Vitamins E and C supplementation reduces hepatic lipid peroxidation and steatosis in neonatal Yucatan piglets receiving prolonged parenteral nutrition

Parenteral nutrition (PN) is essential in neonatal care for many infants born prematurely or with impaired gastrointestinal function. However, prolonged PN use is associated with complications such as PN-associated liver disease and intestinal atrophy, potentially related to oxidative stress. Commercial PN lipid emulsions with fish oil are used to counteract PN-associated liver damage but may also contribute to oxidative stress due to their high content of long-chain polyunsaturated fatty acids. Using neonatal Yucatan miniature piglets as an established animal model for investigating PN-associated complications in neonates, this study investigated whether co-supplementation of vitamins E and C could reduce oxidative stress-related injury in the liver and small intestine during PN. The objective of this study was to determine whether supplementing a mixed-lipid emulsion (SMOFlipid®) with vitamins E and C would attenuate hepatic oxidative damage and enhance intestinal perfusion and morphology in neonatal piglets. Neonatal Yucatan piglets were surgically fitted with intravenous catheters and an indwelling blood flow probe around the superior mesenteric artery (SMA). Piglets received either standard PN (Control; n = 10) or PN supplemented with vitamins E (10 mg/kg/d) and C (100 mg/kg/d) (Vit E&C, n = 10) for ten days. Vitamin supplementation was associated with lower hepatic lipid accumulation and lipid peroxidation (P < 0.05 for both), compared with the control group. Plasma and liver vitamin E concentrations were markedly higher in the Vit E&C group (P < 0.001 and P < 0.01, respectively). No differences were determined between groups in liver or plasma triglyceride and cholesterol levels, SMA blood flow, intestinal villus height, crypt depth, or overall intestinal morphology. Hepatic and intestinal protein synthesis rates and in vivo bile acid clearance were also not significantly different between groups. Co-supplementation of PN with vitamins E and C was associated with lower hepatic oxidative stress and steatosis in neonatal piglets. Although no improvements were measured in intestinal structure or perfusion, these findings support the potential of antioxidant-enriched PN formulations to mitigate PN-associated liver complications.