title: Impact of intravenous lipid emulsions on liver function tests: Contribution of parenteral fish oil.
abstract: OBJECTIVE
  Lipids in parenteral nutrition (PN) have been linked to liver damage. The aim of this study is to 1) determine whether the incidence of alterations in liver function tests (LFTs) changes over time among hospitalized adult patients receiving PN; 2) evaluate whether the alteration in LFTs varies with the pattern of lipid administration; and 3) study the relationship between LFT alterations and fish oil (FO) emulsions.
  
  
  METHODS
  Patients treated with PN over 4 y were included. Demographic, clinical, nutritional, and analytical variables were collected. LFTs (γ-glutamyl transferase [GGT], alkaline phosphatase [AP], alanine aminotransferase [ALT], and total bilirubin [BIL]) were collected during PN treatment. Differences in LFTs were studied with t tests for paired samples. To match the type of lipid with each of the LFTs studied, four multivariate statistical models were performed. Significance was reported with the 95% confidence interval (CI) at p < 0.05 (two-tailed).
  
  
  RESULTS
  We studied 1555 patients. LFT alterations at baseline were high and increased during PN treatment except ALT. GGT and AP showed significant increases from baseline values. In the multivariate study, daily dose of FO (g·kg(-1)·d(-1)) was associated with a significant decrease in GGT (B = -11.189; 95% CI, -19.799 to -2.578) and in AP (B = -5.250; 95% CI, -10.263 to -0.237). Daily dose of vegetal oil (g/kg) had a tendency for a significant increase in GGT (B = 0.441; 95% CI, -0.107 to 1.039) and AP (B = 0.312; 95% CI, -0.023 to 0.648).
  
  
  CONCLUSIONS
  GGT and AP increased throughout the clinical course of PN administration. These alterations had a multifactorial component. The administration of FO was associated with a significant decrease in the levels of GGT and AP.
authors.affiliation: Pharmacy Department, Hospital Universitari Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: mbadia@bellvitgehospital.cat.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Badia-Tahull
authors.affiliation: Pharmacy Department, Hospital Universitari Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Llop-Talaveron
authors.affiliation: Pharmacy Department, Hospital Universitari Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Leiva-Badosa
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D004042:Dietary Fats, Unsaturated / Q000009:adverse effects / Q000494:pharmacology*; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology*; D005260:Female; D005395:Fish Oils / Q000494:pharmacology*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000378:metabolism; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects; D057947:Parenteral Nutrition Solutions / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology*; D010938:Plant Oils / Q000009:adverse effects*; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D004042:Dietary Fats, Unsaturated; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D057947:Parenteral Nutrition Solutions; D010938:Plant Oils; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: Cholestasis; Fat emulsions; Intravenous; Parenteral nutrition; ω-3 fatty acids; ω-6 fatty acids