title: Parenteral Soy Oil and Fish Oil Emulsions: Impact of Dose Restriction on Bile Flow and Brain Size of Parenteral Nutrition-Fed Neonatal Piglets.
abstract: BACKGROUND
  Parenteral nutrition (PN)-associated liver disease (PNALD) remains a significant cause of morbidity and mortality for neonates dependent on PN. Total fat emulsion dose and composition, particularly the large amount of ω-6 long-chain polyunsaturated fatty acids in plant oils, have been proposed as risk factors for PNALD. We hypothesized restriction of the dose of emulsion would prevent PNALD, regardless of the composition, but growth could be compromised.
  
  
  METHODS
  Using a neonatal piglet model, we compared conventional soy oil emulsion (Intralipid), dosed high (SO10, n = 8: 10 g/kg/d) and low (SO5, n = 6: 5 g/kg/d), with fish oil (Omegaven), dosed low (FO5, n = 8: 5 g/kg/d). Piglets were given isonitrogenous PN for 14 days. The normal range for all parameters was determined by measurement in equivalent aged sow-reared piglets.
  
  
  RESULTS
  Bile flow was lower with high-dose Intralipid, outside the normal range, while higher for the other groups (SO10, 5.4 µg/g; SO5, 8.6 µg/g; FO5, 13.4 µg/g; P = .010; normal range, 6.5-12.2 µg/g). Total body weight was low in all treatment groups (SO10, 4.4 kg; SO5, 4.5 kg; FO5, 5.0 kg; P = .038; normal range, 5.2-7.3 kg). Brain weight was not different between groups (SO10, 40.3 g; SO5, 36.0 g; FO5, 36.6 g; P = .122; normal range, 41.8-51.4 g). Corrected for body weight, brain weight was lowest in the fish oil group (SO10, 9.3 g/kg; SO5, 8.0 g/kg; FO5, 7.3 g/kg; P < .001; normal range, 5.9-9.0 g/kg).
  
  
  CONCLUSIONS
  Low-dose fat emulsions reduce the risk of developing PNALD. Further investigation of the risk to brain development in neonates exposed to dose restriction, particularly with fish oil, is required.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Josephson
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada Justine.Turner@albertahealthservices.ca.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Turner
authors.affiliation: Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Field
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Wizzard
authors.affiliation: Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada.
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Nation
authors.affiliation: Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada.
authors.forename: Consolato
authors.initials: C
authors.lastname: Sergi
authors.affiliation: Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada.
authors.forename: Ronald O
authors.initials: RO
authors.lastname: Ball
authors.affiliation: Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Departments of Pediatrics and Nutritional Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Pencharz
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Departments of Pediatrics and Nutritional Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Group for Improvement of Intestinal Function and Treatment, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001646:Bile / Q000378:metabolism*; D001921:Brain / Q000187:drug effects* / Q000254:growth & development; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004655:Emulsions / Q000008:administration & dosage; D005217:Fat Emulsions, Intravenous; D005227:Fatty Acids / Q000097:blood; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage / Q000097:blood; D005395:Fish Oils / Q000008:administration & dosage*; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D009929:Organ Size / Q000187:drug effects; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010743:Phospholipids / Q000008:administration & dosage*; D013024:Soybean Oil / Q000008:administration & dosage*; D013552:Swine; D014280:Triglycerides
chemical_list: D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D005227:Fatty Acids; D043371:Fatty Acids, Omega-6; D005395:Fish Oils; D010743:Phospholipids; D014280:Triglycerides; C568345:fish oil triglycerides; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil
keywords: intestinal failure; liver disease; neonates; parenteral fat emulsions