1
|
Mohamed Elfadil O, Velapati SR, Patel J, Hurt RT, Mundi MS. Enteral Nutrition Therapy: Historical Perspective, Utilization, and Complications. Curr Gastroenterol Rep 2024:10.1007/s11894-024-00934-8. [PMID: 38787510 DOI: 10.1007/s11894-024-00934-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW Enteral nutrition (EN) therapy can provide vital nutrition support for patients with various medical conditions as long as it is indicated and supported by ethical reasoning. This review seeks to offer a detailed account of the history of EN development, highlighting key milestones and recent advances in the field. Additionally, it covers common complications associated with EN and their management. RECENT FINDINGS After years of research and development, we have reached newer generations of enteral feeding formulations, more options for enteral tubes and connectors, and a better understanding of EN therapy challenges. Given the availability of many different formulas, selecting a feeding formula with the best evidence for specific indications for enteral feeding is recommended. Initiation of enteral feeding with standard polymeric formula remains the standard of care. Transition to small-bore connectors remains suboptimal. Evidence-based practices should be followed to recognize and reduce possible enteral feeding complications early.
Collapse
Affiliation(s)
- Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Saketh R Velapati
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Janki Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
2
|
Romano C, Lionetti P, Spagnuolo MI, Amarri S, Diamanti A, Verduci E, Lezo A, Simona G. Trends and challenges in home enteral feeding methods for children with gastrointestinal disorders: an expert review on bolus feeding delivery methods. Expert Rev Gastroenterol Hepatol 2024; 18:193-202. [PMID: 38030649 DOI: 10.1080/17474124.2023.2289530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION New evidence supports the benefits of bolus feeding for children receiving home enteral feeding (HEN). Current home methods of bolus feeding have certain limitations, particularly in mobile or restless patients. Therefore, innovative delivery methods have been introduced to provide more flexible methods of reducing feeding time and formula handling. AREAS COVERED This manuscript presents an expert review of the updates in HEN for children and the results of an online user experience questionnaire about an innovative new cap-based bolus feeding system. A literature bibliographic search was conducted on Medline via PubMed up to September 2023 to collect relevant studies. We presented recent evidence demonstrating a dramatic increase in HEN use among children requiring EN and its benefits on patients' nutritional status and quality of life. In addition, the article examined the clinical and social benefits of bolus feeding and current challenges in delivery methods. We described the benefits of the new system and its user experience. EXPERT OPINION The uses and indications for bolus feeding in HEN are increasing among children. However, there are still some unmet needs regarding traditional delivery methods. Innovative techniques can improve flexibility, reduce feeding time, and improve user experience and quality of life.
Collapse
Affiliation(s)
- Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Department NEUROFARBA - University of Florence, Florence, Italy
| | - Maria Immacolata Spagnuolo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Sergio Amarri
- Pediatric Palliative Care, Fondazione Hospice MT. C. Seràgnoli, BO, Bentivoglio, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children's Hospital, Rome, Italy
| | - Elvira Verduci
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Antonella Lezo
- Division of Clinical Nutrition, Regina Margherita Children's Hospital, Turin, Italy
| | - Gatti Simona
- Department of Pediatrics,Università Politecnica delle Marche, Italy
| |
Collapse
|
3
|
Li W, Guo H, Li L, Cui J. Cost-Effectiveness Analyses of Home Parenteral Nutrition for Incurable Gastrointestinal Cancer Patients. Front Oncol 2022; 12:858712. [PMID: 35664760 PMCID: PMC9157576 DOI: 10.3389/fonc.2022.858712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Appropriate nutritional support, including supplemental home parenteral nutrition (sHPN), may improve prognosis and quality of life (Qol) of malnourished cancer patients. We aimed to explore the cost-effectiveness of sHPN for incurable gastrointestinal cancer patients from the Chinese healthcare perspective. Method Clinical data were extracted from a randomized controlled trial (NCT02066363). Patients were randomized into the sHPN group or the non-sHPN group (receiving best practice nutritional care). A Markov model was established with a 6-week cycle length. Costs were acquired from local hospitals, effect parameters included quality-adjusted life year (QALY), Qol, body mass index, fat-free mass (FFM), FFM index, handgrip strength, and a 6-min walking test. Sensitivity analyses were conducted with a willingness-to-pay (WTP) set at 3 per capita gross domestic product ($29,307/QALY). Results When considering QALY as a utility, the incremental cost-effectiveness ratio (ICER) was $24,289.17, with an incremental cost of $2,051.18 and an incremental QALY of 0.0844 between the sHPN group and the non-sHPN group. Furthermore, we explored the cost-effectiveness of sHPN from multidimensions, where we analyzed various effect parameters at different visits; the results showed a superior benefit for patients in the sHPN group except for the handgrip parameter at visit 2. Sensitivity analysis demonstrated the influence of utilities in the sHPN group, but the sHPN group was still cost-effective with a WTP of $2,500/QALY. Conclusion In China, sHPN was cost-effective for patients with incurable gastrointestinal cancer, which suggested further applications in clinical practice and provided references for clinical decisions and pricing.
