Intravenous Fish Oil and Pediatric Intestinal Failure–Associated Liver Disease: Changes in Plasma Phytosterols,Cytokines, and Bile Acids and Erythrocyte Fatty Acids |
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| Authors: | Kara L. Calkins MD MS Andrea DeBarber PhD Robert D. Steiner MD Martiniano J. Flores MS Tristan R. Grogan MS Susanne M. Henning RN PhD Laurie Reyen RN MN Robert S. Venick MD |
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| Affiliation: | 1. Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, and Mattel Children’s Hospital at UCLA, Los Angeles, California, USA;2. Department of Physiology and Pharmacology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA;3. Departments of Pediatrics and Genetics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA;4. Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA;5. Department of Medicine, Statistics Core, David Geffen of Medicine, University of California, Los Angeles, Los Angeles, California, USA;6. Center for Human Nutrition, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA;7. Department of Pediatrics, Division of Gastroenterology, David Geffen School of Medicine, University of California, Los Angeles, and Mattel Children’s Hospital at UCLA, Los Angeles, California, USA |
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| Abstract: | Background: Soybean oil (SO) emulsions are associated with intestinal failure–associated liver disease (IFALD); fish oil (FO) emulsions are used to treat IFALD. SO and FO differ with respect to their fatty acid and phytosterol content. In children with IFALD whose SO was replaced with FO, we aimed to (1) quantify changes in erythrocyte fatty acids and plasma phytosterols, cytokines, and bile acids and (2) correlate these changes with direct bilirubin (DB). Design: This study enrolled IFALD children who received 6 months of FO. Blood samples were collected prior to FO, and after 2 weeks and 3 and 6 months of FO. The primary outcome was 3‐month vs baseline biomarker concentrations. Results: At study initiation, the median patient age was 3 months (interquartile range, 3–17 months), and mean ± standard deviation DB was 5.6 ± 0.7 mg/dL (n = 14). Cholestasis reversed in 79% of subjects. Eicosapentaenoic and docosahexaenoic acid was greater than baseline (P < .001, all time points). Linoleic and arachidonic acid and sitosterol and stigmasterol were less than baseline (P < .05, all time points). Three‐ and 6‐month interleukin‐8 (IL‐8) and total and conjugated bile acids were less than baseline (P < .05). Baseline IL‐8 was correlated with baseline DB (r = 0.71, P < .01). Early changes in stigmasterol and IL‐8 were correlated with later DB changes (r = 0.68 and 0.75, P < .05). Conclusion: Specific fat emulsion components may play a role in IFALD. Stigmasterol and IL‐8 may predict FO treatment response. |
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| Keywords: | lipids nutrition parenteral nutrition cytokines fatty acids liver disease short bowel syndrome pediatrics life cycle |
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