Effects of Long-Term Triclosan Exposure on Microbiota in Zebrafish.

Background: Triclosan (TCS) is a widely used antibacterial agent in personal care products and is ubiquitous in the environment. We aimed to examine whether TCS exposure affects microbiota in the gastrointestinal tract of zebrafish. Methods: After exposure to TCS 0 (Dimethyl Sulphoxide, DMSO control), 0.03, 0.3, 3, 30, 100, and 300ng/ml, respectively, from day 0 to 120days post fertilization (dpf), or for 7days in adult 4-month zebrafish, the long- and short-term impact of TCS exposure on the microbiome in the gastrointestinal tract was evaluated by analyzing 16S rRNA gene V3-V4 region sequencing. Results: The top two most dominant microbiota phyla were Proteobacteria and Fusobacteria phylum in all zebrafish groups. In TCS exposure 0-120 dpf, compared with DMSO control, the mean number of microbial operational taxonomic units (OTUs) was 54.46 lower (p<0.0001), Chao indice 41.40 lower (p=0.0004), and Ace indice 34.10 lower (p=0.0044) in TCS 300ng/ml group, but no change was observed in most of the other TCS concentrations. PCoA diagram showed that the microbial community in the long-term TCS 300ng/ml exposure group clustered differently from those in the DMSO control and other TCS exposure groups. A shorter body length of the zebrafish was observed in the long-term TCS exposure at 0.03, 100, and 300ng/ml. For 7-day short-term exposure in adult zebrafish, no difference was observed in alpha or beta diversity of microbiota nor the relative abundance of Proteobacteria or Fusobacteria phylum among DMSO control and any TCS levels, but a minor difference in microbial composition was observed for TCS exposure. Conclusions: Long-term exposure to high TCS concentration in a window from early embryonic life to early adulthood may reduce diversity and alter the composition of microbiota in the gastrointestinal tract. The effect of short-term TCS exposure was not observed on the diversity of microbiota but there was a minor change of microbial composition in adult zebrafish with TCS exposure.

The Association Between Gestational Diabetes and Microbiota in Placenta and Cord Blood.

Objective: Early life is a critical period for gut microbial development. It is still controversial whether there is placental microbiota during a healthy pregnancy. Gestational diabetes mellitus (GDM) is associated with increased risk of metabolic syndrome in the offspring, and the mechanisms are unclear. We sought to explore whether microbiota in placenta and cord blood may be altered in GDM. Methods: Placenta and cord blood samples were collected from eight GDM and seven euglycemic (control) term pregnancies in cesarean deliveries without evidence of clinical infections. The Illumina MiSeq Sequencing System was used to detect the microbiota based on the V3-V4 hypervariable regions of the 16S ribosomal RNA gene. Results: The microbiota were detectable in all placental samples. Comparing GDM vs. controls, there were more operational taxonomic units (OTUs) (mean ± SE = 373.63 ± 14.61 vs. 332.43 ± 9.92, P = 0.024) and higher ACE index (395.15 ± 10.56 vs. 356.27 ± 8.47, P = 0.029) and Chao index (397.67 ± 10.24 vs. 361.32 ± 8.87, P = 0.04). The placental microbiota was mainly composed of four phyla: Bacteroidetes, Firmicutes, Actinobacteria, and Proteobacteria at the phylum level and 10 dominant genera at the genus level in both GDM and controls. Despite the dominant similarity in microbiota composition, at the OTU level, the abundance of Ruminococcus, Coprococcus, Paraprevotella, and Lactobacillus were higher, whereas Veillonella was lower in the placentas of GDM vs. controls. The microbiota was detected in one of the 15 cord blood samples, and its components were similar as to the corresponding placental microbiota at both phylum and genus levels suggesting placental microbiota as the potential source. Conclusions: The most abundant phyla and genus of placental microbiota were similar in GDM and euglycemic pregnancies, but GDM was associated with higher diversity of placental microbiota. Further study is needed to confirm the existence of microbiota in cord blood in pregnancies without clinical infection.

