Corporate Symposium: Addressing Choline Deficiency in Intestinal Failure: Clinical Implications and Management Strategies for Patients Dependent on Parenteral Support

Dinner Buffet will be available beginning at 7:00PM.

Learning Objectives

At the conclusion of this session, participants will be able to:

1. Identify the essential role of choline in human metabolism and recognize the prevalence of choline deficiency in patients dependent on parenteral support.
2. Evaluate the clinical consequences of choline deficiency, particularly hepatic steatosis, cholestasis, and liver dysfunction, cognitive decline and impact on muscle function in pediatric and adult patients on parenteral support.
3. Implement evidence-based strategies for assessing the use of choline in patients dependent on parenteral support.

Statement of Need/Rationale

Choline is an essential nutrient that is critical for cell membrane integrity, neurotransmitter synthesis, DNA repair, and lipid transport and metabolism. Despite its classification as an essential nutrient by the Institute of Medicine in 1998, choline is not included in parenteral nutrition formulations. Recent research indicates that 78% of patients dependent on parenteral support are choline-deficient, with 63% of these patients demonstrating liver dysfunction, including steatosis, cholestasis, and hepatobiliary injury. This underscores a significant gap in current clinical practice.

The American Society for Parenteral and Enteral Nutrition (ASPEN) has recommended that choline be should be included in parenteral support products; ASPEN has defined choline as critical for all infants requiring parenteral support, yet studies on parenteral choline administration in neonates and older children remain insufficient. Phosphatidylcholine and sphingomyelin, containing a choline headgroup, are constitutive membrane phospholipids accounting for >85% of total choline, indicating particularly high requirements during growth.

Currently there are no approved choline products in the US or globally for intravenous use as a source of choline. These patients are or may become choline deficient, which represents a significant unmet medical need for this population. Evidence has demonstrated that choline deficiency contributes to liver injury during dependence on parenteral support, and supplementation can ameliorate and possibly prevent this complication.

This educational session aims to address the need for greater awareness and understanding of the role of choline and choline deficiency in both pediatric and adult populations on parenteral support, with emphasis on assessment, prevention, and management strategies to improve patient outcomes.