Abstract
Parenteral nutrition (PN) provides life-saving nutritional support in situations where caloric supply via the enteral route cannot cover the necessary needs of the organism. However, it does have serious adverse effects, including parenteral nutrition-associated liver disease (PNALD). The development of liver injury associated with PN is multifactorial, including non-specific intestine inflammation, compromised intestinal permeability, and barrier function associated with increased bacterial translocation, primary and secondary cholangitis, cholelithiasis, short bowel syndrome, disturbance of hepatobiliary circulation, lack of enteral nutrition, shortage of some nutrients (proteins, essential fatty acids, choline, glycine, taurine, carnitine, etc.), and toxicity of components within the nutrition mixture itself (glucose, phytosterols, manganese, aluminium, etc.). Recently, an increasing number of studies have provided evidence that some of these factors are directly or indirectly associated with microbial dysbiosis in the intestine. In this review, we focus on PN-induced changes in the taxonomic and functional composition of the microbiome. We also discuss immune cell and microbial crosstalk during parenteral nutrition, and the implications for the onset and progression of PNALD. Finally, we provide an overview of recent advances in the therapeutic utilisation of pro- and prebiotics for the mitigation of PN-associated liver complications.
Highlights
Parenteral nutrition (PN) provides life-saving nutritional support in situations where caloric supply via the enteral route is either not possible or cannot cover the necessary needs of the organism, e.g., preterm neonates with immature gut, perioperatively in patients requiring massive intestinal surgery, or in patients with short bowel syndrome (SBS)
The development of liver injury associated with PN is multifactorial, including non-specific intestine inflammation, compromised intestinal permeability, and barrier function associated with increased bacterial translocation, primary and secondary cholangitis, cholelithiasis, short bowel syndrome, disturbance of hepatobiliary circulation, lack of enteral nutrition, shortage of some nutrients, and toxicity of components within the nutrition mixture itself
Based on the above facts, it is conceivable that the radical alteration of gut microbiome composition and function as a result of switching to total parenteral nutrition could lead to detrimental effects on the intestine and significantly contribute to parenteral nutrition-associated liver disease (PNALD) development
Summary
Parenteral nutrition (PN) provides life-saving nutritional support in situations where caloric supply via the enteral route is either not possible or cannot cover the necessary needs of the organism, e.g., preterm neonates with immature gut, perioperatively in patients requiring massive intestinal surgery, or in patients with short bowel syndrome (SBS). Risk factors include lack of choline, excess of calories, excess of lipids >1 g/kg/day, phytosterols, bowel inflammation, small bowel bacterial overgrowth, and absence of the ileo-caecal valve In both groups, sepsis is a significant complication. The pathogenesis of PNALD is undoubtedly a multifactorial phenomenon, the privileged role may be attributed to the impaired function of the intestine It harbours most of the immune cells in the body and represents the largest area for contact with antigens from the environment. Based on the above facts, it is conceivable that the radical alteration of gut microbiome composition and function as a result of switching to total parenteral nutrition could lead to detrimental effects on the intestine and significantly contribute to PNALD development
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