Mastite Puerperal: Estudo de Fatores Predisponentes

Objetivos: conhecer as características clínicas e bacteriológicas da mastite, classificação e tratamento. Métodos: as pacientes foram inquiridas sobre dados pessoais, pré-natal, atendimento no parto, no puerpério e quadro clínico. A mastite foi classificada pelos critérios de Vinha. Nos casos que evoluíram para abscesso, foi realizada análise bacteriológica, utilizando-se o meio de cultura caldo de enriquecimento Tryptone Soya Broth. Resultados: das 70 lactantes, 57% eram primíparas, 57% com idade entre 20 e 29 anos e 51% com 1º grau incompleto. A renda era menor que um salário mínimo em 63% dos casos. Exerciam atividade domiciliar sem apoio em 66% dos casos. Em 50%, as mamas não foram examinadas. No pré-natal não tiveram orientação sobre aleitamento e ordenha em respectivamente 50% e 58% dos casos. Em 63% o parto não foi em hospitais Amigos da Criança. Ocorreu ingurgitamento em 46% e fissura mamilar em 47% dos casos. Na classificação citada: 44% eram do tipo lobar, 39% ampolar e 17% glandular. No material de cultura houve crescimento de Staphylococcus aureus em 55%. Conclusões: fatores como baixa escolaridade, baixa renda, atividade familiar sem apoio, primiparidade e falta de orientação são fatores de risco para o aparecimento da mastite.

Apolipoprotein and lipid abnormalities in chronic liver failure

Total serum lipids, as well as apolipoproteins A-I (apo A-I) and B (apo B), were determined in 74 patients with chronic liver failure without cholestasis and in 82 normal subjects. The VLDL, LDL and HDL lipid fractions were reduced in the liver failure group by 36%, 24% and 46%, respectively (P<0.001). Apolipoproteins A-I and B were also reduced by 26% and 25%, respectively (P<0.001). However, the reduction of HDL cholesterol (HDLc) was more pronounced than that of apo A-I and the HDLc:apo A-I ratio was significantly lower in the liver failure group. After separating these patients into groups with plasma albumin lower than 3.0, between 3.0 and 3.5, and higher than 3.5 g/dl, the HDLc:apo A-I ratio was proportional to plasma albumin, but the correlation was not statistically significant. When these patients were separated by the Child classification of liver function, there was a correlation between the HDLc:apo A-I ratio and liver function. The differences in the HDLc:apo A-I ratio between the Child groups B and C, and A and C were statistically significant (P<0.05). We conclude that there is a more pronounced reduction in HDL cholesterol than in apo A-I in liver failure patients. Therefore, the HDLc:apo A-I ratio is a marker of liver function, probably because there is a decreased lecithin-cholesterol acyltransferase production by the diseased liver

Neuroprotection by flavonoids

The high morbidity, high socioeconomic costs and lack of specific treatments are key factors that define the relevance of brain pathology for human health and the importance of research on neuronal protective agents. Epidemiological studies have shown beneficial effects of flavonoids on arteriosclerosis-related pathology in general and neurodegeneration in particular. Flavonoids can protect the brain by their ability to modulate intracellular signals promoting cellular survival. Quercetin and structurally related flavonoids (myricetin, fisetin, luteolin) showed a marked cytoprotective capacity in in vitro experimental conditions in models of predominantly apoptotic death such as that induced by medium concentrations (200 µM) of H2O2 added to PC12 cells in culture. Nevertheless, quercetin did not protect substantia nigra neurons in vivo from an oxidative insult (6-hydroxydopamine), probably due to difficulties in crossing the blood-brain barrier. On the other hand, treatment of permanent focal ischemia with a lecithin/quercetin preparation decreased lesion volume, showing that preparations that help to cross the blood-brain barrier may be critical for the expression of the effects of flavonoids on the brain. The hypothesis is advanced that a group of quercetin-related flavonoids could become lead molecules for the development of neuroprotective compounds with multitarget anti-ischemic effects.

