Infants and children who depend on parenteral nutrition are among the most vulnerable to developing potentially devastating intestinal failure–associated liver disease. While the pathogenesis of intestinal failure–associated liver disease remains unclear, evidence for the contribution of fat emulsions to cholestasis and liver injury has rapidly increased in recent years. Data demonstrating the interaction among phytosterols, fatty acids, and antioxidants in cellular pathways that mediate bile flow and hepatic injury have led to the development of newer alternative fat emulsions. This article reviews recent studies that have provided insight into the potential hepatotoxicities of fat emulsions.
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