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Effect of Parenteral Serum Plant Sterols on Liver Enzymes and Cholesterol Metabolism in a Patient With Short Bowel Syndrome

From the ¹ Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland, ² Department of Applied Chemistry and Microbiology, University of Helsinki, Helsinki,³ Department of Pharmacy, Kuopio University Hospital, Kuopio, ⁴ Department of Medicine, Division of Gastroenterology, University of Helsinki, Helsinki, Department of Medicine, Division of Internal Medicine, University of Helsinki, Helsinki, and⁶ Kuopia University Hospital, Kuopia, Finland.

Correspondence: Address correspondence to: Dr Maarit Hallikainen, Department of Clinical Nutrition, University of Kuopia, P.O. Box 1627 Kuopia, Finland FIN-70211; e-mail: Maarit.Hallikainen{at}uku.fi.

Hepatobiliary complications are common during parenteral nutrition. Lipid moiety in commercially available solutions contains plant sterols. It is not known whether plant sterols in parenteral nutrition interfere with hepatic function in adults. We detected how different amounts of plant sterols in parenteral nutrition solution affected serum plant sterol concentrations and liver enzymes during a 1.5-year follow-up in a patient with short bowel syndrome. Serum lipid, plant sterol, and liver enzyme levels were measured regularly during the transition from Intralipid (100% soy-based intravenous fat emulsion) to ClinOleic (an olive oil–based intravenous fat emulsion with 80% olive oil, 20% soy oil and lower plant sterols); the lipid supply was also gradually increased from 20 to 35 g/d. Plant sterols in parenteral nutrition solution and serum were measured with gas-liquid chromatography. During infusion of soy-based intravenous fat emulsion (30 g/d, total plant sterols 87 mg/d), the concentrations of sitosterol, campesterol, and stigmasterol were 4361, 1387, and 378 µg/dL, respectively, and serum liver enzyme values were 2.5 times above upper limit of normal. After changing to olive oil–based intravenous fat emulsion (20-35 g/d, plant sterols 37-65 mg/d), concentrations decreased to 2148 to 2251 µg/dL for sitosterol, 569-297 µg/dL for campesterol, and 95-55 µg/dL for stigmasterol. Concomitantly, liver enzyme values decreased to 1.4 to 1.8 times above upper limit of normal at the end of follow-up. The nutrition status of the patient improved. The amount of plant sterols in lipid emulsion affects serum liver enzyme levels more than the amount of lipid.

Key Words: intravenous fat emulsion • sitosterol • campesterol • stigmasterol • short bowel syndrome • parenteral nutrition • cholestasis

Nutrition in Clinical Practice, Vol. 23, No. 4, 429-435 (2008)
DOI: 10.1177/0884533608321138


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