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Baker M, French C, Hann M, Lal S, Burden S. A scoping review of parenteral requirements (macronutrients, fluid, electrolytes and micronutrients) in adults with chronic intestinal failure receiving home parenteral nutrition. J Hum Nutr Diet 2024; 37:788-803. [PMID: 38409860 DOI: 10.1111/jhn.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Home parenteral nutrition (HPN) prescriptions should be individualised in adults with chronic intestinal failure (IF). The aims of the review were to explore HPN requirements and available guidelines and to determine whether adults (≥ 18 years) receive recommended parenteral nutrient doses. METHODS Online databases searches identified empirical evidence (excluding case-reports), reviews and guidelines (Published 2006-2024 in English language). Additional reference lists were hand-searched. Older studies, cited in national guidelines were highlighted to map evidence source. Two reviewers screened 1660 articles independently, with 98 full articles assessed and 78 articles included (of which 35 were clinical studies). Citation tracking identified 12 older studies. RESULTS A lack of evidence was found assessing parenteral macronutrient (amounts and ratios to meet energy needs), fluid and electrolyte requirements. For micronutrients, 20 case series reported serum levels as biomarkers of adequacy (36 individual micronutrient levels reported). Studies reported levels below (27 out of 33) and above (24 out of 26) reference ranges for single micronutrients, with associated factors explored in 11 studies. Guidelines stated recommended parenteral dosages. Twenty-four studies reported variable proportions of participants receiving HPN dosages outside of guideline recommendations. When associated factors were assessed, two studies showed nutrient variation with type of HPN administered (multichamber or individually compounded bags). Five studies considered pathophysiological IF classification, with patients with short bowel more likely to require individualised HPN and more fluid and sodium. CONCLUSIONS This review highlights substantial evidence gaps in our understanding of the parenteral nutritional requirements of adult receiving HPN. The conclusions drawn were limited by temporal bias, small samples sizes, and poor reporting of confounders and dose. Optimal HPN nutrient dose still need to be determined to aid clinical decision-making and further research should explore characteristics influencing HPN prescribing to refine dosing recommendations.
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Affiliation(s)
- Melanie Baker
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Chloe French
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Mark Hann
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Simon Lal
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - Sorrel Burden
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
- Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
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Stevens P. 25 year experience of patterns of plasma vitamin C levels in patients requiring home parenteral support. Clin Nutr ESPEN 2023; 57:106-116. [PMID: 37739644 DOI: 10.1016/j.clnesp.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Vitamin C deficiency is common in patients with chronic intestinal failure. Risk factors are poorly understood and guidelines for monitoring largely based on expert opinion. The aim of this study was to describe patterns of vitamin C deficiency in patients on long-term home parenteral support (HPS). DESIGN A retrospective review of a prospectively collated database for 236 HPS patients cared for in Glasgow, from 1998 to 2023, was interrogated for subjects with paired CRP and vitamin C measurements. Following analysis of the impact of CRP on vitamin C levels, further review of associated clinical, micronutrient and dietetic details in those with a paired CRP <5 mg L-1 were used to identify risk factors for hypoascorbataemia. RESULTS 1527 recorded episodes with paired CRP and vitamin C measurements were analysed. Period prevalence of hypoascorbataemia was between 29.3 and 52.5%, depending on choice of the lower reference range for vitamin C as either 15 μmol L-1 or 26.1 μmol L-1. The influence of CRP appeared most significant early during HPS with other factors, including extensive mucosal disease, precedent surgery or presence of a colostomy identified as more significant on multivariate analysis for those on long-term HPS (OR 1.3261-1.5609, 1.0752-1.1008, and 0.6260-0.6663 for threshold vitamin C of 26.1 or 15 μmol L-1 respectively). CONCLUSION Vitamin C may present differently in long term HPS patients in comparison to those in the acute phase of illness. An evidence based approach to guideline development should be promoted to reduce morbidity.
