Component Of Total Parenteral Nutrition Research Articles

Are three different lipid combinations effective on the immune system in sepsis patients?

Objective: We aimed to to analyze the effect of the 3 different parenteral nutritions (MCT/LCT (long and midium chain fatty acids), LCT with omega-9 (ω-9) and MCT/LCT with ω-3 and ω-9 on the inflamatory cytokine levels in sepsis patients. This is the first study from the Southern part of Turkey. Patients and Methods: We included 30 patients, diagnosed with sepsis and took total parenteral nutrition in this study. Patients were divided into 3 randomized groups in terms of what parenteral nutrition have been taken. (Group A, B and C) Blood samples were taken and TNF-α, IL-1, IL-6 and IL-8 levels were evaluated. Adverse effects were recorded. TNF-α, IL-1β, IL-6, and IL-8 levels of were analyzed by ELISA method and each sample were studied in dublicate. Results: The median age of the patients included in the study was 52 and 24 (80%) of them were male. The SOFA score was 5 in study group. We examined IL-1, IL-6, IL-8 and TNF-α distribution on the day of the first, third and fifth days depending on time. The inflamatory cytokine levels were not found statistically significant (p > 0.05) when we compared the study groups via 3 different parenteral nutritions. Conclusion: When we compare MCT/LCT, LCT/ω-9 and MCT/LCT, ω-3, ω-9 which are given as a component of total parenteral nutrition we concluded that there was no superiority to others in terms of proinflamatory cytokin levels in sepsis and they didn’t increase proinflamatory cytokins. There is a need for more randomized controlled studies investigating the effect of lipids on the course of the disease in sepsis patients who cannot receive enteral nutrition and require TPN support.

Investigation of parenteral nutrition-induced hepatotoxicity using human liver spheroid co-cultures.

Parenteral nutrition (PN) is typically administered to individuals with gastrointestinal dysfunction, a contraindication for enteral feeding, and a need for nutritional therapy. When PN is the only energy source in patients, it is defined as total parenteral nutrition (TPN). TPN is a life-saving approach for different patient populations, both in infants and adults. However, despite numerous benefits, TPN can cause adverse effects, including metabolic disorders and liver injury. TPN-associated liver injury, known as intestinal failure-associated liver disease (IFALD), represents a significant problem affecting up to 90% of individuals receiving TPN. IFALD pathogenesis is complex, depending on the TPN components as well as on the patient's medical conditions. Despite numerous animal studies and clinical observations, the molecular mechanisms driving IFALD remain largely unknown. The present study was set up to elucidate the mechanisms underlying IFALD. For this purpose, human liver spheroid co-cultures were treated with a TPN mixture, followed by RNA sequencing analysis. Subsequently, following exposure to TPN and its single nutritional components, several key events of liver injury, including mitochondrial dysfunction, endoplasmic reticulum stress, oxidative stress, apoptosis, and lipid accumulation (steatosis), were studied using various techniques. It was found that prolonged exposure to TPN substantially changes the transcriptome profile of liver spheroids and affects multiple metabolic and signaling pathways contributing to liver injury. Moreover, TPN and its main components, especially lipid emulsion, induce changes in all key events measured and trigger steatosis.

Lipid emulsion rich in n–3 polyunsaturated fatty acids elicits a pro-resolution lipid mediator profile in mouse tissues and in human immune cells

Lipid emulsions are a key component of total parenteral nutrition (TPN) and are administered to patients who are unable to ingest their daily required calories orally. Lipid emulsions rich with n-6 (ω-6) PUFAs are known to cause parenteral nutrition-associated liver disease and have inflammatory side effects, whereas n-3 PUFA-rich emulsions have favourable clinical outcomes. The present study used targeted lipid mediator analysis to investigate the metabolism of a n-3 PUFA-rich lipid emulsion and a n-6 PUFA-rich lipid emulsion in a mouse model of TPN and in primary human monocyte-derived macrophages (MDMs) and CD4+ T cells. Mice given n-3 PUFA-based TPN for 7 d had a less proinflammatory lipid mediator profile compared with those receiving n-6 PUFA-based TPN. This was characterized by higher concentrations of specialized pro-resolving mediators (SPMs) and endocannabinoids, including resolvin D (RvD) 1, maresin (MaR) 1, MaR2, protectin D1 (PD1), protectin DX (PDX), and the endocannabinoids eicosapentaenoyl ethanolamide (EPEA) and docosahexaenoyl ethanolamide (DHEA) in the liver and RvD1, 17R-RvD1, RvD2, RvD3, RvD5, MaR1, MaR2, PD1, PDX, and EPEA and DHEA in the spleen. The spleen was identified as a source of high lipid mediator and SPM formation as lipid mediator concentrations were on average 25-fold higher than in the liver. Additionally, n-3 PUFA-treated primary human MDMs produced RvD5 and the endocannabinoids EPEA and DHEA, which was associated with an increased IL-10 secretion. In contrast, primary human CD4+ T cells showed only an increase in SPM precursors and an increase in the endocannabinoids EPEA and DHEA, which was associated with reduced cytokine expression. This demonstrates that lipid mediators, particularly SPMs and endocannabinoids from spleen, could play a key role in facilitating the favorable clinical outcomes associated with the use of n-3 PUFA-rich lipid emulsions in TPN.