Collapse
Affiliation(s)
| | | | | | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
4
|
Folwarski M, Kłęk S, Szlagatys-Sidorkiewicz A, Wyszomirski A, Brzeziński M, Skotnicka M. Trend Observations in Home Parenteral Nutrition. Prevalence, Hospitalizations and Costs: Results from a Nationwide Analysis of Health Care Provider Data. Nutrients 2021; 13:nu13103465. [PMID: 34684466 PMCID: PMC8539115 DOI: 10.3390/nu13103465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The population of patients on home parenteral nutrition (HPN) worldwide is growing. Since only a few counties provide data from national registries long-term observations are valuable to address this specific area of nutrition support. This study is a nationwide analysis determining the trends in the epidemiology of HPN (prevalence, age distribution, death rates), indications for HPN, causes for hospitalizations, and cost analysis of HPN reimbursement in Poland between 2010-2020. METHODS A retrospective analysis of data obtained from the national health fund (NHF) of Poland on adult patients on HPN. RESULTS The prevalence of adult patients on HPN in Poland in 2020 was 53.26 per million citizens with a 2.99-fold increase and a growing trend observed from 2010. Significant decrease in the percentage of patients between 18-34, 45-54 and an increase in patients between 65-74 and patients over 75 years old was observed. Trend analysis showed an increase in new patients between 65-74 and a decrease between 35-54. Malnutrition (34.28%), postprocedural disorders of the GI tract (19.61%), intestinal malabsorption/other intestinal diseases (20.41%) and GI obstruction due to cancer (17.36% as primary and 23.16% as secondary diagnosis) were mostly reported as the primary indications for HPN. Cancer patients were mostly gastric, ovarian and colon cancer (34.74%, 17.83% and 12.3%). HPN and total health cost reimbursement increase was 2.6 and 2.57-fold respectively. Costs of HPN and total health care costs in 2020 per patient were € 10,015 and € 16,038, respectively. Overall death risk rate during the first year of nutrition was 0.59 with a significant increase in the observation period p-trend < 0.004. A significant increase in the death rate was observed in patients above 75 years old (estimate 1.629, p-trend < 0.030). Cancer, infection, malnutrition and GI symptoms were the most common indications for hospitalizations of HPN patients. The rate of patients with a maximal length of HPN of 5 months in 2010 was 54.9% and was growing up to 78.1% in 2020. CONCLUSIONS The prevalence of HPN in Poland is growing. Trends of age distribution show increasing numbers of patients with more advanced age and shorter survival. Costs of HPN are comparable with other European data.
Collapse
Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdańsk, Poland
- Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, 80-803 Gdańsk, Poland
- Correspondence: ; Tel.: +48-58-349-27-23
| | - Stanisław Kłęk
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Cancer Institute, 31-501 Kraków, Poland;
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (A.S.-S.); (M.B.)
| | - Adam Wyszomirski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Michał Brzeziński
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (A.S.-S.); (M.B.)
