Researchers at the USDA/ARS Children Nutrition Research Center at the Baylor College of Medicine and Texas Children’s Hospital found that combining vitamin E with lipid emulsions in premature pigs can avert liver damage. The study, entitled “Vitamin E in New-Generation Lipid Emulsions Protects Against Parenteral Nutrition–Associated Liver Disease in Parenteral Nutrition–Fed Preterm Pigs,” was recently published in the Journal of Parenteral and Enteral Nutrition.
In the United States, it is estimated that over 500,000 infants are born prematurely each year, relying on an intravenous nutrition support method called parenteral nutrition that includes an emulsion of fluid, electrolytes, amino acids, glucose, fats, vitamins and minerals. However, the lipidic element of this nutritional support has been associated with parenteral nutrition-assisted liver disease, a condition that can be fatal in newborns. Currently, the FDA has only approved one lipid emulsion called Intralipid®, however, in Europe there are other combinations that have been found to reduce parenteral nutrition-assisted liver disease.
“There is emerging evidence that new generation emulsions are healthier for premature infants than the pure soybean oil emulsions,” said Dr. Douglas Burrin, professor of pediatrics — nutrition at Baylor College of Medicine and research physiologist with the USDA Agricultural Research Service at the Children’s Nutrition Research Center in a recent news release.
Phytosterols are compounds comparable to cholesterol that are augmented in plant seed oils, especially in the FDA approved soybean lipid emulsion. As a result, the researchers tested Phytosterols in a group of piglets that received the soybean lipid emulsion and compared the results with another group of piglets that received the new-generation combination. The researchers also compared a third group that received the new-generation combination (Omegaven) and Phytosterols, and a fourth group that received the approved soybean lipid emulsion with vitamin E (α-tocopherol) added.
Results revealed that the combination of vitamin E (α-tocopherol) with Intralipid and Omegaven (the new generation combination) was able to prevent liver damage. However, the researchers did not find an association between liver damage and phytosterols combined with Omegaven.
“This paper is important for two reasons,” said Burrin. “First, our results challenge the phytosterol theory since we found that that adding the phytosterols to Omegaven did not cause liver disease. Secondly, we showed that the biologically active vitamin E form, α-tocopherol, is protective and may explain why new generation emulsions prevent liver disease.”
“The enrichment of lipid emulsion with vitamin E may not only delay the development of parenteral nutrition associated liver disease, but also potentially reverse it. The findings from this paper will hopefully serve as the foundation for future clinical studies,” said Dr. Kenneth Ng.
“This paper is clinically relevant because it adds to our understanding of why lipid emulsions cause liver disease infants,” he said in the news release. “The FDA (U.S. Food and Drug Administration) is currently considering whether new generation lipid emulsions are safer than Intralipid for pediatric use. They are concerned that the phytosterols are not healthy for pediatric patients.”
Omegaven is under investigation for use in the treatment of pediatric cholestasis.