:Stigmasterol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin