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Parenteral nutrition including lipids might be associated with liver disease. The cause leading to parenteral nutrition-related liver dysfunction remains largely unknown but is likely to be multifactorial. The study was performed to assess the effects of a lipid emulsion based on soybean oil, medium-chain triglycerides, olive and fish oil (SMOFlipid20%) compared with a lipid emulsion based on olive and soybean oil on hepatic integrity.In a prospective, randomized, double-blinded trial, 44 postoperative patients with an indication for parenteral nutrition were allocated to one of two regimens: group A (n = 22) received SMOFlipid, group B (n = 22) a lipid emulsion based on olive and soybean oil for 5 days. Aspartate aminotransferase, alanin-aminotransferase, and serum alpha-glutathion S-transferase were measured before the start of parenteral nutrition (d0), at day 2 (d2), and day 5 (d5) after the start of parenteral nutrition. The significance level was defined at a P value of less than 0.05.There was no significant difference at d0, but at d2 and d5, significantly lower aspartate aminotransferase (d2: group A: 27 ± 13 vs. group B: 47 ± 36 U l−1; d5: A: 31 ± 14 vs. B: 56 ± 45 U l−1), alanin-aminotransferase (d2: A: 20 ± 12 vs. B: 42 ± 39 U l−1; d5: A: 26 ± 15 vs. B: 49 ± 44 U l−1), and α-glutathion S-transferase levels (d2: A: 5 ± 6 vs. B: 17 ± 21 U l−1; d5: A: 6 ± 7 vs. B: 24 ± 27 μg l−1) were found in soybean oil, medium-chain triglycerides, olive and fish oil group compared with the control group.Hepatic integrity was well retained with the administration of SMOFlipid whereas in patients receiving a lipid emulsion based on olive and soybean oil liver enzymes were elevated indicating a lower liver tolerability.