Guidelines for parenteral and enteral nutrition in geriatric patients in China.

Based on the expert consensus on parenteral and enteral nutrition support for geriatric patients in China in 2013, domestic multidisciplinary experts were gathered to summarize the new evidence in the field of elderly nutritional support at home and abroad. The 2013 consensus was comprehensively updated and upgraded to a guideline by referring to the World Health Organization (WHO) guidelines for the Grading of Recommendations Assessment, Development, and Evaluation system for grading evidence. These guidelines were divided into two parts: general conditions and common diseases. After discussion by all members of the academic group and consultation with relevant experts, 60 recommendations were ultimately established as standardized nutritional support in the field of geriatrics in China.

Plasma Perfluoroalkyl and Polyfluoroalkyl Substances Concentration and Menstrual Cycle Characteristics in Preconception Women.

BACKGROUND: Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are persistent synthetic chemicals that are widely used in industrial applications and often detectable in humans. In rats, PFASs can interfere with the estrous cycle. In humans, menstruation has been viewed as a proxy of female fecundity, and periodic menstruation plays a critical role in endometrial sloughing in the absence of pregnancy and in preparing for embryo implantation. OBJECTIVES: We investigated the association between PFAS exposure and menstrual cycle characteristics in women who plan to become pregnant. METHODS: Plasma level of 10 PFASs was measured in 950 women who were attempting to become pregnant and recruited in two preconception care clinics in Shanghai, China, from August 2013 to April 2015. Information on menstrual cycle characteristics was collected by questionnaires. Associations between PFAS levels and menstrual cycle regularity, length, and bleeding volume were examined using multiple logistic regression models. RESULTS: Pre-pregnant women with higher levels of log-transformed perfluorooctanate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexanesulfonate (PFHxS) had increased odds of self-reported history of irregular menstrual cycle [PFOA-adjusted odds ratio (OR)=1.52 (95% CI: 1.08, 2.15); PFOS OR=1.29 (95% CI: 0.98, 1.70); PFNA OR=1.50 (95% CI: 1.03, 2.07); PFHxS OR=1.80 (95% CI: 1.17, 2.77)] and long menstrual cycle [PFOA OR=1.50 (95% CI: 1.06, 2.10); PFOS OR=1.34 (95% CI: 1.02, 1.75); PFNA OR=1.49 (95% CI: 1.05, 2.11); PFHxS OR=1.73 (95% CI: 1.13, 2.65)]. Log-transformed PFOA, PFOS, PFNA. and PFHxS levels were negatively associated with self-reported history of menorrhagia [PFOA OR=0.37 (95% CI: 0.21, 0.65); PFOS OR=0.57 (95% CI: 0.37, 0.90); PFNA OR=0.47 (95% CI: 0.26, 0.86); PFHxS OR=0.14 (95% CI: 0.06, 0.36)]. CONCLUSIONS: Certain PFASs are associated with abnormal menstruation in humans. https://doi.org/10.1289/EHP1203.

Validity and practicability of smartphone-based photographic food records for estimating energy and nutrient intake.

BACKGROUND AND OBJECTIVES: Image-assisted dietary assessment methods are frequently used to record individual eating habits. This study tested the validity of a smartphone-based photographic food recording approach by comparing the results obtained with those of a weighed food record. We also assessed the practicality of the method by using it to measure the energy and nutrient intake of college students. METHODS AND STUDY DESIGN: The experiment was implemented in two phases, each lasting 2 weeks. In the first phase, a labelled menu and a photograph database were constructed. The energy and nutrient content of 31 randomly selected dishes in three different portion sizes were then estimated by the photograph-based method and compared with a weighed food record. In the second phase, we combined the smartphone-based photographic method with the WeChat smartphone application and applied this to 120 randomly selected participants to record their energy and nutrient intake. RESULTS: The Pearson correlation coefficients for energy, protein, fat, and carbohydrate content between the weighed and the photographic food record were 0.997, 0.936, 0.996, and 0.999, respectively. Bland-Altman plots showed good agreement between the two methods. The estimated protein, fat, and carbohydrate intake by participants was in accordance with values in the Chinese Residents' Nutrition and Chronic Disease report (2015). Participants expressed satisfaction with the new approach and the compliance rate was 97.5%. CONCLUSIONS: The smartphone-based photographic dietary assessment method combined with the WeChat instant messaging application was effective and practical for use by young people.