Atherosclerosis in aged mice over-expressing the reverse cholesterol transport genes

We determined whether over-expression of one of the three genes involved in reverse cholesterol transport, apolipoprotein (apo) AI, lecithin-cholesterol acyl transferase (LCAT) and cholesteryl ester transfer protein (CETP), or of their combinations influenced the development of diet-induced atherosclerosis. Eight genotypic groups of mice were studied (AI, LCAT, CETP, LCAT/AI, CETP/AI, LCAT/CETP, LCAT/AI/CETP, and non-transgenic) after four months on an atherogenic diet. The extent of atherosclerosis was assessed by morphometric analysis of lipid-stained areas in the aortic roots. The relative influence (R²) of genotype, sex, total cholesterol, and its main sub-fraction levels on atherosclerotic lesion size was determined by multiple linear regression analysis. Whereas apo AI (R² = 0.22, P < 0.001) and CETP (R² = 0.13, P < 0.01) expression reduced lesion size, the LCAT (R² = 0.16, P < 0.005) and LCAT/AI (R² = 0.13, P < 0.003) genotypes had the opposite effect. Logistic regression analysis revealed that the risk of developing atherosclerotic lesions greater than the 50th percentile was 4.3-fold lower for the apo AI transgenic mice than for non-transgenic mice, and was 3.0-fold lower for male than for female mice. These results show that apo AI overexpression decreased the risk of developing large atherosclerotic lesions but was not sufficient to reduce the atherogenic effect of LCAT when both transgenes were co-expressed. On the other hand, CETP expression was sufficient to eliminate the deleterious effect of LCAT and LCAT/AI overexpression. Therefore, increasing each step of the reverse cholesterol transport per se does not necessarily imply protection against atherosclerosis while CETP expression can change specific athero genic scenarios.

Modulation of peritoneal macrophage activity by the saturation state of the fatty acid moiety of phosphatidylcholine

To determine the effects of saturated and unsaturated fatty acids in phosphatidylcholine (PC) on macrophage activity, peritoneal lavage cells were cultured in the presence of phosphatidylcholine rich in saturated or unsaturated fatty acids (sat PC and unsat PC, respectively), both used at concentrations of 32 and 64 µM. The treatment of peritoneal macrophages with 64 µM unsat PC increased the production of hydrogen peroxide by 48.3% compared to control (148.3 ± 16.3 vs 100.0 ± 1.8%, N = 15), and both doses of unsat PC increased adhesion capacity by nearly 50%. Moreover, 64 µM unsat PC decreased neutral red uptake by lysosomes by 32.5% compared to the untreated group (67.5 ± 6.8 vs 100.0 ± 5.5%, N = 15), while both 32 and 64 µM unsat PC decreased the production of lipopolysaccharide-elicited nitric oxide by 30.4% (13.5 ± 2.6 vs 19.4 ± 2.5 µM) and 46.4% (10.4 ± 3.1 vs 19.4 ± 2.5 µM), respectively. Unsat PC did not affect anion production in non-stimulated cells or phagocytosis of unopsonized zymosan particles. A different result pattern was obtained for macrophages treated with sat PC. Phorbol 12-miristate 13-acetate-elicited superoxide production and neutral red uptake were decreased by nearly 25% by 32 and 64 µM sat PC, respectively. Sat PC did not affect nitric oxide or hydrogen peroxide production, adhesion capacity or zymosan phagocytosis. Thus, PC modifies macrophage activity, but this effect depends on cell activation state, fatty acid saturation and esterification to PC molecule and PC concentration. Taken together, these results indicate that the fatty acid moiety of PC modulates macrophage activity and, consequently, is likely to affect immune system regulation in vivo.

Production and characterization of lipid microparticles produced by spray cooling encapsulating a low molar mass hydrophilic compound

The objective of this research was to produce and characterize lipid particles (MpLs) that may be used as carriers of high amounts of hydrophilic core and evaluate the influence of the core amount on the performance of lipid microparticles. The MpLs were produced by spray cooling from solid and liquid lipid mixtures (stearic and oleic fatty acids and partly hydrogenated vegetable fat) containing glucose solution as core and soy lecithin as surfactant. The performance of MpLs was evaluated by means of the effective amount of encapsulated core, the core amount present on the surface of MpLs (superficial glucose) and the core release profile in aqueous solution. Morphological observations showed that MpLs presented spherical shape and a rugged and continuous surface, and an average diameter between 25 and 32 µm. The effective amount of encapsulated core was greater than 78% for all formulations evaluated. Larger amounts of superficial glucose were found in formulations in which more concentrated glucose solutions were used, regardless of the glucose lipid-solution ratio. The release results showed that core retention was significantly influenced by the glucose solution concentration, whereas release modulation was influenced by the glucose lipid-solution ratio.