The Effect of High Glucose Intake on Weight Gain in Very Low Birth Weight Neonates: A Randomized Controlled Trial.

This study aims at evaluating the effect of high glucose intake as a component of total parenteral nutrition on birth weight (BW) regain in very low birth weight neonates. Ninety newborns with BW <1500 g were randomized to control or experimental groups. Both groups received the same total parenteral nutrition regimens except glucose intake provided by dextrose water (DW) serum: 7 to 15 g/kg/d (10% DW) in the former versus 8.75 to 18.75 g/kg/d (12.5% DW) in the latter. Body weight as the primary outcome was monitored until the BW was regained. Results revealed that neonates who received 12.5% DW regained BW significantly faster (10.98 ± 2.46 vs 13.24 ± 4.03 days, P = .024) and needed lesser duration of respiratory support (5.34 ± 2.11 vs 7.17 ± 3.19 days, P = .003). As the proposed intervention can reduce neonatal intensive care unit admission duration, it mitigates risks of health care-associated infections, while favorably affecting the health economy.

Impact of Parenteral Lipid Emulsion Components on Cholestatic Liver Disease in Neonates

Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are at risk for the development of liver injury in the form of parenteral nutrition associated cholestasis (PNAC). Current research suggests the lipid component of TPN is a factor in the development of PNAC. Most notably, the fatty acid composition, vitamin E concentration, and presence of phytosterols are believed key mediators of lipid emulsion driven PNAC development. New emulsions comprised of fish oil and medium chain triglycerides show promise for reducing the incidence of PNAC in infants. In this review we will cover the current clinical studies on the benefit of fish oil and medium chain triglyceride containing lipid emulsions on the development of PNAC, the current constituents of lipid emulsions that may modulate the prevalence of PNAC, and potential new supplements to TPN to further reduce the incidence of PNAC.

P038 Anaphylaxis to intralipid after bone marrow transplant

Intralipid, an essential component of total parenteral nutrition (TPN), is a fat emulsion containing soybean oil and egg yolk phospholipids. Allergic reactions to intralipid have been described in case reports, but are very rare. In addition, there are case reports of transplant acquired food allergy transferred after bone marrow or liver transplants from a food allergic donor to a non-allergic recipient. We report a case of anaphylaxis to intralipid in a child who has received a bone marrow transplant.

Enteral nutrition and total parenteral nutrition components in the course of total parenteral nutrition–associated cholestasis in neonatal necrotizing enterocolitis

Newborns with necrotizing enterocolitis (NEC) are at high risk for the development of total parenteral nutritional-associated cholestasis (TPNAC). Patients with NEC were evaluated to determine risk factors for development of TPNAC and predictors of resolution. We hypothesized that there are additional factors relating to the timing of enteral nutrition or TPN components that effect development and persistence of TPNAC in patients with NEC that may be altered to decrease the chance of progression to liver failure. This was a retrospective chart review of NEC patients from 2001 to 2010. TPNAC was defined as direct bilirubin ≥2mg/dL, the level used for cholestasis in neonatal studies relating to TPNAC. Of 178 patients with NEC, 96 developed TPNAC, and in 27 TPNAC had resolved by discharge. Days of TPN did not affect TPNAC resolution by discharge (P=1.0). TPNAC was less likely to occur in patients with body weights >1,500g, enteral nutrition within the first week of life, no infection, fewer TPN days, and lesser hospital stay (P<.01). There were many factors affecting resolution of cholestasis. Enteral nutrition within 6days of birth decreased development of TPNAC (P<.01), and resumption of enteral nutrition within 3weeks after NEC diagnosis increased the resolution of cholestasis (P<.01). No component of TPN was important for the development or resolution of cholestasis. Of the factors that effect development and resolution of TPNAC in NEC, the ones that we can alter include early enteral feeds and surveillance for infection.