The presence and accuracy of nutritional labelling of pre-packaged foods in Shanghai.

BACKGROUND AND OBJECTIVES: The Chinese government officially enacted the Regulation on the Management of Food Nutrition Labelling in 2007 and the General Rules for Nutrition Labelling of Pre-packaged Foods in 2011. Our investigation examined the presence and accuracy of nutrition labelling of pre-packaged foods in Shanghai and provides baseline data for future studies. METHODS AND STUDY DESIGN: Nutrition labels on pre-packaged foods were recorded by photograph, transcription, or purchase in four supermarkets in Shanghai. We compared the observed labelling rate with results from a survey conducted in 2008. To assess labelling accuracy, we sent randomly selected foods to an analytical laboratory to test food energy and nutrient content. RESULTS: The overall labelling rate was 54.8%, representing a great improvement over the rate measured prior to implementation of the Regulation (35.4%). The labelling rate for energy content and core nutrients were all above 98%, whereas the rates for saturated fat, trans-fatty acids, and iron were 11.5%, 7.0%, and 10.7%, respectively. Pre-packaged foods manufactured by domestic Chinese companies were labelled less frequently (45.8%) than foods manufactured by companies from Taiwan/Hong Kong (67.0%) or overseas (65.7%). The accuracy of carbohydrate content on labels was as high as 100%, while the accuracy of protein and fat content were 94.4% and 96.0%, respectively. CONCLUSION: Pre-packaged food manufacturers and government agencies should collaborate to improve the management of nutrition labelling. Mandatory regulations may be the best way to ensure that nutrition labelling facilitates informed consumer decision-making.

Limitations of studies on school-based nutrition education interventions for obesity in China: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: School-based nutrition education has been widely implemented in recent years to fight the increasing prevalence of childhood obesity in China. METHODS AND STUDY DESIGN: A comprehensive literature search was performed using six databases to identify studies of school-based nutrition education interventions in China. The methodological quality and the risk of bias of selected literature were evaluated. Stratified analysis was performed to identify whether different methodologies influenced the estimated effect of the intervention. RESULTS: Seventeen articles were included in the analysis. Several of the included studies had inadequate intervention duration, inappropriate randomization methods, selection bias, unbalanced baseline characteristics between control and intervention groups, and absent sample size calculation. Overall, the studies showed no significant impact of nutrition education on obesity (OR=0.76; 95% CI=0.55-1.05; p=0.09). This can be compared with an OR of 0.68 for interventions aimed at preventing malnutrition and an OR of 0.49 for interventions aimed at preventing iron-deficiency anemia. When studies with unbalanced baseline characteristics between groups and selection bias in the study subjects were excluded, the impact of nutrition education on obesity was significant (OR=0.73; 95% CI=0.55-0.98; p=0.003). An analysis stratified according to the duration of intervention revealed that the intervention was effective only when it lasted for more than 2 years (OR=0.49, 95% CI=0.42-0.58; p<0.001). CONCLUSION: Studies of school-based nutrition education programs in China have some important limitations that might affect the estimated effectiveness of the intervention.

Optimal timing for introducing enteral nutrition in the neonatal intensive care unit.

