What have low plasma choline levels in long term PN patients been associated with?

What have low plasma choline levels in long term PN patients been associated with?

• A. Elevated liver aminotransferase concentrations
• B. Decreased bilirubin levels
• C. Improved liver function
• D. No change in liver enzymes

Answer: (A)

Choline acts as a lipotropic nutrient, essential for assembling triglycerides into VLDL for export from the liver. In long-term parenteral nutrition, inadequate choline impairs this export, leading to hepatic fat accumulation (steatosis) and hepatocellular injury. That injury is reflected by increases in liver enzymes, such as AST and ALT. Therefore, low plasma choline levels in these patients are associated with elevated liver aminotransferase concentrations. The other possibilities don’t fit this pattern: decreased bilirubin would not typically accompany choline deficiency-induced liver injury, and an overall improvement or no change in liver enzymes would contradict the expected hepatocellular injury seen with insufficient choline.

Choline acts as a lipotropic nutrient, essential for assembling triglycerides into VLDL for export from the liver. In long-term parenteral nutrition, inadequate choline impairs this export, leading to hepatic fat accumulation (steatosis) and hepatocellular injury. That injury is reflected by increases in liver enzymes, such as AST and ALT. Therefore, low plasma choline levels in these patients are associated with elevated liver aminotransferase concentrations. The other possibilities don’t fit this pattern: decreased bilirubin would not typically accompany choline deficiency-induced liver injury, and an overall improvement or no change in liver enzymes would contradict the expected hepatocellular injury seen with insufficient choline.