Related Experiment Video
Updated: Aug 6, 2025
A Fluorescence-based Assay for Characterization and Quantification of Lipid Droplet Formation in Human Intestinal Organoids
Published on: October 13, 2019
Intestinal Failure-Associated Liver Disease and Growth Pre- and Post-Transition to a Composite Lipid Emulsion
Alexandra S Hudson1,2, Nicole Tyminski2, Justine M Turner1,2
1From the Division of Pediatric Gastroenterology & Nutrition, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
Insights
Composite intravenous lipid emulsion (ILE) reduced intestinal failure-associated liver disease (IFALD) in infants needing prolonged parenteral nutrition. Growth parameters remained unaffected by the type of lipid emulsion used.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Infants with intestinal failure face a high risk of liver complications, specifically intestinal failure-associated liver disease (IFALD).
- Intravenous lipid emulsions (ILEs) are crucial for parenteral nutrition (PN) but can influence liver health.
- Composite ILEs are hypothesized to mitigate the risk of cholestasis compared to traditional soybean oil-based ILEs.
Purpose of the Study:
- To compare the incidence of IFALD in infants with intestinal failure receiving composite ILE versus soybean oil ILE.
- To evaluate and compare the growth outcomes in infants receiving either type of ILE.
Main Methods:
- A retrospective study identified infants (≤1 year) receiving ≥6 weeks of PN between 2010-2018 at two tertiary centers.
- IFALD was defined as serum conjugated bilirubin >33 µmol/L. Liver and growth parameters were analyzed.
- Nonparametric statistical tests were employed for all comparative analyses.
Main Results:
- Fifty infants were included: 35 on composite ILE and 15 on soybean oil ILE. Infants on composite ILE had longer PN duration and higher baseline conjugated bilirubin.
- Despite these factors, the IFALD rate decreased from 54% to 20% with composite ILE, whereas it remained stable at 7% with soybean oil ILE.
- No significant differences in weight, length, or head circumference z-scores were observed between the groups.
Conclusions:
- Composite ILE was associated with reduced IFALD rates in infants with chronic intestinal failure requiring extended PN, even with higher baseline cholestasis.
- The choice of ILE did not impact infant growth parameters.
- Composite ILE appears to be a beneficial option for managing PN in infants at risk for IFALD.
Objectives:
Infants with intestinal failure have an increased risk of intestinal failure-associated liver disease (IFALD). Composite intravenous lipid emulsion (ILE) may reduce the risk of cholestasis. The primary outcome was to compare IFALD rates in infants with intestinal failure, between those receiving a composite ILE versus soybean oil ILE. The secondary outcome compared growth between these 2 groups.
Methods:
At our 2 tertiary neonatal/pediatric hospitals, we identified all patients (≤1 year old) who received ≥6 weeks parenteral nutrition (PN) from 2010 to 2018. Data included liver and growth parameters. IFALD was defined as serum conjugated bilirubin (CB) >33 µmol/L (≥2 mg/dL). Nonparametric tests were used for all comparisons.
Results:
Fifty infants (35 composite ILE, 15 soybean oil ILE) were included. Those on composite ILE received PN for longer (10.1 vs 7.6 weeks; P = 0.001) and had higher baseline CB (29 vs 6.5 μmol/L; P = 0.001). No differences were found by 6 weeks (14.5 vs 5 μmol/L; P = 0.54) and by PN cessation (4 vs 4 μmol/L; P = 0.33). The proportion of patients with IFALD decreased from 54% to 20% for composite ILE, while stable given soybean oil ILE (7%). There were no differences in weight, length, or head circumference z scores ( P > 0.05).
Conclusions:
In our institutions, over 8 years, chronic intestinal failure was rare. Composite ILE was the predominant lipid choice for infants who needed longer courses of PN or had developed cholestasis. Despite longer PN duration, and higher baseline CB, overall rates of IFALD decreased with composite ILE. Regardless of parenteral lipid used, there were no differences in growth.
More Related Videos
Related Concept Videos
01:24Liver Regeneration
Cells of Liver
The liver comprises four major types of cells— hepatocytes, stellate, Kupffer, and sinusoidal endothelial cells. The hepatocytes are...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:24Lipid Absorption
These breakdown products bind with bile salts and lecithin to form micelles, which quickly pass between microvilli to come in close contact with the apical...
01:06Lipid Digestion