OBJECTIVE: To identify the optimal time for introducing enteral nutrition to critically ill neonates. METHODS: This prospective cohort study included all eligible critically ill neonates who were admitted to a multidisciplinary tertiary neonatal intensive care unit (NICU) between 1st June and 30th November 2013. Nutrient intake and clinical outcomes during NICU stay were recorded. The effect of early (<24 hours after NICU admission) and delayed (>=24 hours) enteral nutrition introduction on clinical outcomes was assessed. RESULTS: Energy deficit in critically ill neonates was frequent: 84.7% could not achieve the caloric goal during the NICU stay. Growth retardation was common especially among the preterm: the frequency of neonates whose weight was below the 10th percentile increased significantly from 21.6% on admission to 67.6% at discharge. Compared with delayed enteral nutrition, early enteral nutrition was associated with better median time to starting weight gain (0 vs 6 days, p=0.0002), a lower chance of receiving parenteral nutrition (41.7% vs 95.9%, p<0.0001), shorter NICU stays (196 vs 288 hours, p=0.0001), fewer hours on mechanical ventilation and a lower chance of developing pulmonary infection (37.5% vs 56.0%, p=0.005). The accumulated energy deficit to the subjects who were exposed to delayed nutrition could not be compensated by subsequent nutrition. Neonates who underwent mechanical ventilation had suboptimal nutrient delivery: they took longer to gain weight and were more likely to develop respiratory distress and receive parenteral nutrition. CONCLUSIONS: Early enteral nutrition initiation (<24 hours) is recommended. Neonates with mechanical ventilation should be monitored with particular attention.

Effects of a summer program for weight management in obese children and adolescents in Shanghai.

OBJECTIVE: To investigate the effects of a combined intervention of diet and physical activity on body composition, resting energy expenditure (REE) and metabolic factors in obese children and adolescents. METHODS: Twenty obese children and adolescents aged 7 to 17 years completed a 4-week summer camp program which focussed on personal behaviour, including energy-restricted diets and supervised physical activity. Anthropometry, bioelectrical impedance, ultrasonography (US) for subcutaneous and hepatic fat, and abdominal Magnetic Resonance Imaging assessments were made and blood pressure (BP) recorded before and after the 4-week intervention. RESULTS: 1) Weight loss was 7.2 ± 2.2 kg, with losses of 5.5 ± 2.2 kg and 1.7 ± 1.2 kg in fat mass (FM) and fat free mass (FFM), respectively, with associated reductions in abdominal and hip fat and in the waist/hip circumference ratio and in BP. 2) There were no significant changes in REE or in its ratio with weight. 3) Reductions in uric acid, total cholesterol, triglycerides, LDL cholesterol, HbA1C, insulin, C-Peptide and insulin resistance (HOMA-IR) and the ratio of fatty liver were observed, but not in the inflammatory marker hsCRP. CONCLUSIONS: With behavioural intervention during a summer camp, body fat and its distribution were favourably changed, but with some loss of lean mass. However, there were no detectable reductions in REE. Weight management programs which achieve fat loss with maintenance of REE ought to be more sustainable.

Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis.

OBJECTIVE: To systematically review the effects of omega-3 poly unsaturated fatty acids (FA) enriched nutrition support on the mortality of critically illness patients. METHODS: Databases of Medline, ISI, Cochrane Library, and Chinese Biomedicine Database were searched and randomized controlled trials (RCTs) were identified. We enrolled RCTs that compared fish oil enriched nutrition support and standard nutrition support. Major outcome is mortality. Methodological quality assessment was conducted based on Modified Jadad's score scale. For control heterogeneity, we developed a method that integrated I2 test, nutritional support route subgroup analysis and clinical condition of severity. RevMan 5.0 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for meta-analysis. RESULTS: Twelve trials involving 1208 patients that met all the inclusion criteria. Heterogeneity existed between the trials. A random model was used, there was no significant effect on mortality RR, 0.82, 95% confidence interval (CI) (0.62, 1.09), p = 0.18. Knowing that the route of fish oil administration may affect heterogeneity, we categorized the trials into two sub-groups: parenteral administration (PN) of omega-3 and enteral administration (EN) of omega-3. Six trials administered omega-3 FA through PN. Pooled results indicated that omega-3 FA had no significant effect on mortality, RR 0.76, 95% CI (0.52, 1.10), p = 0.15. Six trials used omega-3 fatty acids enriched EN. After excluded one trial that was identified as source of heterogeneity, pooled data indicated omega-3 FA enriched EN significant reduce mortality, RR=0.69, 95% CI [0.53, 0.91] (p = 0.007). CONCLUSION: Omega-3 FA enriched nutrition support is safe. Due to the limited sample size of the included trials, further large-scale RCTs are needed.

