Cholestasis induced by total parenteral nutrition; effects of the addition of Taurine (Tauramin®) on hepatic function parameters; possible synergistic action of structured lipids (SMOFlipid®)

Objective: Assess the hepatoprotective effect of Taurine (Tau) in cases of hepatic cholestasis induced by Total Parenteral Nutrition (TPN). Methods: We describe a retrospective series of 54 patients who received TPN, in which cholestasis was detected at an (Intermediate) point that separates the duration of TPN into 2 Phases. From this moment -Phase 2- on, and according to clinical criteria, some patients (Group A, n = 27) received amino acids with Tau (22.41 +/- 3.57 mg/kg/day)(Tauramin(R)), while the rest (Group B, n = 27) received the standard solution without Tau. The mean TPN durations were 39.2 +/- 17.1 and 36.4 +/- 18.1 days respectively, with the Intermediate points on days 19.56 +/- 10.51 and 17.89 +/- 11.14. They all received diets that were homogeneous in terms of kcal and macronutrients. In Phase 2, 21 patients from Group A received structured lipids (SMOFlipid(R)); while 20 from Group B received soy MCT/LCT [Medium Chain Triglycerides/Long Chain Triglycerides] (physical or structured mixture). In a retrospective study, differences could not be avoided. The analytical parameters from three periods (Initial, Intermediate, and Final) were obtained from Nutridata(R) and Servolab(R). We compared interperiod values using the Wilcoxon test SPSS(R) (p < 0.05). Results: After introducing Taurine AST, ALT, and GGT were significantly reduced; Bilirubin was also reduced, but not significantly. The values obtained for GGT in Group A were (Mean(sigma)/median): Initial 48.6 (23.1)/46; Intermediate 473.7(276.2)/438, and Final 328.9 (190.4)/305. We stress that the mean GGT value is reduced by 30.56% after adding Taurine, while in its absence all parameters are elevated, and mean GGT increases 45.36%. Conclusion: These results show Taurine's hepatoprotective effect and support its use in cases of TPN-induced cholestasis. We acknowledge the possibility that the differences between SMOF and the MCT/LCT mixtures also may have influenced the results in a combined effect with taurine. (Nutr Hosp. 2012;27:1900-1907) DOI: 10.3305/nh.2012.27.6.6047