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. Abdominal computed tomography (CT) was performed at baseline, biweekly during the
choline supplementation, and 4 weeks after discontinuation of
choline. During
choline administration, the plasma-free
choline concentration increased into the normal range within 1 week in all four patients and remained at or above the normal range for all 6 weeks, but decreased back to baseline when
choline supplementation was discontinued. Hepatic steatosis resolved completely, as estimated by CT. Liver density increased from -14.2 +/- 22.3 Hounsfield units (HU) to 8.4 +/- 10.3 HU at week 2 (P = .002); 9.6 +/- 10.7 HU at week 4 and 13.1 +/- 7.3 HU at week 6, as determined by the liver-spleen CT number difference obtained by the subtraction of the average spleen CT number (in HU) from the average liver CT number. This improvement continued up to 4 weeks after
choline supplementation (13.8 +/- 2.8 HU). Hepatic steatosis was shown to have recurred in one patient after 10 weeks of return to
choline-free
parenteral nutrition. The hepatic steatosis associated with
parenteral nutrition can be ameliorated, and possibly prevented, with
choline supplementation. Therefore,
choline may be an essential nutrient for patients who require long-term
parenteral nutrition.