Hepatic dysfunction in patients receiving intravenous lipid emulsions.

Area of Science:

• Hepatology
• Parenteral Nutrition
• Pediatric Gastroenterology

Background:

• Intravenous lipid emulsions (ILEs) historically used soybean oil (SO), but can lead to intestinal failure-associated liver disease (IFALD).
• IFALD presents as cholestasis in infants and steatosis in older patients.
• Emerging ILE formulations aim to mitigate or reverse IFALD.

Approach:

• Review of recent developments in ILEs and their impact on IFALD.
• Evaluation of alternative ILEs, including SMOF (soybean oil, medium-chain triglycerides, olive oil, fish oil) and fish oil (FO) only ILEs.
• Analysis of clinical data on the efficacy of different ILEs in managing IFALD.

Key Points:

• SMOF and FO ILEs are investigated as alternatives to SO ILEs.
• FO ILEs have shown potential in reversing IFALD in adults, despite initial pediatric approval.
• IFALD appears to be dose-related, with excessive caloric or macronutrient intake potentially contributing to liver injury.

Conclusions:

• Transitioning from SO to SMOF may not always resolve IFALD.
• Partial or complete replacement with FO-based ILEs can halt and reverse IFALD.
• Further research into the dose-dependent effects of macronutrients on ILE-induced liver injury is warranted.