Intralipid Versus SMOFlipid in HPN Patients

Inclusion Criteria: * Newly initiated Mayo Clinic HPN patient * Able to provide informed consent * Anticipated duration of HPN greater than 3 months, * Infusion company is able to provide Smoflipid Exclusion Criteria: * Age less than 18 years * Pregnant and lactating women * Failure to provide consent * Patients with underlying liver dysfunction (defined as liver function studies equal to or more than 2 times upper limit of normal) or pathology as determined by primary investigator * Patients with active malignancy * Patients who are deemed to be on HPN for less than three months * Patients who have previous proven addiction and dependence to alcohol/ heavy alcohol AND consumption/active use reported during last 12 months. * Known hypersensitivity to fish, egg, soybean, or peanut protein, or to any of the active ingredients or excipients in Smoflipid * Patients who will not be managed by the Mayo Clinic HPN team * Patients who have active infection (as determined by the clinician) at the time of enrollment. * Patients who have received Smoflipid greater than 4 weeks in the last 12 months prior to enrollment. * Patients who have been on TPN greater than 4 weeks in the last 12 months prior to enrollment. * Enrolled in another interventional study. * Severe hyperlipidemia or severe disorders of lipid metabolism with serum triglycerides more than 1,000 mg/dL.