# Depletion of phytosterols from intravenous lipid emulsions: to be or not to be

## TL;DR

This paper discusses whether removing phytosterols from intravenous lipid emulsions can help prevent liver disease in patients on long-term nutrition.

## Contribution

The paper reviews the evidence and challenges of using phytosterol-depleted lipid emulsions to prevent intestinal failure-associated liver disease.

## Key findings

- Animal studies show phytosterols can cause liver toxicity.
- High phytosterol levels in patients correlate with more severe liver disease.
- Using phytosterol-depleted emulsions may lead to oxidation by-products and higher costs.

## Abstract

Long-term total parenteral nutrition (TPN) results in the development of intestinal failure-associated liver disease (IFALD). Fligor et al. have depleted phytosterols from soy-based intravenous lipid emulsions in an attempt to prevent IFALD. Animal studies describe the mechanism of hepatotoxicity of phytosterols, while studies in patients associate high phytosterols with the severity of liver disease. Yet, there are unanswered questions on how much IFALD could be attributed to phytosterols. Challenges to using a phytosterol-depleted ILE include the possibility of the development of oxidation by-products in the lipid, higher cost in the face of as yet unknown clinical benefit from phytosterol depletion and challenges in performing randomised controlled trials to validate the efficacy of newer ILEs.