Liver complications of total parenteral nutrition: the latest therapeutic strategies

Total parenteral nutrition (TPN) is a life-saving nutritional therapy in conditions where enteral nutrition is contraindicated or inadequate. However, it has been associated with side effects, one of which is parenteral nutrition-associated liver damage (PNALD). The main features of PNALD are cholestasis, fatty liver disease, and early fibrosis, followed by disease progression, cirrhosis, and liver failure. Risk factors for parenterally fed patients include short bowel syndrome, bacterial overgrowth and translocation, disturbances in hepatobiliary circulation and lack of enteral nutrition, and the choice of an inappropriate fat mixture. The source of the oil present in lipid emulsions is believed to play an important role in the development of long-term complications.This review analyzes the current literature and research on the pathogenesis of PNALD. Likewise, possible options for preventing this complication were discussed.

Automated summary

Total parenteral nutrition (TPN) is a life-saving nutritional therapy used when enteral nutrition is not possible or sufficient. However, it can cause parenteral nutrition-associated liver damage (PNALD) as a side effect. Risk factors for PNALD in parenterally fed patients include short bowel syndrome, bacterial overgrowth and translocation, disturbances in hepatobiliary circulation, lack of enteral nutrition, and the use of inappropriate fat mixtures. This review explores the pathogenesis of PNALD and discusses possible options for prevention.