Postharvest technologies for mangosteen (Garcinia mangostana L.) conservation

The application of technologies to extend the postharvest life of mangosteen fruit was studied and compared to storage at 25 °C/70-75%R.H (25 °C control treatment). The fruits were packed in expanded polystyrene (EPS) trays (5 fruits/tray). Five treatments were carried out at 13 °C/ 90-95% RH: application of carnauba wax coating, lecithin + CMC (carboxymethyl cellulose) coating, 50 µm LDPE (low density polyethylene) film coating, 13 µm PVC (Polyvinyl chloride), and non-coated sample (13 °C control treatment). Physicochemical analyses were performed twice a week. A statistical design was completely randomized with 8 repetitions for each treatment plus the control treatment. The results were submitted to variance analysis, and the averages compared by the Tukey test at 5% probability. Among the quality parameters analyzed, more significant differences were observed for weight loss, texture, and peel moisture content. The results showed that the maximum storage period for mangosteen at 25 °C is two weeks; while storage at13 °C can guarantee the conservation of this fruit for 25 days. Therefore, the treatment at 13 °C/90-95% RH without the use of coatings and films was more effective and economical.

Screening and kinetics of glutaminase and glutamate decarboxylase producing lactic acid bacteria from fermented Thai foods

L-glutaminase and glutamic acid decarboxylase (GAD) catalyzes the hydrolysis of L-glutamine and glutamate, respectively. L-glutaminase widely used in cancer therapy along with a combination of other enzymes and most importantly these enzymes were used in food industries, as a major catalyst of bioconversion. The current investigation was aimed to screen and select L-glutaminase, and GAD producing lactic acid bacteria (LAB). A total of 338 LAB were isolated from fermented meat, fermented fish, fermented soya bean, fermented vegetables and fruits. Among 338 isolates, 22 and 237 LAB has been found to be positive for L-glutaminase and GAD, respectively. We found that 30 days of incubation at 35 ºC and pH 6.0 was the optimum condition for glutaminase activity by G507/1. G254/2 was found to be the best for GAD activity with the optimum condition of pH 6.5, temperature 40 ºC and ten days of incubation. These LAB strains, G507/1 and G254/2, were identified as close relative of Lactobacillus brevis ATCC 14869 and Lactobacillus fermentum NBRC 3956, respectively by 16S rRNA sequencing. Further, improvements in up-stream of the fermentation process with these LAB strains are currently under development.

The structural effects of divalent cations and insulin on phospholipid model membranes /

It is well accepted that structural studies with model membranes are of considerable value in understanding the structure of biological membranes. Many studies with models of pure phospholipids have been done; but the effects of divalent cations and protein on these models would make these studies more applicable to intact membrane. The present study, performed with above view, is a structural analysis of divalent io~cardio1ipin complexes using the technique of x-ray diffraction. Cardiolipin, precipitated from dilute solution by divalent ionscalcium, magnesium and barium, contains little water and the structure formed is similar to the structure of pure cardiolipin with low water content. The calcium-cardiolipin complex forms a pure hexagonal type II phase that exists from 40 to 400 C. The molar ratio of calcium and cardiolipin in the complex is 1 : 1. Cardiolipin, precipitated with magnesium and barium forms two co-existing phases, lamellar and hexagonal, the relative quantity of the two phases being dependent on temperature. The hexagonal phase type II consisting of water filled channels formed by adding calcium to cardiolipin may have a remarkable permeability property in intact membrane. Pure cardiolipin and insulin at pH 3.0 and 4.0 precipitate but form no organised structure. Lecithin/cardiolipin and insulin precipitated at pH 3.0 give a pure lamellar phase. As the lecithin/cardiolipin molar ratio changes from 93/7 to SO/50, (a) the repeat distance of the lamellar changes from 72.8 X to 68.2 A; (b) the amount of protein bound increases in such a way that cardiolipin/insulin molar ratio in the complex reaches a maximum constant value at lecithin/cardiolipin molar ratio 70/30. A structural model based on these data shows that the molecular arrangement of lipid and protein is a lipid bilayer coated with protein molecules. The lipid-protein interaction is chiefly electrostatic and little, if any, hydrophobic bonding occurs in this particular system. So, the proposed model is essentially the same as Davson-Daniellifs model of biological membrane.

