Report Title

The Effectiveness of Smoflipid on Liver Function in Pediatric Patients with Intestinal Failure Related Parenteral Nutrition Associated Liver Disease (PNALD)

Collective Title

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.

LLU Discipline

Nutrition and Dietetics


Nutrition and Dietetics


School of Allied Health Professions

First Advisor

Woosley, Kyndra

Second Advisor

Bains, Gurinder

Third Advisor

Estanque, Rebecca

Fourth Advisor

Cabreros, Charity Joy

Fifth Advisor

French, Kristine

Sixth Advisor

Pelster, Jenifer

Seventh Advisor

Coronado, Mike

Eighth Advisor

Bahiri, Khaled

Degree Name

Master of Science (MS)

Degree Level


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


Research Report

Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

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.


Loma Linda University Research Reports

Collection Website


Loma Linda University. University Libraries.