A hospitalized patient receives total parenteral nutrition (TPN) without added choline and has poor hepatic function. Which analysis correctly predicts their risk and the rationale?

Moderate risk of bone fractures rather than liver problems, because choline deficiency primarily affects bone mineralization while liver remains unaffected.

No risk, because choline is water-soluble and is synthesized rapidly in the bloodstream at rates that always exceed tissue demand even during hepatic dysfunction.

Risk is negligible because lipoic acid in TPN formulations will substitute fully for choline’s membrane functions without the need to include choline.

High risk of hepatic steatosis because TPN without choline removes dietary choline and impaired liver function may limit endogenous synthesis, making choline conditionally essential in this clinical context.