| | - Magdalena Skotnicka
- Department of Commodity Science, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| |
Collapse
|
5
|
Gao X, Zhang Y, Zhang L, Liu S, Liu H, Zhou D, Li J, Wang X. Effect of Home Enteral Nutrition on Nutritional Status, Body Composition and Quality of Life in Patients With Malnourished Intestinal Failure. Front Nutr 2021; 8:643907. [PMID: 34277678 PMCID: PMC8281236 DOI: 10.3389/fnut.2021.643907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/31/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The ultimate goal of intestinal failure (IF) management is to maintain optimal nutritional status, improve the quality of life (QoL), and promote intestinal adaptation. Enteral nutrition support is safe and effective in patients with IF and plays a central role in the management of patients with IF. The purpose of this study was to evaluate the effect of home enteral nutrition on nutritional status, body composition (BC), QoL and other clinical outcomes in malnourished patients with intestinal failure. Methods: This prospective observational study included 166 malnourished patients with intestinal failure presented to Jinling Hospital from January 2016 to October 2018. All patients were supported with home enteral nutrition after discharge. We evaluated clinical outcomes, including nutritional status, BC, phase angle (PhA), QoL, mortality, gastrointestinal complications related to enteral feeding, and other clinical outcomes at 1, 3, and 6 months after discharge. Results: Body weight, BC, and other nutritional parameters were maintained or significantly increased during the period of home enteral nutrition after discharge (p < 0.01). Especially, the quality of skeletal muscle mass in body composition was significantly improved (p < 0.01). SF-36 quality of life scores was significantly improved (discharged at 6 months: reported health transition 40.7 ± 12.1 vs. 69.3 ± 16.3, p < 0.01). There were no differences between hospital and out of hospital with respect to tube-related or gastrointestinal complications. Advanced age, disease type, and poor nutritional status were risk factors for poor clinical outcomes. Conclusions: Home enteral nutrition support is effective for malnourished patients with intestinal failure. It improves nutritional status, BC, PhA, and QoL. Clinical Trial Registration: identifier: ChiCTR2000035145.
Collapse
Affiliation(s)
- Xuejin Gao
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Yupeng Zhang
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Li Zhang
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Sitong Liu
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Hao Liu
- Affiliated Jinling Hospital, Research Institute of General Surgery, Southern Medical University, Guangzhou, China
| | - Da Zhou
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Jieshou Li
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| | - Xinying Wang
- Affiliated Jinling Hospital, Research Institute of General Surgery, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
6
|
Wyszomirska K, Wyszomirski A, Brzeziński M, Borkowska A, Zagierski M, Kierkuś J, Książyk J, Romanowska H, Świder M, Toporowska-Kowalska E, Szlagatys-Sidorkiewicz A. Home Artificial Nutrition in Polish Children: An Analysis of 9-Year National Healthcare Provider Data. Nutrients 2021; 13:nu13031007. [PMID: 33800968 PMCID: PMC8004018 DOI: 10.3390/nu13031007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Home artificial nutrition (HAN) is a developing method of treatment that reduces the need for hospitalizations. The epidemiology of pediatric HAN in Poland has not yet been covered in detail. This study is a longitudinal nationwide analysis of incidence, prevalence, and patients’ profile for HAN in Polish children. Methods: Assessment of National Health Fund (NFZ) data covering all pediatric patients treated with HAN in Poland between 2010 and 2018. Results: HAN was received by 4426 children, 65 patients were on home enteral nutrition (HEN) or home parenteral nutrition (HPN) at different times (HEN n = 3865, HPN n = 626). HAN was most frequently started before the child was 3 years old and long-term HAN programs (5–9 years) were reported. The most common principal diagnosis in HEN was food-related symptoms and signs. In HPN, it was postoperative gastrointestinal disorders. A regionally differentiated prevalence of HAN patients and centers was demonstrated. Mortality among patients was 24.9% for HEN, and 9.6% for HPN, and the main in-hospital cause of death was cardiac arrest. Conclusions: HAN’s use is increasing and evolving in Poland. Uneven distribution of patients and centers results in difficult access to the nutritional procedure which, together with the increasing number of patients, highlights the need for data analysis and development of nutrition centers.
Collapse
Affiliation(s)
- Karolina Wyszomirska
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, 80-803 Gdansk, Poland; (M.B.); (A.B.); (M.Z.); (A.S.-S.)
- Correspondence: ; Tel.: +48-58-7640-440
| | - Adam Wyszomirski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, 80-211 Gdansk, Poland;
| | - Michał Brzeziński
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, 80-803 Gdansk, Poland; (M.B.); (A.B.); (M.Z.); (A.S.-S.)
| | - Anna Borkowska
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, 80-803 Gdansk, Poland; (M.B.); (A.B.); (M.Z.); (A.S.-S.)
| | - Maciej Zagierski
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, 80-803 Gdansk, Poland; (M.B.); (A.B.); (M.Z.); (A.S.-S.)
| | - Jarosław Kierkuś
- Department of Gastroenterology, Hepatology and Feeding Disorders, The Children’s Memorial Health, Institute, 04-730 Warsaw, Poland;
| | - Janusz Książyk
- Department of Pediatrics, Nutrition and Metabolic Disorders, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Hanna Romanowska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, 71-252 Szczecin, Poland;
| | - Magdalena Świder
- Department of Anesthesiology and Critical Care Medicine, Clinical Provincial Hospital No. 2 in Rzeszow, 35-301 Rzeszow, Poland;
| | - Ewa Toporowska-Kowalska
- Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, 91-738 Lodz, Poland;
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, 80-803 Gdansk, Poland; (M.B.); (A.B.); (M.Z.); (A.S.-S.)
