title: Lecithin increases plasma free choline and decreases hepatic steatosis in long-term total parenteral nutrition patients.
abstract: Plasma-free choline levels have previously been found below normal in patients receiving long term parenteral nutrition (TPN). In a group of 15 patients receiving home TPN who had low plasma free choline levels (6.3 +/- 0.8 mmol/L), we found 50% had hepatic steatosis. These patients were given oral lecithin or placebo in a double-blind randomized trial for 6 weeks. Lecithin supplementation led to an increase in plasma free choline of 53.4% +/- 15.4% at 2 weeks (P = 0.04), which continued at 6 weeks. The placebo group had no change in plasma-free choline at 2 weeks, but a significant decrease of 25.4% +/- 7.1% (P = 0.01) at 6 weeks. A significant and progressive decrease in hepatic fat was indicated by increased liver-spleen CT Hounsfield units at 2 and 6 weeks (7.5 +/- 1.7 units, P = 0.02; 13.8 +/- 3.5 units, P = 0.03) in the lecithin supplemental group. Nonsignificant changes were seen in the placebo group. It was concluded that hepatic steatosis in many patients receiving long term TPN is caused by plasma-free choline deficiency and may be reversed with lecithin supplementation. Choline is a conditionally essential nutrient in this population.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, UCLA Medical Center.
authors.forename: A L
authors.initials: AL
authors.lastname: Buchman
authors.forename: M
authors.initials: M
authors.lastname: Dubin
authors.forename: D
authors.initials: D
authors.lastname: Jenden
authors.forename: A
authors.initials: A
authors.lastname: Moukarzel
authors.forename: M H
authors.initials: MH
authors.lastname: Roch
authors.forename: K
authors.initials: K
authors.lastname: Rice
authors.forename: J
authors.initials: J
authors.lastname: Gornbein
authors.forename: M E
authors.initials: ME
authors.lastname: Ament
authors.forename: C D
authors.initials: CD
authors.lastname: Eckhert
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002331:Carnitine / Q000097:blood; D002794:Choline / Q000097:blood*; D002796:Choline Deficiency / Q000209:etiology; D005234:Fatty Liver / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D010713:Phosphatidylcholines / Q000494:pharmacology*
chemical_list: D010713:Phosphatidylcholines; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D002794:Choline; D002331:Carnitine