Nutritional Risk Factors in the Pathogenesis of Parenteral Nutrition-Associated Liver Disease

Berkeley N. Limketkai, Monica Choe, Shruti Patel, Neha D. Shah, Valentina Medici

Research output: Contribution to journalReview article

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 languageEnglish (US)
Pages (from-to)281-290
Number of pages10
JournalCurrent Nutrition Reports
Volume6
Issue number3
DOIs
StatePublished - Sep 1 2017

Fingerprint

Parenteral Nutrition
liver diseases
parenteral feeding
Liver Diseases
risk factors
pathogenesis
Food
Emulsions
nutrient excess
Small Intestine
emulsions
Lipids
nutrient deficiencies
lipids
medium chain triacylglycerols
Soybean Oil
Essential Fatty Acids
Water-Electrolyte Balance
hepatotoxicity
nutrient balance

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 journalReview article

Limketkai, Berkeley N. ; Choe, Monica ; Patel, Shruti ; Shah, Neha D. ; Medici, Valentina. / Nutritional Risk Factors in the Pathogenesis of Parenteral Nutrition-Associated Liver Disease. In: Current Nutrition Reports. 2017 ; Vol. 6, No. 3. pp. 281-290.
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