PS-035 The use of a different amino acid solution in total parenteral nutrition mixtures for critical newborns

BackgroundAt the request of the intensive neonatal care unit, in order to give the babies less fluid, we replaced the usual amino acid mixture TPH 6% with Primene 10%. After...

Complications of treatment in the neonatal period

The lifesaving therapies and procedures used in the care of neonates may result in untoward effects and complications. Retinitis of prematurity (ROP) may present as a spectrum of disease ranging from spontaneously resolving vasculopathy to retinal detachment and blindness. Total parenteral nutrition (TPN) is found in 40–60% of infants requiring prolonged intravenous feeding for intestinal failure. Host factors combined with deleterious components of TPN play a role. There is cholestasis, steatosis, portal inflammation and oedema, ductopenia and fibrosis. Sudden unexpected death (SUD) is the typical presentation of cardiac tamponade due to TPN solution entering the pericardial sac. Arterial cannulation for frequent blood pressure monitoring and blood sampling may be complicated by vasospasm, thrombosis, haematoma, infection, breakage, migration, displacement, peripheral nerve damage, ischaemia and tissue necrosis. The immature central nervous system is particularly susceptible to cerebrovascular damage. Periventricular leukomalacia (PML) with destruction of white matter and severe germinal matrix haemorrhage with intraventricular rupture and infarction may occur. Bronchopulmonary dysplasia (BPD) in the post-surfactant era is confined to very low birth weight infants. There is disturbed alveogenesis with large and simplified airspaces, interstitial fibrosis, and disruption of microvascular development.

Reduction in newborn screening metabolic false-positive results following a new collection protocol

Newborn screening includes testing for many metabolic diseases. False-positive results are higher among neonatal intensive care unit infants, resulting in increased confirmatory testing and family stress. Amino acid administration as a component of total parenteral nutrition is commonly used in the neonatal intensive care unit and suggested as a factor increasing false-positive results. The purpose of this study was to investigate the impact of a new sample collection protocol on false-positive results. This was a 2-year retrospective cohort study. Infants were grouped by birth year into pre- and postprotocol implementation and stratified by birth weight category. In 2010, newborn screening samples were collected from all infants regardless of total parenteral nutrition administration. In 2011, the protocol was changed, and total parenteral nutrition was replaced with 10% dextrose in water (D10W) for 3 h before sample collection. Data from 539 neonatal intensive care unit admissions were reviewed. The new protocol reduced false-positive results for each birth weight group by at least 50% and overall by 74% (P = 0.008). The odds of having a false-positive result preintervention were 3.87 times higher than postintervention. The protocol reduced estimated costs by >80%. A protocol interrupting total parenteral nutrition for 3 h before newborn screening collection resulted in a 74% reduction in false-positive results in a neonatal intensive care unit.

Successful treatment of permethrin toxicosis in two cats with an intravenous lipid administration

The present work describes successful treatment of permethrin toxicosis in two cats with a novel therapy of intravenous lipid administration. Two cats presented in lateral recumbency and with generalized tremor after they had been incidentally treated with permethrin for flea control by their owners. Initial therapy consisted of diazepam, propofol, bathing, and intravenous fluids. After an initial bolus of 2mg/kg BW pentobarbital a pentobarbital continuous rate infusion (CRI) was started. Both cats received an emulsion of 20% soybean oil and 80% olive oil, commonly used as fat component of total parenteral nutrition in humans, later in the course of therapy. A bolus of 2 ml/kg BW of the emulsion followed by a CRI of 4 ml/kg BW/h for 4 hours was administered via a jugular catheter as reported previously. One cat received two cycles of therapy with intravenous lipid whereas the other cat needed just one application. Both cats recovered completely without requiring any further treatment. In conclusion, administration of intravenous lipids for permethrin toxicosis in cats is a novel treatment approach which seems to be highly effective in shortening the recovery time for permethrin toxicosis and possibly other fat-soluble toxins.

