Pediatr Gastroenterol Hepatol Nutr.  2020 Jan;23(1):98-104. 10.5223/pghn.2020.23.1.98.

Impact of Intravenous Omega-3-Enriched Lipid Emulsion on Liver Enzyme and Triglyceride Serum Levels of Children Undergoing Gastrointestinal Surgery

• Hanindita
• Widjaja NA
• Irawan R
• Hidayat B
• Hariastawa IA

• KMID: 2467898
• DOI: http://doi.org/10.5223/pghn.2020.23.1.98

Abstract

PURPOSE
To investigate the impact of omega-3-enriched lipid emulsion (LE) on liver enzyme (aspartate transaminase [AST] and alanine aminotransferase [ALT]) and triglyceride (TG) levels of children undergoing gastrointestinal surgery.
METHODS
This experimental randomized controlled group pretest-posttest design study included 14 children who underwent gastrointestinal surgery due to duodenal atresia, jejunal atresia, esophageal atresia, and need for parenteral nutrition for a minimum of 3 days at RSUD Dr. Soetomo Surabaya between August 2018 and January 2019. These children were divided into two groups, those who received standard intravenous LE (medium-chain triglyceride [MCT]/long-chain triglyceride [LCT]) and those who received intravenous omega-3-enriched LE. Differences in AST, ALT, and TG levels were measured before surgery and 3 days after the administration of parenteral nutrition.
RESULTS
Liver enzyme and TG levels in each group did not differ significantly before versus 3 days after surgery. However, TG levels were significantly lower in the omega-3-enriched intravenous LE group (p=0.041) at 3 days after surgery, and statistically significant difference in changes in TG levels was noted at 3 days after surgery between MCT/LCT intravenous LE group and the omega-3-enriched intravenous LE group (p=0.008).
CONCLUSION
The intravenous omega-3-enriched LE had a better TG-lowering effect than the MCT/LCT intravenous LE in children undergoing gastrointestinal surgery.

Keyword

Omega-3; Fatty acids; Parenteral nutrition; Gastrointestinal surgery

MeSH Terms

Alanine Transaminase
Child*
Esophageal Atresia
Fatty Acids
Humans
Intestinal Atresia
Liver*
Parenteral Nutrition
Triglycerides*
Alanine Transaminase
Fatty Acids

Reference

1. Wang J, Yu JC, Kang WM, Ma ZQ. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition. 2012; 28:623–629. PMID: 22113064.

2. Ammoury RF, Croffie JM. Malabsorptive disorders of childhood. Pediatr Rev. 2010; 31:407–415. quiz 415-6. PMID: 20889735.

3. Skillman HE, Wischmeyer PE. Nutrition therapy in critically ill infants and children. JPEN J Parenter Enteral Nutr. 2008; 32:520–534. PMID: 18753390.

4. Chawla BK, Teitelbaum DH. Profound systemic inflammatory response syndrome following non-emergent intestinal surgery in children. J Pediatr Surg. 2013; 48:1936–1940. PMID: 24074671.

5. Buchman A. Total parenteral nutrition-associated liver disease. JPEN J Parenter Enteral Nutr. 2002; 26(5 Suppl):S43–S48.

6. Mullick FG, Moran CA, Ishak KG. Total parenteral nutrition: a histopathologic analysis of the liver changes in 20 children. Mod Pathol. 1994; 7:190–194. PMID: 8008742.

7. Grau T, Bonet A, Rubio M, Mateo D, Farré M, Acosta JA, et al. Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care. Liver dysfunction associated with artificial nutrition in critically ill patients. Crit Care. 2007; 11:R10. PMID: 17254321.

8. Pereira-da-Silva L, Nóbrega S, Rosa ML, Alves M, Pita A, Virella D, et al. Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions. Clin Nutr ESPEN. 2017; 22:7–12. PMID: 29415837.

9. Kasirer Y, Bin-Nun A, Raveh A, Schorrs I, Mimouni FB, Hammerman C. SMOFlipid protects preterm neonates against perinatal nutrition-associated cholestasis. Am J Perinatol. 2019; 36:1382–1386. PMID: 30620942.

10. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. Parenteral Nutrition Guidelines Working Group. European Society for Clinical Nutrition and Metabolism; European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN); European Society of Paediatric Research (ESPR). Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005; 41(Suppl 2):S1–S87.

11. Wu MH, Wang MY, Yang CY, Kuo ML, Lin MT. Randomized clinical trial of new intravenous lipid (SMOFlipid 20%) versus medium-chain triglycerides/long-chain triglycerides in adult patients undergoing gastrointestinal surgery. JPEN J Parenter Enteral Nutr. 2014; 38:800–808. PMID: 24285251.

12. Ma CJ, Wu JM, Tsai HL, Huang CW, Lu CY, Sun LC, et al. Prospective double-blind randomized study on the efficacy and safety of an n-3 fatty acid enriched intravenous fat emulsion in postsurgical gastric and colorectal cancer patients. Nutr J. 2015; 14:9. PMID: 25609264.

13. Jiang W, Chen G, Zhang J, Lv X, Lu C, Chen H, et al. The effects of two mixed intravenous lipid emulsions on clinical outcomes in infants after gastrointestinal surgery: a prospective, randomized study. Pediatr Surg Int. 2019; 35:347–355. PMID: 30474700.

14. Diamond IR, Sterescu A, Pencharz PB, Wales PW. The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease. Pediatr Surg Int. 2008; 24:773–778. PMID: 18504595.

15. Costa S, Iannotta R, Maggio L, Barone G, Serrao F, Vento G. Fish oil-based lipid emulsion in the treatment of parenteral nutrition-associated cholestasis. Ital J Pediatr. 2018; 44:101. PMID: 30139361.

16. Carpentier YA, Simoens C, Siderova V, el Nakadi I, Vanweyenberg V, Eggerickx D, et al. Recent developments in lipid emulsions: relevance to intensive care. Nutrition. 1997; 13(9 Suppl):73S–78S. PMID: 9290113.

17. Wiik H. Inflammatory response following abdominal surgery and its modulation by recombinant human granulocyte colonystimulating factor (rhg-csf, filgrastim) [Internet]. Oulu: Oulu University Press;2002. cited 2017 Dec 18. Available from: http://jultika.oulu.fi/files/isbn9514268474.pdf.

18. Hallay J, Olah AV, Fulesdi B, Kocsor M, Vegh T, Kovacs G, et al. Hepatobiliary response in postoperative lipid therapy in gastrointestinal surgery. Hepatogastroenterology. 2010; 57:1069–1073. PMID: 21410033.

19. Berger MM, Tappy L, Revelly JP, Koletzko BV, Gepert J, Corpataux JM, et al. Fish oil after abdominal aorta aneurysm surgery. Eur J Clin Nutr. 2008; 62:1116–1122. PMID: 17538537.

20. Shearer GC, Savinova OV, Harris WS. Fish oil -- how does it reduce plasma triglycerides? Biochim Biophys Acta. 2012; 1821:843–851. PMID: 22041134.