Glutamine supplementation in preterm infants receiving parenteral nutrition leads to an early improvement in liver function.

OBJECTIVE: The aim of study was to confirm the protective effects of parenteral glutamine supplementation on liver injury in premature infants and determine how quickly effects became evident. METHODS: We performed a double-blind, randomized, controlled clinical study to assess the effect of parenteral nutrition (PN) supplemented with glutamine in premature infants. Thirty infants from two children's centers, were randomly assigned to either a control group (Standard PN; n=15) or a glutamine-supplemented group (GlnPN; n=15). The primary endpoint was hepatic function. The secondary endpoints were total duration of PN, weight and head circumference gain, length of hospitalization, and days on a ventilator. RESULTS: The serum level of alkaline phosphatase (AKP) after parenteral nutrition for 14 days was significantly higher (p<0.05) in the control group. But in the glutamine-supplemented group, the serum concentration of aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT) significantly decreased after PN for 7 days and 14 days (p<0.05), and the level of alkaline phosphatase (AKP) showed no increase. The levels of AKP and GGT were significantly different with time by group interaction. Levels of AKP was higher in control group than glutamine-supplemented group, and GGT level was lower in glutamine-supplemented group compared with controls. There were no significant differences between the groups in terms of total duration of PN, weight gain (g/d), increase in head circumference (cm/w), length of hospitalization, and duration of mechanical ventilation. CONCLUSION: The longer the duration of parenteral nutrition, the more severe hepatic dysfunction became. Parenteral glutamine supplementation suggested a hepatoprotective effect.

[Development and interpretation of China medical nutrition therapy guideline for diabetes (2010)].

Nutritional therapy is the basis for all types of diabetes treatment, but has not been properly applied due to the lack of scientific criteria. In 2010, the China Medical Nutrition Therapy Guideline for Diabetes was successfully developed based on the up-to-dated scientific research evidences (especially those from China) using Oxford Centre for Evidence-Based Medicine grading system. These guidelines cover the nutrition-based prevention and treatment of diabetes and its complication as well as the parenteral and enteral nutritional supports, with an attempt to improve the quality of life and lower the burdens of diabetes and its complications.

Food nutrition labelling practice in China.

OBJECTIVE: The present study aimed to scrutinize the food nutrition labelling practice in China before the Chinese Food Nutrition Labeling Regulation (CFNLR) era. DESIGN: Nutrition information of pre-packaged foods collected from a supermarket between December 2007 and January 2008 was analysed and compared with findings from a survey conducted in Beijing. SETTING: Information collected from a supermarket in Shanghai. SUBJECTS: A total of 850 pre-packaged foods. RESULTS: In the Shanghai survey, the overall labelling rate was 30·9 %, similar to that found in the Beijing study (29·7 %). While only 20·5 % of the snacks in Shanghai had nutrition labelling, the percentage of food items labelled with SFA (8·6 %), trans fatty acid (4·7 %) or fibre (12·1 %) was very low. Of those food items with nutrition labels, a considerable proportion (7-15 %) did not label energy, fat, carbohydrate or protein. Food products manufactured by Taiwan and Hong Kong companies had a lower labelling rate (13·6 %) than those manufactured by domestic (31·6 %) or international manufacturers (33·8 %). CONCLUSIONS: The very low food nutrition labelling rate among products sold in large chain supermarkets in major cities of China before CFNLR emphasizes the need for such critical regulations to be implemented in order to reinforce industrial compliance with accurate nutrition labelling.

Protective effect of parenteral glutamine supplementation on hepatic function in very low birth weight infants.

