Low plasma choline levels in long-term PN patients have been associated with which liver-related change?

Low plasma choline levels in long-term PN patients have been associated with which liver-related change?

• A. Elevated bilirubin concentrations
• B. Elevated liver aminotransferase concentrations
• C. Decreased alkaline phosphatase
• D. Increased albumin level

Answer: (B)

Choline is needed to make phosphatidylcholine, a key component for assembling VLDL particles that export triglycerides from the liver. When choline is deficient in long-term parenteral nutrition, triglycerides accumulate in hepatocytes, leading to fatty liver and hepatocellular injury. This injury elevates liver aminotransferase levels (ALT and AST) in the blood, making increased aminotransferases the most direct liver change seen with low choline. Bilirubin and alkaline phosphatase elevations are more typical of cholestasis, while albumin reflects long-term synthetic function rather than acute injury.

Choline is needed to make phosphatidylcholine, a key component for assembling VLDL particles that export triglycerides from the liver. When choline is deficient in long-term parenteral nutrition, triglycerides accumulate in hepatocytes, leading to fatty liver and hepatocellular injury. This injury elevates liver aminotransferase levels (ALT and AST) in the blood, making increased aminotransferases the most direct liver change seen with low choline. Bilirubin and alkaline phosphatase elevations are more typical of cholestasis, while albumin reflects long-term synthetic function rather than acute injury.