Impact of Intravenous Omega-3-Enriched Lipid Emulsion on Liver Enzyme and Triglyceride Serum Levels of Children Undergoing Gastrointestinal Surgery원문보기
Hanindita, Meta Herdiana
(Department of Child Health, Dr. Soetomo Hospital, Medical School, Airlangga University)
,
Widjaja, Nur Aisiyah
(Department of Child Health, Dr. Soetomo Hospital, Medical School, Airlangga University)
,
Irawan, Roedi
(Department of Child Health, Dr. Soetomo Hospital, Medical School, Airlangga University)
,
Hidayat, Boerhan
(Department of Child Health, Dr. Soetomo Hospital, Medical School, Airlangga University)
,
Hariastawa, IGB Adria
(Department of Pediatric Surgery, Dr. Soetomo Hospital, Medical School, Airlangga University)
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-po...
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.
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.
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문제 정의
This study aimed to investigate the impact of omega-3-enriched LE on liver enzyme (aspartate transaminase [AST] and alanine transaminase [ALT]) and TG levels in children undergoing gastrointestinal surgery.
제안 방법
Soetomo Surabaya took part in this study; all already met the inclusion and exclusion criteria. The study participants were classified into two groups: that receiving the MCT/LCT intravenous LE, and that receiving the omega-3-enriched intravenous LE.
This experimental randomized controlled group pretest-posttest design study aimed to explain the effect of omega-3-enriched LE in parenteral nutrition therapy on liver function and TG levels in pediatric patients post gastrointestinal surgery compared to standard LEs.
대상 데이터
Fourteen pediatric inpatients at RSUD Dr. Soetomo Surabaya took part in this study; all already met the inclusion and exclusion criteria. The study participants were classified into two groups: that receiving the MCT/LCT intravenous LE, and that receiving the omega-3-enriched intravenous LE.
Participants of this study were pediatric patients undergoing gastrointestinal surgery at RSUD Dr. Soetomo Surabaya between August 2018 and January 2019, with the inclusion criteria of 0-18 years of age, having undergone gastrointestinal surgery due to duodenal atresia, jejunal atresia, or esophageal atresia; patients requiring parenteral nutrition for at least 3 days; and willingness to participate in the study (informed consent provided by their parents/guardians). The exclusion criteria of this study were one or more chronic diseases involving the heart, liver, or kidney; and history of fish/egg/soy/nut protein allergy.
데이터처리
Differences in liver function levels, namely AST and ALT, and TG levels were measured before surgery and 3 days after the administration of parenteral nutrition. Statistical analyses were performed using paired sample t-tests to investigate the effect of omega-3-enriched intravenous LEs on liver function and TG levels.
성능/효과
In conclusion, based on the results of this study, the administration of intravenous omega-3-enriched LE as parenteral nutrition therapy significantly lowers the TG levels of children undergoing gastrointestinal surgery compared to the standard intravenous LE and has no significant effect on liver enzyme levels.
In this study, levels of hemoglobin, leukocytes, C-reactive protein (CRP), AST, ALT, albumin, and TG did not differ significantly before versus 3 days after surgery in either group (Table 2). However, TG levels were significantly higher in the MCT/LCT intravenous LE group compared to the omega-3-enriched intravenous LEs group (p=0.
As a result, hyperlipidemia may occur in patients receiving parenteral nutrition after surgery [19]. In this study, postoperative TG levels in the omega-3-enriched intravenous LE group were significantly lower than those in the MCT/LCT intravenous LE group.
Wilk reported that the consumption of fish or fish oil can reduce cardiovascular risk by decreasing TG level. Our study findings are like those of a study of a healthy population that showed that intravenous LEs enriched in fish oil significantly improved lipid profile and counteracted dyslipidemia. More efficient TG elimination by omega-3-enriched intravenous LEs than LCT intravenous LEs has been reported by several studies in postoperative patients [20].
There was no statistically significant intergroup difference in changes in laboratory parameters for hemoglobin, leukocytes, CRP, AST, ALT, or albumin at 3 days postoperative. This study showed statistically significant difference in changes in TG levels at 3 days postoperative between the MCT/LCT intravenous LE group and the omega-3-enriched intravenous LE group (p=0.
This study showed no significant differences in laboratory parameters such as hemoglobin, leukocytes, CRP, albumin, AST, and ALT, before surgery or 3 days after surgery, between the MCT/LCT intravenous LE group and the omega-3-enriched intravenous LE group. These results are in accordance with those of several previous studies [11-13].
There was no statistically significant intergroup difference in changes in laboratory parameters for hemoglobin, leukocytes, CRP, AST, ALT, or albumin at 3 days postoperative. This study showed statistically significant difference in changes in TG levels at 3 days postoperative between the MCT/LCT intravenous LE group and the omega-3-enriched intravenous LE group (p=0.008) (Table 4).
참고문헌 (20)
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 22113064
3 Skillman HE Wischmeyer PE Nutrition therapy in critically ill infants and children JPEN J Parenter Enteral Nutr 2008 32 520 534 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 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 8008742
7 Grau T Bonet A Rubio M Mateo D Farre M Acosta JA 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 17254321
8 Pereira-da-Silva L Nobrega S Rosa ML Alves M Pita A Virella D 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 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 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 24285251
12 Ma CJ Wu JM Tsai HL Huang CW Lu CY Sun LC 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 25609264
13 Jiang W Chen G Zhang J Lv X Lu C Chen H 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 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 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 30139361
16 Carpentier YA Simoens C Siderova V el Nakadi I Vanweyenberg V Eggerickx D Recent developments in lipid emulsions: relevance to intensive care Nutrition 1997 13 9 Suppl 73S 78S 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 Hepatobiliary response in postoperative lipid therapy in gastrointestinal surgery Hepatogastroenterology 2010 57 1069 1073 21410033
19 Berger MM Tappy L Revelly JP Koletzko BV Gepert J Corpataux JM Fish oil after abdominal aorta aneurysm surgery Eur J Clin Nutr 2008 62 1116 1122 17538537
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