Glycerophosphate Does Not Interact with Components of Parenteral Nutrition

Background/Aims: The primary objective of this study was to determine and compare the pharmacokinetic (PK) profiles of inorganic phosphate in the serum after continuous administration of pure glycerophosphate and glycerophosphate contained in total parenteral nutrition (TPN) emulsions. This approach was selected to identify potential PK interactions between TPN components and glycerophosphate. Methods: The serum PK profile of inorganic phosphate after continuous intravenous administration of a sodium glycerophosphate containing TPN emulsion was determined in 10 healthy, white (5 male/5 female) volunteers. A pure sodium glycerophosphate formulation served as reference. Standard criteria of bioequivalence were applied. Subjects were enrolled in the double-blinded study and were randomly allocated to receive the test and reference preparations on two occasions in a 2-sequence crossover study design. The volunteers received 1/3 of the maximum recommended body weight- (BW) adjusted intravenous daily dosage (13.3 ml/kg BW) of the test drug over a period of 8 h. The amount of total phosphate (0.101 mmol/kg) and duration of administration were identical for the test and reference drugs. Study days were separated by washout periods of at least 88 h. Serum concentrations of total inorganic phosphate were measured serially over a 36-hour period using a validated method. A statistical mixed ANOVA, based on population averages, was used for testing bioequivalence between these study preparations. Results: The 90% confidence intervals (90% CIs) of inorganic phosphate in serum were calculated for the test/reference ratios of the area under the time-concentration curve from time 0 to 36 h (AUC_0–36), the maximum concentration (C_max) and the concentration 5 min before the end of infusion (C_ss) for a bioequivalence range from 0.80 to 1.25. The mean test/reference ratios fell completely within the 90% CIs with values of 1.016 (90% CI 1.005–1.028), 1.013 (90% CI 0.981–1.047) and 0.932 (90% CI 0.886–0.980) for AUC_0–36, C_max and C_ss, respectively. In total, 3 mild adverse events in the reference group were detected after starting intravenous infusion, while no adverse events were observed in the test group after treatment. Conclusion: Primary PK parameters were within the defined bioequivalence range of 0.8–1.25. Thus, inorganic phosphate levels were essentially similar between the two investigational medicinal products tested in the present study. These findings confirm the concept that nutritional components of the test drug do not significantly interact with glycerophosphate. The two study preparations proved to be safe during the investigation.

Detection of TPN contamination of dried blood spots used in newborn and metabolic screening and its impact on quantitative measurement of amino acids

BackgroundMarkers derived from dextrose (d-glucose) are observed in the MS/MS-based acylcarnitine profiles from dried-blood spots of some premature infants receiving intravenous nutrition. The presence of these markers at m/z 325, 399 and 473 are thought to arise from contamination of blood by total parenteral nutrition (TPN) solutions during specimen collection from premature infants. These solutions contain high concentrations of amino acids and as a result, false-positive screening results for amino acid disorders may occur. This study investigates quantitative parameters of dextrose and amino acids in blood samples enriched with different TPN solutions. MethodsWhole blood collected in heparin was enriched with three different TPN solutions containing 5, 10 or 12.5% dextrose and amino acids that were originally prepared for delivery of 2.5, 3 or 4g/kg/day of Premasol® then spotted onto filter paper cards. Acylcarnitine and amino acid profiles using MS/MS were obtained. Ion ratios of dextrose relative to specific acylcarnitine stable isotope internal standards and amino acid concentrations were obtained. ResultsThe ion ratios for each of the dextrose markers at m/z 325, 399 and 473 exhibit linearity with the concentration of the dextrose component of TPN added to blood. The lowest detectable dextrose concentration added to blood was 7.6mmol/l at 1:80v/v TPN in blood. Furthermore, the concentrations of amino acids were linear with the concentration of the amino acid component of TPN added to blood. At the lowest detectable concentrations of dextrose marker, the amino acid concentrations were at or above the values considered abnormal in newborn screening laboratories. The molar ratios of amino acids approached the relative quantity of amino acid in the TPN solution with increasing enrichments in blood. ConclusionsDetection of the combinations of dextrose markers, very high elevations of amino acids and unusual molar ratios can be used to reject a specimen as improperly collected rather than declaring it a false positive and hence reduce false positive rates. This process enhances efficiency, reduces parental anxiety, and improves positive predictive values.

