Treatment of parenteral nutrition-associated liver disease: the role of lipid emulsions.
Parenteral nutrition is a life-saving therapy for infants with intestinal failure. However, long-term parenteral nutrition carries the risk of progressive liver disease. Substantial data has implicated components of parenteral soybean oil in the pathogenesis of parenteral nutrition-associated liver disease (PNALD). Elevated serum concentrations of phytosterols, an abundance of omega-6 polyunsaturated fatty acids, and a relative paucity of α-tocopherol have been associated with the risk of cholestasis and hepatic injury observed in PNALD. Currently available treatment strategies include the reduction of the dose of administered parenteral soybean oil and/or the replacement of parenteral soybean oil with alternative parenteral lipid emulsions. The purpose of this review is to provide an overview of the pathogenetic mechanisms associated with the development of PNALD and the data evaluating currently available treatment strategies.
Boston Children's Hospital, Boston, MA.
Prathima
P
Nandivada
Sarah J
SJ
Carlson
Melissa I
MI
Chang
Eileen
E
Cowan
Kathleen M
KM
Gura
Mark
M
Puder
D002779:Cholestasis / Q000209:etiology; D004041:Dietary Fats / Q000009:adverse effects* / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D043371:Fatty Acids, Omega-6 / Q000009:adverse effects; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010840:Phytosterols / Q000009:adverse effects / Q000097:blood; D013024:Soybean Oil / Q000009:adverse effects* / Q000627:therapeutic use; D024502:alpha-Tocopherol / Q000008:administration & dosage
D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D043371:Fatty Acids, Omega-6; D010840:Phytosterols; D013024:Soybean Oil; D024502:alpha-Tocopherol