Abnormal liver function tests in the parenteral nutrition fed patient

Area of Science:

• Gastroenterology
• Pediatric Hepatology
• Clinical Nutrition

Background:

• Parenteral nutrition (PN) is frequently associated with liver dysfunction, particularly in neonates and infants.
• While short-term PN-induced liver issues are often transient, long-term use can lead to severe liver damage and end-stage liver disease.
• The complex etiology involves numerous patient-specific and nutrition-related factors, making intestinal failure-associated liver disease (IFALD) a more fitting term than PN-associated liver disease.

Purpose of the Study:

• To discuss the multifactorial causes of liver dysfunction in patients receiving parenteral nutrition.
• To highlight the importance of preventative measures and current management strategies for intestinal failure-associated liver disease (IFALD).
• To review the evidence for specific nutritional interventions and treatments in IFALD.

Main Methods:

• Literature review and synthesis of current evidence on PN-induced liver disease.
• Analysis of etiological factors, including patient-related and nutrition-related aspects.
• Evaluation of therapeutic interventions and preventative strategies for IFALD.

Main Results:

• IFALD is a complex condition influenced by various factors, necessitating a shift in terminology from PN-associated liver disease.
• Preventative strategies include managing sepsis, avoiding overfeeding, using cyclical PN, and promoting enteral nutrition.
• Modifying lipid emulsions (reducing soybean oil, considering alternatives like fish oil) and limited evidence for choline/taurine supplementation are discussed.

Conclusions:

• IFALD prevention is paramount, focusing on optimizing PN delivery and enteral nutrition support.
• Management involves careful selection of lipid emulsions and consideration of adjunct therapies like oral antibiotics and ursodeoxycholic acid.
• Severe IFALD may ultimately require intestinal and/or liver transplantation.