Choline deficiency: A cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation

  title={Choline deficiency: A cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation},
  author={Alan L. Buchman and Mark Dubin and Adib A. Moukarzel and Donald J. Jenden and Margareth Roch and Kathleen M. Rice and Jeffrey Gornbein and Marvin E. Ament},
Patients receiving long‐term total parenteral nutrition (TPN) develop hepatic steatosis as a complication. Our previous studies have shown this to be caused, at least in part, by choline deficiency. We studied four patients (1 man, 3 women) aged 50 ± 13 years who had low plasma‐free choline concentrations 4.8 ± 1.7 (normal, 11.4 ± 3.7 nmol/mL). The patients had received TPN for 9.7 ± 4.7 years. They received parenteral nutrition solutions containing choline chloride (1 to 4 g/d) for 6 weeks… 

Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial.

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

Plasma choline concentrations in children requiring long-term home parenteral nutrition: a case control study.

The data support the notion that patients who need long-term HPN without significant enteral feeding have a significant risk for the development of choline deficiency with its associated hepatic dysfunction.

Whole-blood–free Choline and Choline Metabolites in Infants Who Require Chronic Parenteral Nutrition Therapy

Examination of the status of FCho and related metabolites in infants on prolonged (≥4 weeks) PN suggested possible evidence of choline deficiency as illustrated by decreased whole-blood PCho, which should be investigated in infants who require prolonged PN.

Oral Choline Supplementation in Children With Intestinal Failure

This unblinded, open-label study studied 7 children with IF on parenteral nutrition, measured their plasma free choline level, and, if low, supplemented enterally with adequate intake (AI) doses of choline, finding infants did not respond to oral choline supplementation at AI doses.

Essential nature of choline with implications for total parenteral nutrition.

  • E. Shronts
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    Journal of the American Dietetic Association
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Changes in plasma free and phospholipid-bound choline concentrations in chronic hemodialysis patients.

  • A. BuchmanD. JendenW. SukiM. Roch
  • Medicine, Biology
    Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
  • 2000
Plasma free choline concentration is elevated before dialysis, and choline is lost to a significant degree in the dialysate, and the choline homeostatic mechanism requires further investigation in renal failure patients.

Parenteral nutrition-associated liver disease in adult and pediatric patients.

  • V. Kumpf
  • Medicine
    Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 2006
Modifications to the PN regimen that may be helpful include reduction of calories, reduction of IVFE dose to <1 g/kg/d, supplementation of taurine in the infant, and use of cyclic infusion.

Choline deficiency is associated with increased risk for venous catheter thrombosis.

Choline deficiency is a significant risk factor for development of catheter thrombosis in patients with intestinal failure who require long-term parenteral nutrition.

Serum B12 Concentration Is Elevated in Patients Receiving Chronic Parenteral Nutrition, But Is Not a Marker of Intestinal Failure-Associated Liver Disease

Elevated serum B12 concentration is commonly encountered in patients who receive long-term parenteral nutrition and does not seem to be an indicator of hepatic pathology; rather it may reflect the provision of excessive intravenous vitamin B12 and other as yet unknown factors.

Preservation of liver function in intestinal failure patients treated with long-term total parenteral nutrition

Parenteral nutrition can be a life-saving therapy for patients with short bowel syndrome; however, its long-term use can be limited by hepatic complications, and conservative measures have a role in management, they are often ineffective once advanced liver disease has developed.



Plasma choline concentration in humans fed parenterally.

It is concluded that malnourished humans who eat no choline have diminished stores of plasma (and possibly tissue) choline.

Plasma Amino Acid Concentrations in Children Receiving Long‐Term Parenteral Nutrition

The data indicate that children receiving long-term parenteral nutrition will develop abnormalities in their plasma amino acid concentrations even though they appear to receive adequate amounts of amino acids in their intravenous solutions.

Choline pharmacokinetics during intermittent intravenous choline infusion in human subjects

A study of choline pharmacokinetics was undertaken in four patients receiving long‐term total parenteral nutrition in which the data fit a two‐compartment model in which elimination from the central compartment was saturable significantly better than a one‐compartments model in all four subjects.

Serum hepatic enzyme and bilirubin elevations during parenteral nutrition.

Serial liver enzyme and bilirubin concentrations were measured in 100 patients undergoing total parenteral nutrition and infusion of tryptophan conversion products into rats resulted in periportal fatty change of the livers identical to that seen in patients receiving total paretteralnutrition.

Plasma concentrations of transsulfuration pathway products during nasoenteral and intravenous hyperalimentation of malnourished patients.

The data suggest that biosynthesis of several products of the transsulfuration pathway may be inadequate in both cirrhotic and noncirrhotic patients during TPN with FreAmine III.

Modern nutrition in health and disease

The concept of nutrition as a clinical subject has reached maturity and is well presented in an excellent book edited by two prominent nutritionists, Drs.

The relation of liver fat to computed tomography numbers: a preliminary experimental study in rabbits.

The relation of liver fat content to CT number was studied in rabbits, where fatty degeneration was produced by carbon tetrachloride (CCl4) ingestion, and changes (decrease) in CT number were compared with triglyceride, water, and protein content of resected livers.

Difference between liver and spleen CT numbers in the normal adult: its usefulness in predicting the presence of diffuse liver disease.

A constant relationship was found between the mean CT numbers of the liver and spleen in 100 normal adults; the fatty liver will exhibit a lower mean CT number than the spleen, which may be useful in the clinical setting in which a normal liver with low CT numbers must be differentiated from one in which the CT number is low because of fatty infiltration.

Choline and phospholipid metabolism and the synthesis of acetylcholine in rat brain

The metabolism of choline by rat brain, plasma, and liver was investigated using combined gas chromatography mass spectrometry following microwave irradiation and treatment with deuterium‐labeled