title: Pathogenesis and treatment of parenteral nutrition-associated liver disease.
abstract: BACKGROUND
  Parenteral nutrition-associated liver disease (PNALD) has been common in patients who require long-term parenteral nutrition. PNALD develops in 40%-60% of infants on long-term parenteral nutrition compared with 15%-40% of adults on home parenteral nutrition for intestinal failure. The pathogenesis of PNALD is multifactorial and remains unclear. There is no specific treatment. Management strategies for its prevention and treatment depend on an understanding of many risk factors. This review aims to provide an update on the pathogenesis and treatment of this disease.
  
  
  METHODS
  A literature search was performed on the MEDLINE and Web of Science databases for articles published up to October 2011, using the keywords:  parenteral nutrition associated liver disease,  intestinal failure associated liver disease, lipid emulsions and fish oil. The available data reported in the relevant literatures were analyzed.
  
  
  RESULTS
  The literature search provided a huge amount of evidence about the pathogenesis and management strategies on PNALD. Currently, lack of enteral feeding, extended duration of parenteral nutrition, recurrent sepsis, and nutrient deficiency or excess may play important roles in the pathogenesis of PNALD. Recent studies found that phytosterols, present as contaminants in soy-based lipid emulsions, are also an important factor in the pathogenesis. Moreover, the treatment of PNALD is discussed.
  
  
  CONCLUSIONS
  The use of lipid emulsions, phytosterols in particular, is associated with PNALD. Management strategies for the prevention and treatment of PNALD include consideration of early enteral feeding, the use of specialized lipid emulsions such as fish oil emulsions, and isolated small bowel or combined liver and small bowel transplantation. A greater understanding of the pathogenesis of PNALD has led to promising interventions to prevent and treat this condition. Future work should aim to better understand the mechanisms of PNALD and the long-term outcomes of its treatment.
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
authors.forename: Zi-Wei
authors.initials: ZW
authors.lastname: Xu
authors.forename: You-Sheng
authors.initials: YS
authors.lastname: Li
mesh_terms: D000818:Animals; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control / Q000628:therapy*; D002796:Choline Deficiency / Q000150:complications; D004750:Enteral Nutrition; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D005395:Fish Oils / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010840:Phytosterols / Q000009:adverse effects*; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D013654:Taurine / Q000172:deficiency
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D010840:Phytosterols; D013654:Taurine