Measurement of forces between and within bilayers of neutral phospholipids

Phospholipids in water form lamellar phases made up of alternating layers of water and bimolecular lipid leaflets. Three complementary methods, osmotic, mechanical, and vapour pressures, were used to measure the work of removing water from lamellar phases composed of frozen dipalmitoylphosphatidylcholine ( DPPC ), melted DPPC, egg phosphatidylethanolamine or equimolar mixtures of DPPC and cholesterol ( DPPC/CHOL ), Concurrently the structural changes that resulted from this water removal were measured using X-ray diffraction. The work was divided into that which forces the bilayers together ( F ) and that which compresses the molecules together within the bilayers ( F )# A large repulsive force exists between bilayers composed of each of the lipids studied and this force increases exponentially as bilayer separation is decreased. F is affected by the nature of the head groups, conformation of the acyl chains and heterogeneity of these chains. In general all of the melted phosphatidylcholines ( melted DPPC, egg lecithin and DPPC/CHOL ) have large equilibrium separations in excess water resulting from large repulsive hydration forces between these bilayers. By comparison, egg PE has an increased attractive force, and frozen DPPC has a decreased hydration force; each results in smaller separations in water for these two lipids. The chemical potentials of the water between the bilayers for all these lipids lie on a continuum, indicating that interbilayer water cannot be characterized by two discrete states, usually referred to as "bound" or "non**bound". For all lipids studied a maximum of 25 % of the total work done on the system goes into deforming the bilayers. The method used here viii to separate repulsion from deformation, developed for us by v. A. Parsegian, provides a unique method for the measurement of lateral pressure of a bilayer and its modulus of deformability ( Y ). Lateral pressure is affected by the nature of the head group, conformation and heterogeneity of the acyl chains. For small changes in molecular surface area ( A ) near equilibrium, both melted and frozen DPPC have similar values for the deformability modulus. Thus in this regime it requires about the same force to change the angle of tilt of frozen chains as it does to compress the fluid bilayer. The introduction of cholesterol into bilayers of DPPC reduces dramatically the lateral pressure of the bilayers over a large range of molecular surface areas ( A ). The variation in the magnitude of bilayer repulsion with different phospholipids provides a basis for the mechanism of lipid segregation in mixed lipid systems and suggests that interacting heterogeneous membranes may influence or modulate the composition of the opposing membrane. The measurements of deformabilities of bilayers provides a direct comparison of them with the properties of monolayers.

Measurement of repulsive forces between charged phospholipid bilayers

Electrostatic forces between membranes containing charged lipids were assumed to play an important role in influencing interactions between membranes long before quantitative measurements of such forces were available. ~ur measurements were designed to measure electrostatic forces between layers of lecithin charged with lipi~s carrying ionizable head groups. These experiments have shown that the interactions between charged lipid bila.yere are dominated by electrostatic forces only at separations greater than 30 A. At smaller separations the repulsion between charged bilayers is dominated by strong hydration forces. The net repulsive force between egg lecithin bilayers containing various amounts of cherged lipids (phosphatidylglycerol (PG) 5,10 ano 50 mole%, phosphatidyli. nosi tol (PI) 10 mole% and sodium oleate (Na-Ol) 3,5 and 10 mole%, where mole% gives the ratio of the number of moles' of .charged lipid to the total number of moles of all lipids present in the sample) was stuoied with the help ('If the osmotic streas technique described by LeNeveu et aI, (1977). Also, the forces between pure PG were j_nvestigated in the same manner. The results have been plotted showing variation of force as a function of bilay- _ er separation dw• All curVes 90 obtained called force curves, were found to be similar in sha.pe, showing two distinct regions, one when dw<.30 A is a region cf very rapid iiivariation of force with separation ( it is the region dominated by hydre,tion force) and second when dw> 40 A is a region of very slow variation of force with separB.tion ( it is the region dominated by the electrostatic force). Between these two regions there exists a transition area in which, in most systems studied, a phase separation of lipids into fractions containing different amounts of charged groups, was observed. A qualitative analysis showed that our results were v/ell described by the simple electrostatic double -le.yer theory. For quantitative agreement between measured and calculated force curves however, the charge density for the calculations had to be taken as half of that given by the number density of charged lipids present in the lecithin bilayers. It is not clear at the moment what causes such low apparent degree of ionization among the charged head groups, and further study is needed in this area.

