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Increased incidence of cholestasis during total parenteral nutrition in children--factors affecting stone formation
1Department of Pediatric Surgery, Kurume University School of Medicine, Japan.
Insights
Gallstones are rare in children, but total parenteral nutrition (TPN) can increase risk. High amino acid and non-protein intake with low fat during TPN is linked to gallstone formation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Nutrition
Background:
- Cholelithiasis (gallstones) is uncommon in pediatric populations.
- Emerging evidence links gallstone formation to total parenteral nutrition (TPN) in children.
Purpose of the Study:
- To prospectively investigate the incidence of cholelithiasis in pediatric patients receiving TPN.
- To identify nutritional factors associated with gallstone and sludge formation during TPN.
Main Methods:
- Prospective evaluation of 400 children undergoing TPN.
- Ultrasonography used to detect gallstones and sludge.
- Detailed analysis of nutrient intake, including amino acids, fat, and non-protein calories.
Main Results:
- Eight children (2%) developed cholelithiasis during TPN.
- Gallstone formation was associated with high amino acid intake (>= 1.8g/kg/day) and low fat intake (<= 1.7g/kg/day).
- A high ratio of non-protein to kcal/ml was also a risk factor.
Conclusions:
- High amino acid administration and a high non-protein:kcal/ml ratio during TPN increase the risk of gallstone and sludge formation in children.
- Adequate fat administration appears to be a preventive measure against TPN-associated cholelithiasis.
Abstract:
Cholelithiasis is extremely unusual in infants and children. Recently, some cases of cholelithiasis associated with total parenteral nutrition (TPN) have been reported. A group of 400 children receiving TPN were evaluated prospectively for the presence of gallstones and sludge in this report. Eight children (2%) were determined by ultrasonography to have developed cholelithiasis. All of these patients had received large amounts of amino acids (> or = 1.8g/kg/day) and relatively low amounts of fat (< or = 1.7g/kg/day) with a high ratio of non-protein: kcal/ml (> 0.8). It was concluded that the administration of large amounts of amino acids and a high ratio of non-protein: kcal/ml enhanced the risk for formation of gallstones and sludge. Conversely, these are prevented by the administration of appropriate amounts of fat.