Josephson Jessica, Turner Justine M, Field Catherine J, Wizzard Pamela R, Nation Patrick N, Sergi Consolato, Ball Ronald O, Pencharz Paul B, Wales Paul W
Department of Pediatrics, University of Alberta, Edmonton, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Canada Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Canada
JPEN J Parenter Enteral Nutr. 2015 Aug;39(6):677-87. doi: 10.1177/0148607114556494. Epub 2014 Oct 17.
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.
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.
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).
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.
肠外营养（PN）相关肝病（PNALD）仍然是依赖PN的新生儿发病和死亡的重要原因。全脂乳剂剂量和成分，尤其是植物油中大量的ω-6长链多不饱和脂肪酸，已被认为是PNALD的危险因素。我们假设限制乳剂剂量可预防PNALD，无论其成分如何，但生长可能会受到影响。
使用新生仔猪模型，我们将高剂量（SO10，n = 8：10 g/kg/d）和低剂量（SO5，n = 6：5 g/kg/d）的传统大豆油乳剂（英脱利匹特）与低剂量（FO5，n = 8：5 g/kg/d）的鱼油（奥米加文）进行比较。仔猪接受等氮PN 14天。所有参数的正常范围通过对同龄母猪饲养的仔猪进行测量来确定。
高剂量英脱利匹特组胆汁流量较低，超出正常范围，而其他组较高（SO10，5.4 μg/g；SO5，8.6 μg/g；FO5，13.4 μg/g；P = 0.010；正常范围，6.5 - 12.2 μg/g）。所有治疗组的总体重均较低（SO10，4.4 kg；SO5，4.5 kg；FO5，5.0 kg；P = 0.038；正常范围，5.2 - 7.3 kg）。各组间脑重无差异（SO10，40.3 g；SO5，36.0 g；FO5，36.6 g；P = 0.122；正常范围，41.8 - 51.4 g）。校正体重后，鱼油组脑重最低（SO10，9.3 g/kg；SO5，8.0 g/kg；FO5，7.3 g/kg；P < 0.001；正常范围，5.9 - 9.0 g/kg）。
低剂量脂肪乳剂可降低发生PNALD的风险。需要进一步研究剂量限制，尤其是鱼油对新生儿脑发育风险的影响。
