Total parenteral nutrition (TPN) is a life‐saving therapy administered to millions of patients. However, it is associated with significant adverse effects, namely liver injury, risk of infections, and metabolic derangements. In this review, the underlying causes of TPN‐associated adverse effects, specifically gut atrophy, dysbiosis of the intestinal microbiome, leakage of the epithelial barrier with bacterial invasion, and inflammation are first described. The role of the bile acid receptors farnesoid X receptor and Takeda G protein‐coupled receptor, of pleiotropic hormones, and growth factors is highlighted, and the mechanisms of insulin resistance, namely the lack of insulinotropic and insulinomimetic signaling of gut‐originating incretins as well as the potentially toxicity of phytosterols and pro‐inflammatory fatty acids mainly released from soybean oil‐based lipid emulsions, are discussed. Finally, novel approaches in the design of next generation lipid delivery systems are proposed. Propositions include modifying the physicochemical properties of lipid emulsions, the use of lipid emulsions generated from sustainable oils with favorable ratios of anti‐inflammatory n‐3 to pro‐inflammatory n‐6 fatty acids, beneficial adjuncts to TPN, and concomitant pharmacotherapies to mitigate TPN‐associated adverse effects.

中文翻译：

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预防全肠外营养引起的肠道和肝脏炎症以及不良代谢结果的新策略

全肠外营养 (TPN) 是一种挽救生命的疗法，适用于数百万患者。然而，它与显着的不良反应有关，即肝损伤、感染风险和代谢紊乱。在这篇综述中，首先描述了 TPN 相关不良反应的根本原因，特别是肠道萎缩、肠道微生物群失调、上皮屏障渗漏与细菌入侵和炎症。强调了胆汁酸受体法尼醇 X 受体和武田 G 蛋白偶联受体、多效激素和生长因子的作用，以及胰岛素抵抗的机制，即讨论了源自肠道的肠促胰岛素缺乏促胰岛素和拟胰岛素信号，以及主要从基于大豆油的脂质乳液中释放的植物甾醇和促炎脂肪酸的潜在毒性。最后，提出了设计下一代脂质递送系统的新方法。提议包括改变脂质乳剂的理化特性，使用由具有抗炎 n-3 与促炎 n-6 脂肪酸有利比例的可持续油产生的脂质乳剂，TPN 的有益辅助剂，以及伴随的药物疗法以减轻 TPN -相关的不良反应。