Effects of Light Exposure on Total Parenteral Nutrition and its Implications in the Neonatal Population

Total parenteral nutrition (TPN) is a necessary form of nutrition in neonates with functional or anatomical disruption of the digestive tract. However, laboratory and human investigation have shown that exposure of the TPN solution to light causes the formation of peroxides and other degradation products that are quantifiable in experimental TPN solutions, laboratory animals, and neonates. Premature neonates are at a higher risk for the development and progression of peroxide damage due to their relative lack of antioxidant and free radical scavenger reserves. Furthermore, cell damage seen in a number of neonatal disease states is exacerbated by the presence of peroxides that are generated via intrinsic pathologic processes and from exogenous sources such as TPN. Numerous studies show that the formation of TPN photodegradation products can be slowed or prevented by the application of various light protection mechanisms. While it is not yet known if minimizing TPN associated photodegradation byproducts has a significant direct effect on preventing or mitigating the overall clinical course of some neonatal disease states, it is becoming increasingly clear that light protecting TPN can avoid specific metabolic complications in neonatal patients. It is prudent to implement mechanisms that prevent photodegradation of TPN components from the manufacturer source to the point of patient administration.

Neonatal nutrition: a brief review

With increasing survival of extremely premature infants, emphasis is now focused on the quality of these survivors' lives. Possibly the most important factor in the premature's ability to survive in the NICU and thrive is the ability to replicate in utero growth through enteral and parenteral nutrition. Current literature and review articles were retrieved from PubMed and personal files of the authors. The use and complications of the various components of total parenteral nutrition (TPN) were reviewed. The composition of appropriate enteral feeds for the premature was reviewed as was the difficulties associated with the establishment of adequate enteral feeds in the premature infants. Early initiation of amino acids in TPN and timely increases in the components of TPN can improve the caloric intake of prematures. Enteral feeds, particularly of breast milk, may be started within the first few days of life in all but hemodynamically unstable prematures. Newer lipid preparations show promise in reversing the hepatic damage of TPN associated cholestatic jaundice.

Branched chain amino acids as the protein component of parenteral nutrition in cancer cachexia

A prospective randomized trial was conducted to determine the effects of branched chain amino acids (BCAA) as the protein component of total parenteral nutrition (TPN) on protein kinetics in patients with intraabdominal adenocarcinoma. Nine malnourished patients were given both conventional TPN containing 19 per cent BCAA (AA) and isocaloric, isonitrogenous TPN containing 50 per cent BCAA (BCAA-TPN), in random order. Both [13C]leucine and [14C]tyrosine were employed as tracers to avoid the potential bias due to the different amino acid composition of the two TPN solutions. With BCAA-TPN, leucine and tyrosine flux increased significantly from (mean +/- s.d.) 158.0 +/- 37.2 to 243.5 +/- 75.8 mumol kg-1 h-1 (P less than 0.025) and from 35.0 +/- 8.4 to 42.6 +/- 11.0 mumol kg-1 h-1 (P less than 0.05) respectively. Leucine oxidation was significantly higher on BCAA-TPN (24.1 +/- 6.3 on AA versus 68.3 +/- 37.1 mumol kg-1 h-1, P less than 0.025) while tyrosine oxidation was significantly lower (3.7 +/- 1.8 mumol kg-1 h-1 on AA versus 2.5 +/- 2.0 mumol kg-1 h-1 on BCAA-TPN, P less than 0.05). Whole body protein synthesis and breakdown was significantly higher on BCAA-TPN by the tyrosine tracer (31.3 +/- 7.3 on AA versus 40.1 +/- 9.3 mumol kg-1 h-1, P less than 0.025 and 33.0 +/- 8.4 on AA versus 41.3 +/- 11.1 mumol kg-1 h-1, P less than 0.05) respectively. Using the leucine tracers both synthesis and breakdown were increased, but not significantly, from 133.8 +/- 40.0 to 175.3 +/- 65.1 mumol kg-1 h-1 and from 127.9 +/- 33.6 to 167.7 +/- 71.2 mumol kg-1 h-1 respectively. The fractional albumin synthetic rate increased significantly on BCAA-TPN from 4.3 +/- 2.9 on AA to 8.0 +/- 5.1 per cent per day (P less than 0.05). The reduction in tyrosine oxidation, suggesting improved protein utilization, coupled with an increase in protein and albumin synthesis, strongly support a positive benefit from BCAA-TPN in cancer cachexia.

