Clinical expressions of iron, zinc, and copper deficiencies associated with total parenteral nutrition (TPN) prompted recommendations by the Nutritional Advisory Group of the American Medical Association's Department of Foods and Nutrition for trace element additives for parenteral use. In the 11 years since that conference, home parenteral nutrition (HPN) has gained increasing popularity as a means to support patients with gut failure for many years. Observations in the long-term patients on HPN confirmed the risks of Fe, Zn, and Cu deficiencies and provided new evidence for clinically significant deficiencies of selenium, chromium, and molybdenum.