[Fatty liver in indirect calorimetry controlled total parenteral nutrition]

The authors have investigated the relationship between total parenteral nutrition (TPN) under indirect calorimetry and the development of fatty infiltrations of the liver in 21 surgical and traumatized patients. TPN was monitored by indirect calorimetry in order to balance lipid and amino acid intake. Glucose intake was adapted only when daily glucose utilization was higher than 150 g. Non protein respiratory quotient (npRQ) and respiratory quotient (RQ) remained below 0.9 during the whole study. The need for lipids was always significantly higher than the lipid intake up to the 5th day after operation or trauma. The need for carbohydrates was significantly lower than the intake of carbohydrates up to the 9th day after operation or trauma. In addition, the utilization of lipids was higher than the utilization of carbohydrates. After 2 weeks of TPN, no fatty infiltration of the liver could be detected by computer tomography and chemical analysis. The calorimetric monitoring of the TPN regimen and the individual adaptation of substrate intake might be responsible for the protection of the liver observed in this study.