| |
Collapse
|
7
|
Leńska-Mieciek M, Jurczak-Kobus P, Kuls-Oszmaniec A, Fiszer U, Sobocki J. Carotid artery intima-media thickness in adults receiving long-term home parenteral nutrition. Nutr Metab Cardiovasc Dis 2021; 31:489-497. [PMID: 33127253 DOI: 10.1016/j.numecd.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Nutrition regimen in parenteral nutrition (PN) patients allows for a control of diet components. This may affect the process of lipid deposition in the vascular wall and change the risk of atherosclerosis. This study aims to examine the effect of long-term PN in adults on carotid intima-media thickness. METHODS AND RESULTS Thirty long-term PN patients (15 men and 15 women, mean age 64.7 ± 8.5 years) and thirty healthy volunteers (HV) (15 men and 15 women, mean age 64.9 ± 8.77 years) entered the study. Total amino acid and lipid formulation intake as well as duration of PN were calculated for PN patients. The common carotid artery intima-media thickness (CCA IMT) was examined in both groups. A lower CCA IMT (right/left mean: PN - 776 ± 121 vs HV - 848 ± 121 μm, p < 0.05; right/left maximum CCA IMT: PN - 935 ± 139 vs HV - 1024 ± 135 μm, p < 0.05) in PN patients was observed. A lower serum level of total (PN - 131.43 ± 43.12 vs HV - 209.2 ± 48.01 mg/dl, p < 0.05) and HDL (PN- 44.16 ± 12.45 vs HV - 72.57 ± 25.04 mg/dl, p < 0.05) cholesterol was reported in the PN patients. A correlation between patients' age and CCA IMT was observed in the control group, but not in the PN patients (right/left mean CCA IMT - PN: r = 0.48, p-0.007 vs HV: p-0.073; right/left maximum CCA IMT - PN: r = 0.48, p-0.008, vs HV: p-0.073). CONCLUSIONS Long term PN in adults is associated with lower CCA IMT. Long-term PN patients are a unique group in which carotid intima-media thickness does not correlate with the age.
Collapse
Affiliation(s)
- Marta Leńska-Mieciek
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Paulina Jurczak-Kobus
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Aleksandra Kuls-Oszmaniec
- Department of Neurology and Epileptology Professor Orlowski's Hospital, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Urszula Fiszer
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| |
Collapse
|
8
|
You Q, Li X, Ma Y, Shi L, Hu W. A retrospective analysis on epidemiological characteristics of home enteral nutrition: results from a Chinese tertiary hospital in 2018. Eur J Clin Nutr 2020; 75:473-479. [PMID: 32939039 DOI: 10.1038/s41430-020-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/31/2020] [Accepted: 09/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use of home enteral nutrition (HEN) has increased enormously. HEN has been shown to decrease length of stays, improve clinical outcomes, and increase quality of life. Literature on HEN epidemiology has also sprouted recently. Nevertheless, studies on Chinese HEN users are hardly seen. The objective of this study was thus to describe the epidemiological characteristics of HEN users from a Chinese tertiary hospital in 2018. METHODS Data were retrospectively analyzed using the personal patient profiles we created upon each HEN initiation. In the year of 2018, 2007 patients and a cumulative total of 3375 episodes were recorded. RESULTS The median age was 61 (IQR 46-75) years, and 63 (IQR 49-75) for males and 55 (IQR 43-72) for females. The most frequent indication for HEN implementation was oncological diseases (35.8%), followed by digestive diseases (13.4%), and neurological diseases (9.0%). Overall, 90.0% of the episodes were prescribed for oral nutrition supplement (ONS) and 9.5% for tube feeding (TF). Majority (70.8%) of the episodes comprised standard commercial formula. CONCLUSIONS Our study revealed some fundamental epidemiological characteristics of Chinese HEN patients. This preliminary single-center study has multiple limitations but still possesses revelatory and referential significance for other Chinese practitioners in the field of HEN. In future, multicenter studies and qualified HEN registries are widely needed in China.
