title: The effect of 5 intravenous lipid emulsions on plasma phytosterols in preterm infants receiving parenteral nutrition: a randomized clinical trial.
abstract: BACKGROUND
  Elevated plasma phytosterol concentrations are an untoward effect of parenteral nutrition (PN) with vegetable oil-based lipid emulsions (LEs). Phytosterols are elevated in neonatal cholestasis, but the relation remains controversial.
  
  
  OBJECTIVE
  The objective was to study the effect of 5 LEs on plasma phytosterols in preterm infants.
  
  
  METHODS
  One hundred forty-four consecutive admitted preterm infants (birth weight: 500-1249 g) were studied. Patients were randomly assigned to receive 1 of 5 different LEs: S [100% soybean oil (SO)], MS [50% medium-chain triglycerides (MCTs) and 50% SO], MSF (50% MCTs, 40% SO, and 10% fish oil (FO)], OS (80% olive oil and 20% SO), or MOSF (30% MCTs, 25% olive oil, 30% SO, and 15% FO). Phytosterols in the LEs and in plasma (on postnatal day 7 and day 14) were measured by gas chromatography-mass spectrometry.
  
  
  RESULTS
  Patients in the S group had significantly higher total phytosterol intakes than did the other study groups. On PN days 7 and 14, plasma phytosterol concentrations were highest in the S group and lowest in the MOSF group. Despite similar β-sitosterol intakes between the MS and MSF groups, plasma concentrations were significantly lower in the MSF than in the MS group. Only 3 patients (2.1%) developed cholestasis: 1 in the MS, 1 in the MSF, and 1 in the MOSF group. No cases of cholestasis were observed in the S and OS groups.
  
  
  CONCLUSIONS
  In uncomplicated preterm infants receiving routine PN, we found a correlation between phytosterol intake and plasma phytosterol concentrations; however, cholestasis was rare and no difference in liver function at 6 wk was observed.
authors.affiliation: Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Savini
authors.forename: Rita
authors.initials: R
authors.lastname: D'Ascenzo
authors.forename: Chiara
authors.initials: C
authors.lastname: Biagetti
authors.forename: Giulia
authors.initials: G
authors.lastname: Serpentini
authors.forename: Adriana
authors.initials: A
authors.lastname: Pompilio
authors.forename: Alice
authors.initials: A
authors.lastname: Bartoli
authors.forename: Paola E
authors.initials: PE
authors.lastname: Cogo
authors.forename: Virgilio P
authors.initials: VP
authors.lastname: Carnielli
mesh_terms: D001724:Birth Weight; D002779:Cholestasis / Q000209:etiology / Q000503:physiopathology; D004655:Emulsions / Q000737:chemistry; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008297:Male; D000069463:Olive Oil; D010288:Parenteral Nutrition / Q000009:adverse effects; D010840:Phytosterols / Q000008:administration & dosage / Q000097:blood*; D010938:Plant Oils / Q000008:administration & dosage; D012855:Sitosterols / Q000008:administration & dosage / Q000097:blood; D013024:Soybean Oil / Q000008:administration & dosage; D014280:Triglycerides / Q000097:blood
chemical_list: D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D000069463:Olive Oil; D010840:Phytosterols; D010938:Plant Oils; D012855:Sitosterols; D014280:Triglycerides; C025473:gamma-sitosterol; D013024:Soybean Oil