During this review period, outcome data relating to long-term home parenteral nutrition (HPN) were reported in both adult and pediatric patients from the United States and Europe. Several diagnostic categories including inflammatory bowel disease, radiation enteritis, cancer, hyperemesis gravidarum, and pediatrics were discussed and issues pertaining to complications associated with long-term therapy for, in particular, metabolic bone disease and liver disease were reviewed. Choline and taurine supplements have been demonstrated to reverse hepatic steatosis, while catheter-related sepsis continues to be reported and appears to be more prevalent in pediatric patients and the immunocompromised, However, conflicting data were published regarding the HPN complication rate in patients with AIDS. Several case reports described serious complications associated with thiamine deficiency in patients not receiving vitamin supplements. Future developments in long-term HPN should address the role of new substrates such as alternative fat sources, including medium-chain triglycerides, structured lipids, and fish oils and the requirement for and provision of conditionally essential nutrients, eg, glutamine, arginine, taurine, choline, and S-adenosyl-L-methionine. In particular, health care reform and limited resources will drive the demand for objective outcome data especially in patients with a short-term prognosis.
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