Liver complications of total parenteral nutrition: the latest therapeutic strategies

Abstract

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.