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?

• A. Moderate risk of bone fractures rather than liver problems, because choline deficiency primarily affects bone mineralization while liver remains unaffected.
• B. 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.
• C. Risk is negligible because lipoic acid in TPN formulations will substitute fully for choline’s membrane functions without the need to include choline.
• D. 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.

Answer: (D)