Prevention of parenteral nutrition-associated liver disease: lipid minimization.
OBJECTIVE
The cause of parenteral nutrition-associated liver disease (PNALD) is unknown. Evidence over the past decade has suggested soybean oil-based intravenous emulsions are a contributing factor to the development of PNALD.


RESULTS
This review details the historical and scientific rationale, which associates intravenous lipid emulsion administration and PNALD. The article then reviews our own group's experience with lipid restriction and the reversal of PNALD in neonates on long-term parenteral nutrition. Finally, a clinical approach to restricting soybean-based intravenous lipid emulsions in parenteral nutrition is given.


CONCLUSIONS
An association between intravenous lipid emulsion administration and the development of PNALD seems probable. Strategies to reduce lipid emulsions or develop new, nonsoybean-based lipid emulsions should be considered.
Cober
M Petrea
MP
Department of Pharmacy, University of Michigan Hospitals and Health Centers, and CS Mott Children's Hospital, Ann Arbor, Michigan, USA. mcober@umich.edu
Teitelbaum
Daniel H
DH
D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects*; D005228:Fatty Acids, Essential / Q000172:deficiency; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013024:Soybean Oil / Q000009:adverse effects*
D005217:Fat Emulsions, Intravenous; D005228:Fatty Acids, Essential; D013024:Soybean Oil; D001663:Bilirubin