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Lecithin increases plasma free choline and
decreases hepatic steatosis in long-term total parenteral nutrition
patients.
Buchman AL,
Dubin M,
Jenden D,
Moukarzel A, Roch MH,
Rice K,
Gornbein J,
Ament ME,
Eckhert CD.
Division of Pediatric
Gastroenterology and Nutrition, UCLA Medical Center.
Plasma-free choline levels have previously been found below normal
in patients receiving long term parenteral nutrition (TPN). In a
group of 15 patients receiving home TPN who had low plasma free
choline levels (6.3 +/- 0.8 mmol/L), we found 50% had hepatic
steatosis. These patients were given oral lecithin or placebo in a
double-blind randomized trial for 6 weeks. Lecithin supplementation
led to an increase in plasma free choline of 53.4% +/- 15.4% at 2
weeks (P = 0.04), which continued at 6 weeks. The placebo group had
no change in plasma-free choline at 2 weeks, but a significant
decrease of 25.4% +/- 7.1% (P = 0.01) at 6 weeks. A significant and
progressive decrease in hepatic fat was indicated by increased
liver-spleen CT Hounsfield units at 2 and 6 weeks (7.5 +/- 1.7
units, P = 0.02; 13.8 +/- 3.5 units, P = 0.03) in the lecithin
supplemental group. Nonsignificant changes were seen in the placebo
group. It was concluded that hepatic steatosis in many patients
receiving long term TPN is caused by plasma-free choline deficiency
and may be reversed with lecithin supplementation. Choline is a
conditionally essential nutrient in this population.
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