Effects of lipid emulsions on parenteral nutrition associated liver dysfunction (PNALD)
[eng] Parenteral nutrition-associated liver dysfunction (PNALD) is one of the most severe long-term parenteral nutrition complications, which was attributed to the phytosterols, found in vegetable oil based lipid emulsions (LE). On the other hand, among various options for its prevention, addition o...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2019 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/141919 |
| Acceso en línea: | https://hdl.handle.net/2445/141919 http://hdl.handle.net/10803/667607 |
| Access Level: | acceso abierto |
| Palabra clave: | Malalties del fetge Alimentació parenteral Vitamina E Fitosterols Liver diseases Parenteral feeding Vitamin E Phytosterols |
| Sumario: | [eng] Parenteral nutrition-associated liver dysfunction (PNALD) is one of the most severe long-term parenteral nutrition complications, which was attributed to the phytosterols, found in vegetable oil based lipid emulsions (LE). On the other hand, among various options for its prevention, addition of antioxidant α-tocopherol, has been investigated. The main objective of this thesis is to determine the content of phytosterols present in LE for parenteral nutrition and assess their clinical effect on patients receiving this therapy. Firstly, a simple analytical method for simultaneous determination of phytosterols, cholesterol, squalene and tocopherols was developed and validated for analyses of LE available on the Spanish pharmaceutical market. The obtained results demonstrated a significant variation of all analysed fractions between various providers and different batches. The use of LEs was investigated in a survey, performed among various hospitals in Catalonia. The results showed the extended use of third generation of LE, based on the combination of vegetable oils and fish oil, in doses recommended by manufacturers. Lastly, a clinical trial was conducted on hospitalised adult patients at the Bellvitge University Hospital in order to evaluate changes of biochemical parameters after administration of LEs. The obtained results showed that the use of LE, based on vegetable oils, is associated to alterations of the hepatic function as from seven days of its administration. The study concludes that monitoring the concentrations of phytosterol fractions and hepatic function is essential and that the use of fish oil based LE is more effective in the PNALD preventive than reducing the dose of vegetable oil LE. The addition of α-tocopherol as excipient would also be adequate due to its hepatoprotective effect. |
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