Abstract
Purpose of Review: Parenteral nutrition has been a lifesaving therapy for individuals who cannot sustain adequate oral or enteral nutrient intake to maintain fluid, electrolyte, and nutrient balance. Nonetheless, parenteral nutrition can lead to an increased risk of complications, such as parenteral nutrition-associated liver disease (PNALD). The pathogenesis of PNALD has been associated with multiple risk factors, such as longer duration, reduced small bowel length, decreased enteral intake, and bacterial infections. Nutritional risk factors also play an important role in the development of PNALD. This review presents several nutrient deficiencies and excesses that have been associated with PNALD. Recent Findings: Deficiencies in certain nutrients (amino acids, essential fatty acids, enteral intake), excesses of certain nutrients (calories, carbohydrates, lipids), types of lipid emulsions, and mineral toxicities (aluminum, copper, manganese) have been associated with PNALD. Strategies to address PNALD require correction of these risk factors. The use of newer mixed lipid emulsions (including soybean, medium-chain triglycerides, olive oil, and fish oil) may also have less hepatotoxicity than traditional soybean oil-based lipid emulsions. Summary: Knowledge of nutritional risk factors for PNALD will help the clinician in the systematic evaluation and treatment of these specific risk factors. Moreover, an understanding of their effects guides the balance between addressing the patient’s nutritional needs and reducing the risk of PNALD.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 281-290 |
| Number of pages | 10 |
| Journal | Current Nutrition Reports |
| Volume | 6 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2017 |
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Keywords
- Aluminum
- Amino acid deficiency
- Carnitine
- Choline
- Copper
- Fatty acid deficiency
- Hepatotoxicity
- Lipid emulsion
- Manganese
- Methionine
- Mineral toxicity
- Taurine
- TPN
ASJC Scopus subject areas
- Food Science
- Nutrition and Dietetics
Cite this
Nutritional Risk Factors in the Pathogenesis of Parenteral Nutrition-Associated Liver Disease. / Limketkai, Berkeley N.; Choe, Monica; Patel, Shruti; Shah, Neha D.; Medici, Valentina.
In: Current Nutrition Reports, Vol. 6, No. 3, 01.09.2017, p. 281-290.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Nutritional Risk Factors in the Pathogenesis of Parenteral Nutrition-Associated Liver Disease
AU - Limketkai, Berkeley N.
AU - Choe, Monica
AU - Patel, Shruti
AU - Shah, Neha D.
AU - Medici, Valentina
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Purpose of Review: Parenteral nutrition has been a lifesaving therapy for individuals who cannot sustain adequate oral or enteral nutrient intake to maintain fluid, electrolyte, and nutrient balance. Nonetheless, parenteral nutrition can lead to an increased risk of complications, such as parenteral nutrition-associated liver disease (PNALD). The pathogenesis of PNALD has been associated with multiple risk factors, such as longer duration, reduced small bowel length, decreased enteral intake, and bacterial infections. Nutritional risk factors also play an important role in the development of PNALD. This review presents several nutrient deficiencies and excesses that have been associated with PNALD. Recent Findings: Deficiencies in certain nutrients (amino acids, essential fatty acids, enteral intake), excesses of certain nutrients (calories, carbohydrates, lipids), types of lipid emulsions, and mineral toxicities (aluminum, copper, manganese) have been associated with PNALD. Strategies to address PNALD require correction of these risk factors. The use of newer mixed lipid emulsions (including soybean, medium-chain triglycerides, olive oil, and fish oil) may also have less hepatotoxicity than traditional soybean oil-based lipid emulsions. Summary: Knowledge of nutritional risk factors for PNALD will help the clinician in the systematic evaluation and treatment of these specific risk factors. Moreover, an understanding of their effects guides the balance between addressing the patient’s nutritional needs and reducing the risk of PNALD.
AB - Purpose of Review: Parenteral nutrition has been a lifesaving therapy for individuals who cannot sustain adequate oral or enteral nutrient intake to maintain fluid, electrolyte, and nutrient balance. Nonetheless, parenteral nutrition can lead to an increased risk of complications, such as parenteral nutrition-associated liver disease (PNALD). The pathogenesis of PNALD has been associated with multiple risk factors, such as longer duration, reduced small bowel length, decreased enteral intake, and bacterial infections. Nutritional risk factors also play an important role in the development of PNALD. This review presents several nutrient deficiencies and excesses that have been associated with PNALD. Recent Findings: Deficiencies in certain nutrients (amino acids, essential fatty acids, enteral intake), excesses of certain nutrients (calories, carbohydrates, lipids), types of lipid emulsions, and mineral toxicities (aluminum, copper, manganese) have been associated with PNALD. Strategies to address PNALD require correction of these risk factors. The use of newer mixed lipid emulsions (including soybean, medium-chain triglycerides, olive oil, and fish oil) may also have less hepatotoxicity than traditional soybean oil-based lipid emulsions. Summary: Knowledge of nutritional risk factors for PNALD will help the clinician in the systematic evaluation and treatment of these specific risk factors. Moreover, an understanding of their effects guides the balance between addressing the patient’s nutritional needs and reducing the risk of PNALD.
KW - Aluminum
KW - Amino acid deficiency
KW - Carnitine
KW - Choline
KW - Copper
KW - Fatty acid deficiency
KW - Hepatotoxicity
KW - Lipid emulsion
KW - Manganese
KW - Methionine
KW - Mineral toxicity
KW - Taurine
KW - TPN
UR - http://www.scopus.com/inward/record.url?scp=85057644734&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85057644734&partnerID=8YFLogxK
U2 - 10.1007/s13668-017-0217-7
DO - 10.1007/s13668-017-0217-7
M3 - Review article
VL - 6
SP - 281
EP - 290
JO - Current Nutrition Reports
JF - Current Nutrition Reports
SN - 2161-3311
IS - 3
ER -