OC65 Blood phytosterol levels in children with intestinal failure on home parenteral nutrition, and relation to liver disease

• Published in: Frontline gastroenterology 2023-07, Vol.14 (Suppl 1), p.A40-A40
• Main Authors: Abdelhafez, H, Gayda-Pimlott, D, Horn, V, Al-Araji, R, Koeglmeier, J, Hill, S
• Format: Article
• Language: English
• Subjects: Enteral nutrition; Lipids; Liver diseases; Motility; Nutrition; Parenteral nutrition; Patients; Vitamin E
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2023-bspghan.64

Intestinal failure-associated liver disease(IFALD) in children on parenteral nutrition(PN) probably has a multifactorial aetiology. In particular, soya lipid emulsion has been associated with accumulation of phytosterols and associated cholestatic liver disease.1 More recently mixed lipid emulsions which include fish, as well as soya, olive and coconut oil, >vitamin E and 6 months. Data collected included: age, gender, diagnosis (categorised as short bowel syndrome[SBS], motility disorder or intestinal mucosal disorder), years on PN, nights/week PN infused, nights/week with lipid, whether tolerating some oral/enteral nutrition and liver US. Blood results reviewed were phytosterol, albumin, liver enzyme(ALT, ALP, GGT), Vitamin A, E, D, clotting screen, and platelet levels.There were 29 children,16 female,13 male, aged 2–18 years. Eleven, 38%, had SBS, 9, 31% motility disorder and 9, 31% a mucosal disorder. Twenty-three, 79% tolerated some oral/enteral nutrition and 6, 21% did not.Eighteen patients, 62% were on PN since infancy. Patients had 3–7(mean 6.3) PN infusions/week, administered over 10–24(mean 13.5)hours, with lipid included from 0–5(mean 2.6) nights/week. The lipid used was SMOFlipid.Three patients, 10.3% had mildly elevated phytosterol levels, three, 10.3% borderline raised levels (within 10% of normal range) and 23, 79.3% had normal levels. One child on anti-fungal medication had a raised fungal related sterol, lanosterol. The elevated phytosterols in the three patients were:1. mild elevation of whole phytosterol profile2. raised Sitosterol and a cholesterol precursor level3. raised SitosterolTwo patients with high phytosterol levels had low blood albumen, 28g/l. Albumin was normal in the other 27 patients. ALT was normal in 27/29 patients and raised in 2/29(range 9–138U/L, median 28 U/L). Bilirubin was normal/borderline raised in all cases ranging from 2–20(median 8)umol/l. GGT ranged from 10–14(median 22) U/L. ALP ranged from 95–324U/L, median 202U/l. Vitamin A levels were 0.62–2.13(median 1.37) umol/L, Vitamin E was normal 11.5–46.4 umol/L in all 29 cases. Vitamin D was 33