Collapse
Affiliation(s)
- Qian You
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Xuemei Li
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Ya Ma
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Shi
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Hu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
9
|
Folwarski M, Kłęk S, Zoubek-Wójcik A, Szafrański W, Bartoszewska L, Figuła K, Jakubczyk M, Jurczuk A, Kamocki Z, Kaźmierczak-Siedlecka K, Kowalczyk T, Kwella B, Matras P, Skonieczna-Żydecka K, Sonsala-Wołczyk J, Szopiński J, Urbanowicz K, Zmarzły A. Home Enteral Nutrition in Adults-Nationwide Multicenter Survey. Nutrients 2020; 12:nu12072087. [PMID: 32674453 PMCID: PMC7400937 DOI: 10.3390/nu12072087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/13/2023] Open
Abstract
Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018–1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%—neurovascular, 13.7%—neurodegenerative), 33.9% cancer (20.2%—head and neck, 11.7%—gastrointestinal cancer), 2.5%—gastroenterology, 1.5%—inherited diseases. Of new registrations in 2018—cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m2, NRS 2002 score—4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.
Collapse
Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdansk, 80-210 Gdansk, Poland
- Correspondence: ; Tel.: +0048-58-349-27-23
| | - Stanisław Kłęk
- General Surgery Unit with Intestinal Failure Center, Stanley Dudrick’s Memorial Hospital, 32-050 Skawina, Poland;
| | | | - Waldemar Szafrański
- Home Enteral and Parenteral Nutrition Unit, General Surgery Department, Nicolaus Copernicus Hospital, 80-803 Gdansk, Poland;
| | - Lidia Bartoszewska
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, 20-954 Lublin, Poland; (L.B.); (P.M.)
| | - Krzysztof Figuła
- Nutricare Clinical Nutrition Center, 31-559 Krakow, Poland; (K.F.); (T.K.)
| | - Marlena Jakubczyk
- Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-067 Torun, Poland;
| | - Anna Jurczuk
- Outpatient Clinic of Nutritional Therapy Clinical Hospital, 15-001 Bialystok, Poland;
| | - Zbigniew Kamocki
- 2nd Department of General and Gastroenterological Surgery Medical University, 15-276 Bialystok, Poland;
| | | | - Tomasz Kowalczyk
- Nutricare Clinical Nutrition Center, 31-559 Krakow, Poland; (K.F.); (T.K.)
| | - Bogna Kwella
- Department of Clinical Nutrition, Provincial Specialist Hospital, 10-561 Olsztyn, Poland; (B.K.); (K.U.)
| | - Przemysław Matras
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, 20-954 Lublin, Poland; (L.B.); (P.M.)
| | | | - Joanna Sonsala-Wołczyk
- Clinical Nutrition Unit, Gromkowski Citi Hospital, 51-149 Wroclaw, Poland; (J.S.-W.); (A.Z.)
| | - Jacek Szopiński
- Department of General Hepatobiliary and Transplant Surgery, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Krystyna Urbanowicz
- Department of Clinical Nutrition, Provincial Specialist Hospital, 10-561 Olsztyn, Poland; (B.K.); (K.U.)
| | - Anna Zmarzły
- Clinical Nutrition Unit, Gromkowski Citi Hospital, 51-149 Wroclaw, Poland; (J.S.-W.); (A.Z.)
| |
Collapse
|
10
|
Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy. NUTR HOSP 2020; 36:758-763. [PMID: 31448625 DOI: 10.20960/nh.02606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period.
Collapse
|
11
|
Enteral nutritional therapy practices for adults in a district hospital and primary healthcare centers in KwaZulu-Natal province of South Africa: Knowledge and attitude of health care professionals. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
12
|
Tran V, Bielawska B, Jeejeebhoy KN, Gramlich LM, Raman M, Whittaker JS, Armstrong D, Marliss EB, Allard JP. Variations in practice patterns for adult cancer patients on home parenteral nutrition in Canada. Nutrition 2019; 65:27-32. [DOI: 10.1016/j.nut.2019.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/12/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
|
13
|
Abstract
PURPOSE OF REVIEW Catheter-related blood stream infections (CRBSI) pose a significant risk to patients on home parenteral nutrition (HPN). Recurrent loss of catheters can lead to scarring and eventual loss of central access, a potentially fatal situation for patients dependent on HPN. RECENT FINDINGS In the past, the standard of care to treat these infections required catheter removal. More recently, several studies have indicated that many CRBSI can be treated without removal of the catheter. Successful treatment without removal can be achieved by intentionally following a catheter salvage protocol. We define this as a previously defined protocol to accurately diagnose CRBSI, identify the organism(s) involved, and effectively treat not only the blood stream infection, but also sterilize the catheter. For patients on HPN with CRBSI, consider attempting line salvage if the patient is not suffering from severe sepsis, other infection related complications, or certain specific infections. Success rates vary depending on the organism causing the infection and the risks; benefits and chance of success should be considered when deciding to attempt line salvage.