Effect of coadministration of parenteral multivitamins with lipid emulsion on lung remodeling in an animal model of total parenteral nutrition

Exposure of parenteral multivitamin solutions (MVP) to ambient light generates peroxides and vitamin loss, and induces initiation of fibrosis and a reduced alveolar count in an animal model of total parenteral nutrition (TPN). Adding MVP to the lipid moiety of TPN prevents lipid peroxidation and vitamin loss. The aim of the study was to compare modes of delivery of MVP on lung procollagen mRNA and alveolar counts. Three-day-old guinea pig pups were infused continuously with one of three intravenous solutions: 1) control = dextrose; 2) AA + MVP = MVP given with the dextrose + amino-acid moiety, in a "piggyback" setup with a lipid emulsion mixed close to the infusion site; and 3) LIP + MVP = same as AA + MVP, except that MVP is given with the lipid emulsion. After 4 days, lungs were prepared for alveolar count (intercept technique) and for quantification of the procollagen/beta-actin mRNA ratio (initial step of fibrosis). Data were compared by ANOVA. The procollagen mRNA was lower (P < 0.05) in animals receiving LIP + MVP than those with AA + MVP. But the two modes of admixture of MVP had the same effect on the alveolar counts, which were lower (P < 0.01) than controls. The mode of delivery of TPN affects lung remodeling. Although LIP + MVP protects against the initiation of lung fibrosis, the absence of a beneficial effect on alveolar counts suggests that these features of lung remodeling are not caused by a unique component of TPN. Specific roles of peroxides, components of MVP, and light exposure on lung remodeling need to be explored before LIP + MVP can be recommended as an alternative mode of parenteral vitamin delivery.

Modulation of immune cell function by polyunsaturated fatty acids

The n-3 and n-6 polyunsaturated fatty acids (PUFAs) are essential dietary constituents. They are important as a source of energy, as structural components of cell membranes, and as signalling molecules. They have been demonstrated to be potent modulators of the immune response, and research has endeavoured to optimise the ratio of n-3 to n-6 PUFAs in the lipid component of total parenteral nutrition (TPN) to optimise their beneficial effects in the clinical setting. Critically ill neonates on TPN have an increased incidence of sepsis, and additional studies have determined that lipid emulsions depress various elements of cellular immune responses in monocytes, lymphocytes, and neutrophils. It has been proposed that PUFAs may mediate their manifold effects through the modification of eicosanoid production and by directly or indirectly modifying intracellular signal transduction pathways, including the alteration of gene transcription, in various tissues. They are susceptible to lipid peroxidation, and there is evidence that the products of this process may result in cell death by apoptosis, a nonphlogistic homeostatic process of cell deletion. PUFAs have been shown to induce apoptosis in primary lymphocytes, colonic mucosal cells, and various cell lines. Additionally, our laboratory has shown them to be potent inducers of apoptosis in neonatal monocytes. This may represent a novel mechanism whereby PUFAs may modify the immune response.

Total parenteral nutrition for premature infants 1,2,3

In the late 1970s the age of viability was approximately 28 weeks’ gestation. Most infants less than 1,000 grams and some less than 1,500 grams were considered nonviable, therefore, resuscitation attempts were less aggressive. Advancing technology has led to improvements in ventilators, intravenous access materials, and surfactant therapy; have all had an impact on lowering the age of viability. It is not unusual today to resuscitate infants as young as 22 weeks’ gestation. One of the major obstacles in the care of babies on the edge of viability is to provide adequate nutritional intake. This article discusses the importance of adequate nutrition, reviews the components of total parenteral nutrition (TPN), and makes suggestions concerning initiation of enteral feedings for premature infants.

Effects of lipid administration on liver apoptotic signals in a mouse model of total parenteral nutrition (TPN).

Lipids are an important component of total parenteral nutrition (TPN), contributing the largest caloric load per volume of solution and providing essential fatty acids necessary for survival. However, lipids are known to be causative factors in oxidative stress, which are expressed via the Bcl-2 family of proteins and/or Fas-mediated apoptosis in several tissues. Interestingly, we have recently observed an increase in hepatocyte apoptosis with administration of TPN. To address the mechanism of this apoptosis, we investigated the effects of parenteral lipid administration on apoptotic signaling in a mouse model. C57BL/6J male mice received physiologic saline and standard chow (control) or standard TPN solution with (TPN+L) or without lipid (TPN-L) emulsion. After 7 days of infusion, apoptosis increased in the TPN+L at a significantly higher rate compared with control and TPN-L groups ( p<0.05). Both TPN, with and without lipids, suppressed the pro-apoptotic signals Bid and Bcl-xs ( p<0.05). In contrast, TPN with lipid increased the expression of Fas and both the pro-apoptotic factor Bad and the anti-apoptotic factor Bcl-xl ( p<0.05). These changes may contribute to TPN-induced hepatocyte injury (apoptosis) or suppress the ability of liver hepatocytes to regenerate.