The Effectiveness of Smoflipid on Liver Function in Pediatric Patients with Intestinal Failure Related Parenteral Nutrition Associated Liver Disease (PNALD)
Master of Science in Nutrition and Dietetics Research Reports 2018
Background:Parenteral nutrition (PN) is a treatment that supplies one's nutrition and hydration needs intravenously. Intravenous soybean lipid emulsions have been associated with Parenteral Nutrition Associated Liver Disease (PNALD), due to its high phytosterol content and high n-6:n-3 ratio and its propensity to mitigate inflammatory eicosanoid pathways. Composed of soybean oil, medium chain fatty acids, olive oil, and fish oil, Smoflipid may ameliorate PNALD and mitigate anti-inflammatory eicosanoid pathways.
Objective: To examine the effectiveness of Smoflipid on improving liver function and bilirubin levels on home PN-dependent children with intestinal failure related PNALD.
Design: A prospective electronic medical record review was conducted from 2016-2018 at Loma Linda University Children’s Hospital (LLUCH).
Participants: Charts of thirteen outpatient children (8.1±4.2 years, 6 females and 7 males) with intestinal failure who either have completed six-months of Smoflipid or are currently taking Smoflipid.
Main outcomes: Preventing or reducing the severity of PNALD.
Secondary outcomes: Sustaining growth, reducing TPN infection rates and measuring Smoflipid tolerance by assessing essential fatty acid status, fasting glucose levels, hemoglobin A1C, total cholesterol, and serum triglycerides.
Statistics: A Mixed Model was used to account missing values and measure changes in continuous variables. Values were summarized by calculating the mean and standard deviation, before and after Smoflipid treatment.
Results: Although there was a decreasing trend in ALT (N=11, 23.2% after six-months) and AST (N=11, 8.3% after six-months), Smoflipid did not have a statistical significant impact on ALT, AST, and total bilirubin. There was a significant impact on central line infection rates (n= 5, p=0.032) and hemoglobin A1C (n=3, p=0.001).
Conclusion: Smoflipid may yield biochemical effects in reducing elevated liver enzymes associated with PNALD and enhance the quality of life by improving liver function, sustaining growth, and reducing infection rates, and hemoglobin A1C. Smoflipid may be a beneficial alternative to the standard soybean-based lipid emulsion.
Nutrition and Dietetics
Nutrition and Dietetics
School of Allied Health Professions
Cabreros, Charity Joy
Master of Science (MS)
Year Degree Awarded
Date (Title Page)
Library of Congress/MESH Subject Headings
Liver diseases; Parenteral nutrition; Fat emulsions, intravenous;
Parenteral nutrition associated liver disease, Smoflipid, fat emulsion
Loma Linda University Libraries
This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.
Kitazawa, Chelsey; Bates, Kara; and Lew, Shannon, "The Effectiveness of Smoflipid on Liver Function in Pediatric Patients with Intestinal Failure Related Parenteral Nutrition Associated Liver Disease (PNALD)" (2018). Loma Linda University Research Reports. 14.
Loma Linda University Research Reports
Loma Linda University. University Libraries.