LIVER DYSFUNCTION AND ENERGY-SOURCE - RESULTS OF A RANDOMIZED CLINICAL-TRIAL

Controversy still exists regarding the role of the carbohydrate:fat ra tio on liver function abnormalities associated with the administration of total parenteral nutrition (TPN). We designed a prospective clinic al trial comparing standard carbohydrate-based TPN (8.5% amino acids, 50% dextrose, 7.5% of total calories from lipids) with an isocaloric l ipid-based TPN (8.5% amino acids, 30% dextrose, 40% of total calories from lipids) in 43 patients exclusively receiving TPN greater-than-or- equal-to 2 weeks. Energy needs were calculated as basal energy expendi ture x 1.5. The mean daily calorie intake for patients who obtained ca rbohydrate-based TPN (CHO) was 2227 kcal, whereas the lipid-based TPN (LIP-CHO) group achieved a mean of 2310 kcal. Patients with preexistin g liver disease were excluded. There was no significant difference in age or diagnosis between the groups. We monitored total bilirubin, dir ect bilirubin, alkaline phosphatase, gamma-glutamyl transferase, lacti c dehydrogenase, serum glutamic oxaloacetic transaminase, and serum gl utamic pyruvic transaminase. Initial liver-associated tests did not va ry significantly between groups. Group mean values after 2 weeks of TP N were significantly different for total bilirubin (1.5 mg/dL in the C HO group compared with 0.7 in the LIP-CHO group, p < .05) and direct b ilirubin (0.8 mg/dL in the CHO group compared with 0.3 mg/dL in the mi xed substrate group, p < .05). Differences in mean values between grou ps were also noted for serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and lactic dehydrogenase. In conclusion , this prospective trial reveals that the use of a balanced energy sou rce TPN solution prevents the abnormalities in liver-associated tests commonly associated with TPN. This study differs from previous trials in that overfeeding was avoided in both groups and most liver-associat ed tests were within normal limits in patients with mixed calorie sour ce TPN.