BACKGROUND & AIMS: Hepatic dysfunction is one of the most frequent complications of parenteral nutrition. Very low birth weight (VLBW) infants are more sensitive to liver injury due to physiological immaturity. Our studies in animals showed that glutamine supplementation could attenuate TPN-associated liver injury. The aim of study was to investigate whether parenteral glutamine supplementation can improve hepatic tolerance in VLBW infants. METHODS: We performed a double-blind, randomized, and controlled clinical study to investigate whether parenteral glutamine supplementation can improve hepatic tolerance in VLBW infants. Thirty VLBW infants at two children's centers were randomly assigned to either a control group or a glutamine-supplemented group. The primary endpoints were hepatic function and mortality. The secondary endpoints were the time to achieve full enteral nutrition, episodes of gastric residuals, duration of parenteral nutrition, weight and head circumference gain, length of hospitalization, and days on ventilator. RESULTS: The serum levels of aspartate aminotransferase (AST) and total bilirubin (Tbi) were decreased after PN in the glutamine-supplemented group (P < 0.05). No deaths occurred in this study. Four infants assigned to the control group and two infants in the glutamine-supplemented group were withdrawn from the study, according to intention to treat: relative risk [RR]: 1.182; 95% confidence interval [CI]: 0.937-1.490. CONCLUSIONS: Parenteral glutamine supplementation can improve hepatic tolerance in very low birth weight infant, suggesting a hepato-protective effect.

Nutrition assessment in children with short bowel syndrome weaned off parenteral nutrition: a long-term follow-up study.

PURPOSE: The purpose of the study was to assess long-term growth and nutrition status of children with neonatal short bowel syndrome (SBS) after weaning off parenteral nutrition (PN). METHODS: Eight children with neonatal SBS weaned from PN therapy for more than 2 years were studied. Medical records were reviewed; anthropometric measurements and blood test (hemoglobin, albumin and prealbumin, immunoglobulin, electrolytes, trace elements, and fat-soluble vitamins) were assayed during follow-up. RESULTS: Anthropometric measurements, weight for age, and height for age were normal in all children; one child was found to be overweight according to weight for height z score. No children were found to have anemia, although one presented with macrocytosis and another had microcytosis. Low serum concentrations of zinc in 3 cases and iron in 1 case were detected. Immunoglobulin levels of all children were within the reference value. Low plasma levels of vitamin A in 2 cases, vitamin E in 4 cases, and beta-carotene in 2 cases were found; one of them had obviously low levels of the 3 fat-soluble vitamins. CONCLUSION: Children with SBS are still at risk for different nutrient malabsorption even after weaning off PN for a long time. Therefore, they need long-term, regular monitoring and intensive nutritional care to prevent various nutrient deficiencies.

[Assessment of serum micronutrients in children with short bowel syndrome].

OBJECTIVE: To assess micronutrients level in children with short bowel syndrome. METHODS: Clinical data of 17 children with short bowel syndrome from April 2004 to July 2006 were collected. They received the measurement of serum vitamin A, E and - carotene by high performance liquid chromatography (HPLC). RESULTS: There were 9 boys and 8 girls with age range of 3 months to 18 years. Eleven children did not need parenteral nutrition (PN), and 6 still depended on PN. Six cases were free of ileocolic valve and 11 cases had ileocolic valve. The length of remaining intestine was more than 75 cm in 5 patients and less than 75 cm in 12 patients. Among 11 cases without PN, 9 were tested for serum iron, zinc and copper levels. Their incidences of below the reference value of vitamin A, E and beta - carotene were 23.5%, 35.3% and 58.8%, respectively. The incidences of below the reference value of vitamin A and beta - carotene were higher in patients with weaned PN, less than 75 cm remaining intestine and without ileocolic valve. The patients with more than 75 cm remaining intestine and still with PN had a higher incidence of below the reference of vitamin E, but the incidence was similar in the patients with or without ileocolic valve. Serum zinc was lower than normal level in 3 cases and serum iron was low in 1 case. CONCLUSION: Supplement of extra micronutrients is essential for short bowl syndrome patient whatever they receive the PN or have normal diets, and follow- up is recommended.