Déficit familial de la LCAT au Québec : description d’une première mutation et contribution du génotype de l’APO E sur le phénotype lipoprotéique

Le déficit familial de LCAT (FLD) est une maladie caractérisée par un défaut de l’activité de l’enzyme lecithin:cholesterol acyltransferase (LCAT). Ce défaut résulte en une concentration plasmatique de C-HDL extrêmement basse, des opacités cornéennes prématurées, la présence d’anémie, de protéinurie et d’insuffisance rénale. Nous avons identifié les premiers patients canadiens-français atteints de déficit familial de LCAT. Deux frères, présentant les signes classiques de FLD étaient homozygotes pour une nouvelle mutation du gène de la LCAT: la mutation c.102delG. Cette mutation se traduit au niveau protéique par un changement du cadre de lecture au niveau du codon His35 et l’insertion d’un codon stop en position 61 entraînant une abolition de l’activité LCAT in vitro et in vivo. La présence de cette mutation cause une réduction importante du C-HDL chez les hétérozygotes (22%) et les homozygotes (88%) ainsi qu’une baisse du C-LDL chez les hétérozygotes (35%) et les homozygotes (58%). De plus, le profil lipidique différait de manière importante entre les deux frères atteints de FLD qui présentaient des génotypes APOE différents. Nous suggérons que APOE est un gène qui modifie le phénotype du FLD et pourrait expliquer l’hétérogénéité des profils lipidiques chez les patients atteints de FLD. Nos résultats suggèrent également que l’association du génotype LCAT-/- a un allèle APOE ε2 est un nouveau mécanisme conduisant à la dysbétalipoproteinemie. Finalement nous avons montré des différences importantes dans les sous-populations des HDL chez les deux sujets atteints de FLD. Le porteur de l’allèle APOE ε2 présentait une proportion beaucoup plus importante de HDL immatures (preβ discoïdaux) par rapport a son frère (77.9% vs. 31.0%).

La biotechnologie dans l’agriculture : une étude du contenu de la presse écrite argentine des années 1999 à 2006

En Argentine, la biotechnologie agricole, spécialement le soya transgénique, a été adoptée de façon fulgurante et elle a provoqué un fort choc dans l’économie nationale et dans la société. Actuellement, dû à la gravité des conséquences de ce phénomène, les médias, et la presse en particulier, ont fait écho du débat. Le but général de cette étude est d’analyser le débat de société sur ce phénomène dans la presse écrite argentine. Pour ce faire, trois objectifs spécifiques ont été retenus : dresser un portrait général du discours; comprendre le contexte politique et économique qui a permis l’insertion de la biotechnologie agricole en Argentine; et analyser les enjeux socioéthiques subjacents au problème des biotechnologies. Pour répondre à ces objectifs, on a effectué une analyse de contenu du discours social circonscrit à la presse écrite argentine entre les années 1999- 2006. La démarche privilégiée inclut la classification des articles de journaux par l’utilisation de mots-clés et l’assignation à des catégories thématiques avec l’assistance des techniques d’analyse de texte par ordinateur. Les résultats de cette étude signalent pour la période étudiée une importante couverture journalistique des biotechnologies agricoles, couverture qui, en général, a été favorable. La quantité d’articles augmente avec les années et montre un virage important des sujets commerciaux à des questions politiques. Le débat autour des conséquences environnementales et sociales de l’application du nouveau modèle agricole sont pauvrement représentées et montrent une apparition plus tardive dans les journaux argentins. Cependant, cela pourrait s’expliquer par un déplacement dans l’axe de la discussion des biotechnologies vers la sojisation qui devient l’enjeu central du débat autour du phénomène agricole.

Exposition aux pesticides et risque de diabète de type 2 : une étude au nord du Bénin (Afrique de l'Ouest)