Collapse
|
14
|
Cardiac Changes in Patients on Long-Term Parenteral Nutrition. Nutrients 2019; 11:nu11071587. [PMID: 31337013 PMCID: PMC6682873 DOI: 10.3390/nu11071587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
Patients with short bowel syndrome (SBS) on long-term home parenteral nutrition (HPN) chronically receive high fluid volumes directly into the right atrium (RA) through the superior vena cava. We retrospectively evaluated cardiac function measured by routine transthoracic echocardiography (TTE) in a population of 26 SBS patients on long-term HPN and compared their data on echocardiograph-derived right heart structure and function, with those of a control group of 26 patients also bearing a central venous catheter (CVC) for other reasons. Results showed that body weight and BMI were significantly higher in the control group. The echocardiographic estimate of RA pressure was higher in HPN patients than in controls (p = 0.01). An increased estimate of RA pressure indicates the need to consider TTE in the follow-up of long-term HPN patients to detect functional impairment early.
Collapse
|
15
|
Paediatric Home Artificial Nutrition in Italy: Report from 2016 Survey on Behalf of Artificial Nutrition Network of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP). Nutrients 2018; 10:nu10091311. [PMID: 30223620 PMCID: PMC6163787 DOI: 10.3390/nu10091311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 01/09/2023] Open
Abstract
Home Artificial Nutrition (HAN) is a safe and efficacious technique that insures children's reintegration into the family, society and school. Epidemiological data on paediatric HAN in Italy are not available. AIM to detect the prevalence and incidence of Home Parenteral Nutrition (HPN) and Home Enteral Nutrition (HEN), either via tube or mouth, in Italy in 2016. MATERIALS AND METHODS a specific form was sent to all registered SIGENP members and investigators of local HAN centres, inviting them to provide the requested centre's data and demographics, underlying diseases and HAN characteristics of the patients. RESULTS we recorded 3403 Italian patients on HAN aged 0 to 19 years from 22 centres: 2277 HEN, 950 Oral Nutritional Supplements (ONS) and 179 HPN programs. The prevalence of HEN (205 pts/million inhabitants) and HPN (16 pts/million inhabitants) has dramatically increased in Italy in the last 9 years. Neurodisabling conditions were the first indication for HEN by tube or mouth while HPN is mainly requested in digestive disorders. CONCLUSIONS HAN is a widespread and rapidly growing treatment in Italy, as well as in other European countries. Awareness of its extent and characteristics helps improving HAN service and patients' quality of life.
Collapse
|
16
|
Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of Home Parenteral and Enteral Nutrition in the United States. Nutr Clin Pract 2017; 32:799-805. [DOI: 10.1177/0884533617718472] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Manpreet S. Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Adele Pattinson
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan T. McMahon
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob Davidson
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T. Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Kentucky, USA
| |
Collapse
|
17
|
Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, Beretta GD, Nardi M, Laviano A, Zagonel V. Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer 2016; 7:131-5. [PMID: 26819635 PMCID: PMC4716844 DOI: 10.7150/jca.13818] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022] Open
Abstract
Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support. We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. "Alternative hypocaloric anti-cancer diets" (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status. Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.
Collapse
Affiliation(s)
- Riccardo Caccialanza
- 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- 2. Division of Medical Oncology, Department of Hemato-Oncology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- 1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Gavazzi
- 3. Clinical Nutrition Unit, National Cancer Institute, Milan, Italy
| | - Carmine Pinto
- 4. Medical Oncology, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Agostino Paccagnella
- 5. Endocrinology, Metabolism and Nutrition Unit, Local Health Authority ULSS 9, Treviso, Italy
| | | | - Mariateresa Nardi
- 7. Clinical Nutrition Service, Veneto Institute of Oncology-IRCCS, Padova, Italy
| | | | - Vittorina Zagonel
- 9. Medical Oncology 1, Veneto Institute of Oncology-IRCCS, Padova, Italy
| |
Collapse
|
18
|
Parker EK, Faruquie SS, Talbot P. Trends in home enteral nutrition at a tertiary teaching hospital: 2005-2013. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Peter Talbot
- Department of Dietetics and Nutrition; Westmead Hospital; Wentworthville NSW Australia
| |
Collapse
|