[Factors derived from parenteral nutrition associated with cholestasis in 612 neonates].

OBJECTIVE: Some neonates especially premature infants, low birth weight infants and extremely low birth weight infants have limited endogenous energy stores. It is necessary to establish continuous administration of postnatal nutrition. The use of parenteral nutrition (PN) in neonates with immaturity of digestive system and intentionally delayed feedings has gained widespread acceptance. PN has been shown to provide sufficient nutrients to maintain growth in newborn infants. The major complication of PN in neonates is PN-associated cholestasis (PNAC). It remains a significant and frequent clinical problem for neonatal practitioners. In some cases, progressive liver damage, liver failure and death may become inevitable. In order to analyze the risk factors of the PNAC in neonates and to provide the evidence of safety and efficiency in clinical nutrition support, the clinical data of 612 neonates who had received PN for more than 5 days during the past 20 years were reviewed. METHODS: Retrospective analysis on data collected from April 1985 to March 2005 was performed. The records of 612 neonates were divided into two groups according to the established Nutrition Support Team (NST) in our hospital. Each group included two sub-groups. Seventy neonates of the first group were divided into PNAC group (n = 6) and non-PNAC group (n = 64); these patients were seen between 1st April 1985 and 31st March 1995. The remaining 542 neonates of the second group who were also divided into 2 groups, i.e. PNAC group (n = 12) and non-PNAC group (n = 530) who were seen from 1st April 1995 through 31st March 2005. The incidence of PNAC between the first group and the second group was compared and the associated factors were analyzed. The PNAC was defined when serum level of direct-bilirubin exceeded 1.5 mg/dl or direct-bilirubin greater than 50% of the bilirubin and excluding cholestasis resulted from other diseases. RESULTS: The total incidence of PNAC in neonates who had received TPN for more than 5 days was 2.94%. The incidence of PNAC of the first and the second decade was 8.57% and 2.21%, respectively (OR = 0.242, 95% CI = 0.088 approximately 0.666). The average gestational age (GA) and birth weight (BW) of PNAC group were less than those of the non-PNAC group (GA: (33 +/- 5) w vs. (36 +/- 4) w, P = 0.009; OR = 0.827, 95% CI = 0.698 approximately 0.980. BW: (2003 +/- 743) g vs. (2393 +/- 764) g, P = 0.045; OR = 1.001, 95% CI = 0.999 approximately 1.002). The PN duration and calorie intake of PNAC group was longer than that of the non-PNAC group (PN duration: 32 +/- 30 d vs. (13 +/- 10) d, P = 0.000; OR = 1.072, 95% CI = 1.032 approximately 1.112. Calorie intake: [(272 +/- 46) kJ/(kg.d)] [(65.0 +/- 10.9) kcal/(kg.d)] (1 kcal = 4.184 kJ) vs. [(232 +/- 55) kJ/(kg.d) (55.5 +/- 13.1) kcal/(kg.d)], (P = 0.002; OR = 1.066, 95% CI = 1.012 approximately 1.122), but the weight gain in the non-PNAC group had a tendency to increase as compared to that of the PNAC group [(20 +/- 27) g/d vs. (9 +/- 19) g/d, P = 0.175]. CONCLUSIONS: The incidence of PNAC was associated with the longer duration of PN, the smaller age at initiation of PN, the higher calorie intake, prematurity and lower birth weight. Establishment of the nutrition support team can normalize the practice of the PN administration and decrease the incidence of the complication with nutrition support. It is a favorable mode and it can provide a safer, more effective and reasonable means in clinical nutrition support. To avoid PNAC, it is suggested that the administration of enteric feeding should start as soon as possible, which may enhance effective contraction of gallbladder and secretion of gastrointestinal hormones, and it is best to avoid high calorie of PN and control the calorie intake under 251.04 approximately 334.72 kJ/(kg.d) [60 approximately 80 kcal/(kg.d)].