Introduction : La présente étude explore pour la première fois en Afrique, l'association entre l'exposition aux pesticides organochlorés (POC) et le risque de diabète de type 2. L’étude se déroule dans la région du Borgou, au nord du Bénin, où l’utilisation intense de pesticides pour la culture du coton coïncide avec une prévalence élevée du diabète par rapport aux autres régions du pays. Objectifs: 1) Décrire le niveau d’exposition de la population des diabétiques et non diabétiques du Borgou par le taux sérique de certains pesticides organochlorés ; 2) Explorer la relation entre le risque de diabète de type 2 et les concentrations sériques des POC; 3) Examiner l’association entre l’obésité globale, le pourcentage de masse grasse et l’obésité abdominale avec les concentrations sériques des POC; 4) Explorer la contribution de certaines sources d’exposition alimentaire et non-alimentaire aux concentrations sériques des POC. Méthodes : Il s'agit d'une étude cas-témoin qui concerne 258 adultes de 18 à 65 ans identifiés par deux valeurs glycémiques capillaire et veineuse au seuil de 7 mmol/l pour les diabétiques et 5,6mmol/l pour les témoins non diabétiques. Les 129 témoins ont été appariés aux 129 cas selon les critères suivants : l’ethnie, l’âge ± 5ans, le sexe et la localité de résidence. Les informations personnelles et celles portant sur les modes d’exposition ont été recueillies par questionnaire. Les concentrations sériques des POC ont été obtenues par chromatographie gazeuse couplée d’une spectrométrie de masse. L’obésité globale est déterminée par l’IMC ≥ 30 kg/m2. L’obésité abdominale est obtenue par le tour de taille selon les critères consensuels d’Alberti et al. pour la définition du syndrome métabolique. Le pourcentage de masse corporelle a été mesuré par bio-impédance électrique et été considéré comme élevé au seuil de 33% chez les femmes et 25% chez les hommes. Résultats: En comparant les 3ème et premier terciles des concentrations de p,p’-DDE et p,p’-DDT, les sujets du 3e tercile étaient deux à trois fois plus susceptibles de présenter du diabète que ceux du 1er tercile. La probabilité d’obésité abdominale ou de l’obésité générale (en contrôlant pour le statut diabétique) était accrue de trois à cinq fois dans le dernier tercile pour trois des quatre POC qui étaient détectables soit p,p’-DDT, β-HCH et trans-Nonachlore. Les facteurs socioéconomiques associés aux POC sériques sont le niveau d’éducation élevé, un meilleur revenu et la résidence en milieu urbain. Les sources d’exposition non alimentaire significativement associées aux concentrations sériques de POC étaient l’exposition professionnelle mixte (primaire et secondaire) aux pesticides et la consommation de tabac local. L’achat en opposition à l’autoproduction de plusieurs groupes de denrées alimentaire était associé à de plus fortes teneurs de POC. La fréquence de consommation hebdomadaire du poisson, des légumes, du fromage, de l’igname séchée ainsi que du mil, de l’huile de palme et de certaines légumineuses comme le soya, le néré, le niébé et le voandzou était significativement associées aux POC sériques. Conclusion : L’étude a mis en évidence la relation entre le niveau sérique de pesticides organochlorés d’une part, du diabète ou de l’obésité d’autre part. Les concentrations de POC observées au Borgou sont assez élevées et méritent d’être suivies et comparées à celles d’autres régions du pays. Les facteurs contribuant à ces teneurs élevées sont le niveau d’éducation élevé, un meilleur revenu, la résidence en milieu urbain, l’achat et la fréquence de consommation de plusieurs aliments. La contribution du mélange des polluants auxquels les habitants de cette région sont exposés à la prévalence croissante du diabète mérite d’être examinée, notamment les pesticides utilisés actuellement dans la région pour les productions de rente et autres polluants persistants. Ces résultats contribuent à accroître les connaissances sur les facteurs de risque émergents pour le diabète que sont des polluants environnementaux comme les pesticides. Les implications pour la santé publique sont importantes tant pour la prévention des maladies chroniques que pour la sensibilisation des autorités politiques du pays pour une politique agricole et sanitaire adéquate visant la réduction de l’exposition aux pesticides.

Efectividad y seguridad de las emulsiones de pescado en la colestasis asociada a nutrición parenteral en neonatos

El daño hepático asociado a Nutrición Parenteral es una complicación letal en pacientes con nutrición parenteral prolongada. Su etiología no es clara aún, y se cree que las emulsiones lipídicas tradicionales con en base aceite de soya pueden contribuir a su génesis. Recientemente la modificación del contenido de ácidos grasos de las emulsiones lipídicas tradicionalmente de ácidos grasos omega-6 a ricas en omega-3 se postula como terapia prometedora en niños con PNALD. Se realizó una búsqueda sistemática de la literatura en Cochrane y Pubmed, se seleccionaron ensayos clínicos controlados y estudios de cohorte prospectiva. Se utilizó le metodología SIGN para la calificación de los estudios y evaluación del grado de recomendación basada en la evidencia. El meta-análisis que se llevó a cabo incluyó dos artículos de cohorte prospectiva del grupo de Boston para la variable principal de desenlace considerada: tiempo de reverso de la colestasis. Los pacientes que recibieron emulsiones de lípidos de pescado experimentaron regresión de la colestasis significativamente más rápido que los que recibieron emulsiones de soya (HR=10.3, IC 95%:3.7,29,0, efectos fijos), menor mortalidad y menor necesidad de trasplante hepático. Su utilización no se asocia con deficiencia de ácidos grasos, hipertrigliceridemia, coagulopatía o retraso en el crecimiento. Se evidencio una correlación entre la disminución de los niveles de triglicéridos y aumento de los niveles de albúmina, sugiriendo un beneficio nutricional en los pacientes bajo infusiones de lípidos de pescado.