Background and importance The lipid type of parenteral nutrition (PN) may influence the development of cholestasis and hypertriglyceridaemia. Custom PN (CPN) contains medium-chain triglycerides (MCT) and fish oil, rich in omega-3, in contrast to the three-chamber bag PN (3CB) which lacks these lipids.
Aim and objectives This work aimed to compare the relationship between the different lipidic compositions of CPN and 3CB and the outcome of hypertriglyceridaemia and cholestasis.
Material and methods An observational, longitudinal, retrospective, and descriptive study was performed. It included hospitalised non-critical patients aged from 18 to 80 years, without liver diseases, with baseline triglycerides (TG) lower than 200 mg/dL, and gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) lower than three times their upper limit of normal values. These patients had received parenteral nutrition with at least 40 grams of lipids per day for more than 5 days.
Data for TG, GGT and ALP were recorded for patients receiving either CPN or 3BC. The increase in these values was evaluated during the administration of PN.
Presence of cholestasis is established if GGT and/or ALP exceeded three times the upper limit of normal, and of hypertriglyceridaemia when TG exceeded 200 mg/dL.
Quantitative statistical analysis was performed using the Student’s t-test (p value <0.05) whereas the Chi-squared test was used for qualitative analysis.
Results 41 patients, who received PN for 10 days on average, were included in this study: 20 with CPN and 21 with 3CB. Table 1 shows the results obtained for TG, GGT and ALP, both baseline and increased.
Results show that there was a higher risk of hypertriglyceridaemia in patients with 3CB (62% with 3CB vs 25% with CPN; OR 4.87; p<0.05). No significant difference was observed in the development of cholestasis (48% with 3CB vs. 40% with CPN; OR 1.36; p>0.05).
Conclusion and relevance The absence of fish oil and MCT in the lipid composition of 3CB is associated with an increase in TG values. Although GGT and ALP levels are seen to rise as well, further studies are needed in order to prove this correlation.
Conflict of interest No conflict of interest
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