Background
In adult patients with chronic intestinal failure (CIF) a long-term therapy with parenteral fluids and/or nutrients is required. Liver steatosis has been described as a common and serious complication of parenteral nutrition (PN). Liver steatosis associated with intestinal failure-associated liver disease (IFALD) differs from nonalcoholic fatty liver disease (NAFLD) in terms of etiopathogenesis and risk factors. According to earlier literature, IFALD occurs in 15-40% of adult CIF patients. However, more recent data on the incidence of IFALD and liver steatosis describe a lower prevalence of liver steatosis in patients with CIF, which is also indicated by clinical practice. The large differences in the definition of IFALD and the presence of liver steatosis not only indicates a possible discrepancy in the diagnostic criteria but it also largely reflects the complexity and poor recognition of the etiological factors that contribute to the development of the liver disease. Magnetic resonance imaging (MRI) is the most reliable noninvasive method for qualitative and quantitative assessment of liver fat infiltration.
Objectives
Our study aimed to assess the prevalence of liver steatosis among CIF patients treated in our center and find possible new factors that could be connected to liver steatosis in CIF patients on home parenteral nutrition (HPN) therapy. We looked for a correlation between balanced parenteral nutrition, vitamin D status and chronic inflammatory state and liver steatosis in patients with CIF. The purpose of our research was also to determine the association between nutritional and metabolic status and liver steatosis.
Methods
We enrolled 63 patients diagnosed with CIF and undergoing long-term HPN therapy in Department for clinical nutrition, Oncologic institute Ljubljana between January 2017 and December 2018 in a prospective cross-sectional study. Clinical, laboratory and body composition data were collected from their medical records. All of the data collected were part of the routine examination recommended for monitoring patients on HPN therapy. Liver steatosis was diagnosed using a 3 Tesla MRI scanner. The associations between various risk factors and liver steatosis were calculated using uni- and multivariate logistic regression.
Results
The median HPN therapy duration was 70 weeks (IQR 22 – 203 weeks). The prevalence of liver steatosis was 28,6%, only 1 patient had severe steatosis, 3 patients moderate and 14 patients mild liver steatosis. Serum cholesterol level and FFMI were statistically significantly associated with liver steatosis (p = 0,01, p = 0,046). The duration of HPN therapy was not statistically significantly associated with liver steatosis (p = 0,219). There were also no statistically significant associations between the other factors studied and the liver steatosis.
Conclusion
The results of our study indicate that CIF patients on HPN therapy experience a relatively low risk of liver disease if they adhere to a well-controlled treatment regime. Our results showed that parenteral nutrition is not associated with liver steatosis in CIF patients on long-term HPN therapy. With respect to already known risk factors for liver steatosis, we did find a newly described association between FFMI and liver steatosis.
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