THE ROLE OF PHYTOSTEROLS IN THE PATHOGENESIS OF LIVER COMPLICATIONS OF PEDIATRIC PARENTERAL-NUTRITION

Long-term parenteral nutrition of infants who have had major gut resec tions is associated with a high incidence of cholestatic liver disease . Affected infants have high plasma concentrations of phytosierols-com pounds that resemble cholesterol but have an alkylated side chain. The phytosterols that accumulate in patients receiving parenteral nutriti on me derived from the soya oil and/or soya lecithin used to make the intravenous lipid emulsion. There is a striking association between ph ytosterolemia and cholestatic liver disease. This has led us to put fo rward the hypothesis that phytosterols can cause cholestasis in suscep tible infants. Experiments using neonatal piglets indicate that phytos terols (given without any of the other components of parenteral nutrit ion) can indeed reduce bile flow. We suggest that increasing the conte nt of phytosterols in cell membranes may interfere with the function o f important transport proteins involved in the secretion of bile. Othe r factors that might contribute to cholestasis (such as inhibition of cholesterol 7 alpha-hydroxylase) are discussed. (C) Elsevier Science I nc. 1998