Choline Deficiency Causes Reversible Hepatic Abnormalities in Patients Receiving Parenteral Nutrition: Proof of a Human Choline Requirement: A Placebo‐Controlled Trial

Buchman, Alan L.; Ament, Marvin E.; Sohel, Mir; Dubin, Mark; Jenden, Donald J.; Roch, Margaret; Pownall, Henry J.; Farley, William J.; Awal, Mohammad Abdul; Ahn, Chulkyun

doi:10.1177/0148607101025005260

Cited by 213 publications

(109 citation statements)

References 60 publications

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“…Interestingly, smoking is associated with significantly lower PCho concentrations and the reasons for this are unknown [8]. Declines and/ or lower levels of plasma or SCho have been found after major surgery [41], traumatic head injury [40] and more gradually during long-term parenteral nutrition [42]. These and other factors leading to abnormal choline levels are summarized in Box 3.…”

Section: Choline Values In Health Acs and Other Diseasesmentioning

confidence: 99%

Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability

Danne

Möckel

2010

Expert Review of Molecular Diagnostics

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Section: Choline Values In Health Acs and Other Diseasesmentioning

confidence: 99%

Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability

Danne

Möckel

2010

Expert Review of Molecular Diagnostics

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“…Deficiencies of both taurine and choline have been documented in small (n 50) retrospective studies of patients receiving long-term HPN and are associated with increased biochemical markers of liver function. 101 …”

mentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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“…There is considerably less evidence of a benefit of taurine supplementation in adults, with a reduction in aspartate aminotransferase levels being reported in a single small study of adults receiving long-term parenteral nutrition (47) . Similarly, small-scale trials of choline supplementation in adults have demonstrated that both parenteral choline and high-dose oral lecithin can increase plasma choline concentrations (40,41,86) . This outcome has been shown to be associated with a reduction in hepatic steatosis, assessed by computerised tomography scanning, and improvements in plasma ALP, alanine aminotransferase and aspartate aminotransferase concentrations (41) .…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

“…Similarly, small-scale trials of choline supplementation in adults have demonstrated that both parenteral choline and high-dose oral lecithin can increase plasma choline concentrations (40,41,86) . This outcome has been shown to be associated with a reduction in hepatic steatosis, assessed by computerised tomography scanning, and improvements in plasma ALP, alanine aminotransferase and aspartate aminotransferase concentrations (41) . Further larger trials investigating the possible beneficial effects of both choline and taurine are ongoing.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

“…Choline deficiency in patients receiving parenteral nutrition has been shown to correlate with elevated transaminase levels and steatosis in both adults and children receiving parenteral nutrition (38,39) . Small studies have shown that both parenteral choline supplementation and high-dose oral supplementation can reverse these abnormalities (40,41) . Taurine is important for bile salt conjugation, particularly in preterm infants.…”

Section: Nutrient Deficiencymentioning

confidence: 99%

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Managing liver dysfunction in parenteral nutrition

Lloyd

Gabe

2007

Proc. Nutr. Soc.

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Parenteral nutrition is life saving in patients with intestinal failure but liver dysfunction is commonly encountered, especially in neonates. Although abnormal liver function tests associated with short-term parenteral nutrition are usually benign and transient, liver dysfunction in both children and adults receiving long-term parenteral nutrition can progress to end-stage liver disease and liver failure. The aetiology of parenteral nutrition-associated liver disease is complex and multifactorial, with a range of patient, disease and nutrition-related factors implicated. Sepsis is of particular importance, as is the lack of enteral nutrition and overfeeding with intravenous glucose and/or lipid. Deficiencies of a number of amino acids including choline and taurine have also been implicated. Management of hepatic dysfunction in parenteral nutrition should initially focus on preventing its occurrence. Sepsis should be managed appropriately, enteral nutrition should be encouraged and maximised where possible and parenteral overfeeding should be avoided. Provision of parenteral lipid should be optimised to prevent the adverse effects of both deficiency and excess, and cyclical rather than continuous parenteral feeding should be administered. There is some evidence of benefit in neonates from oral antibiotics to prevent intestinal bacterial overgrowth and from oral ursodeoxycholic acid, but less to support their use in adults. Similarly, data to support widespread use of parenteral choline or taurine supplementation are lacking at present. Ultimately, severe parenteral nutrition-associated liver disease may necessitate referral for small intestine and/or liver transplantation.

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Choline Deficiency Causes Reversible Hepatic Abnormalities in Patients Receiving Parenteral Nutrition: Proof of a Human Choline Requirement: A Placebo‐Controlled Trial

Abstract: Choline deficiency is a significant contributor to the development of TPN-associated liver disease. The data suggest choline is a required nutrient for long-term home TPN patients.

Cited by 213 publications

References 60 publications

Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability

Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability

Review article: the management of long‐term parenteral nutrition

Managing liver dysfunction in parenteral nutrition

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