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Barrett MP, Farrer K, Forde C, Deutsch L, Lal S. An evaluation of plasma vitamin C concentrations in individuals requiring home parenteral nutrition. J Hum Nutr Diet 2022; 35:895-900. [PMID: 35147258 DOI: 10.1111/jhn.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ascorbic acid (VitC) is an essential coenzyme to maintain health, but there are minimal data on the adequacy of VitC supply in patients requiring home parenteral nutrition (HPN). METHODS A prospective pilot study measuring plasma VitC, serum vitamins A,D,E and the minerals zinc, copper, selenium and magnesium in 28 adult HPN-dependent (≥6 months) patients was carried out. RESULTS 57% of patients had insufficient VitC status. There was a strong, positive correlation between HPN provision of VitC and plasma VitC concentrations (rs =0.663, p=0.00) with 83% insufficiency rate below a provision of 800mg/week. There was no association seen between plasma VitC and number of HPN days/week (p=0.539); number of months on HPN (p=0.773) or dependency on HPN (86±31% of energy requirements met via HPN v 77±23%, p=0.39). CONCLUSIONS VitC insufficiency is prevalent in HPN-dependent patients. Our data highlight the need for regular monitoring of VitC in those living with type III intestinal failure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maria Patricia Barrett
- Salford Royal Hospital Intestinal Failure Unit, Nutrition and Dietetics, Salford, Greater Manchester, UK
| | - Kirstine Farrer
- Salford Royal Hospital Intestinal Failure Unit, Nutrition and Dietetics, Salford, Greater Manchester, UK
| | - Claire Forde
- Salford Royal Hospital Intestinal Failure Unit, Nutrition and Dietetics, Salford, Greater Manchester, UK
| | - Liat Deutsch
- Tel Aviv Sourasky Medical Center, Department of Gastroenterology and Hepatology, Tel Aviv, IL
| | - Simon Lal
- Salford Royal Hospital Intestinal Failure Unit, Intestinal Failure Unit, Salford, Greater Manchester, UK
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Wallert M, März W, Lorkowski S. [Not Available]. MMW Fortschr Med 2020; 162:50-58. [PMID: 33074510 DOI: 10.1007/s15006-020-4319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Maria Wallert
- Lehrstuhl für Biochemie und Physiologie, Friedrich-Schiller-Universität Jena, Fakultät für Biowissenschaften, Jena, Germany
| | - Winfried März
- Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Stefan Lorkowski
- Friedrich-Schiller-Universität Jena, Lehrstuhl für Biochemie und Physiologie der Ernährung, Dornburgerstr. 25, 07743, Jena, Germany.
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Bétry C, Lauverjat M, Mouillot T, Bergoin C, Barnoud D, Ait S, Chambrier C. Hyperphagia in short bowel patients: Fat-free mass is a strong predictor. Nutrition 2019; 62:146-151. [PMID: 30889456 DOI: 10.1016/j.nut.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/10/2018] [Accepted: 12/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Some patients with short bowel syndrome (SBS) develop hyperphagic behavior. Such an increase in food intake stimulates intestinal adaptation and limits dependence on parenteral nutrition (PN). The aim of this study was to determine the factors modulating food consumption in patients with SBS. METHODS The associations between oral energy intake (OEI) and anthropometric, metabolic, nutritional, and intestinal absorption-related characteristics were determined in a monocentric cohort of patients with SBS on PN with a stable nutritional status. Body composition was assessed by dual x-ray absorptiometry. Data were retrospectively collected from clinical records. RESULTS After screening, 38 adult patients with a SBS on PN were included in this study. OEI ranged from 577 to 4054kcal/d. OEI correlated positively with weight, fat-free mass, handgrip strength, and resting energy expenditure (REE) and negatively with free triiodothyronine and C-reactive protein using Spearman correlation. Fat-free mass and thyroid-stimulating hormone remained positively correlated with OEI independently of all other parameters in a multilinear regression model. CONCLUSIONS Fat-free mass is a strong predictor of OEI in patients with SBS on PN and without debilitating gastrointestinal symptoms. Increasing fat-free mass could be a way to stimulate OEI in these patients. Further studies are needed to assess this assumption.
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Affiliation(s)
- Cécile Bétry
- The Medical School, University of Nottingham, Nottingham, UK; Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France.
| | - Madeleine Lauverjat
- Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France
| | - Thomas Mouillot
- Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France; CHU François Mitterrand, Bourgogne-Franche Comté, Dijon, France
| | - Charlotte Bergoin
- Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France
| | - Didier Barnoud
- Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France
| | - Sabrina Ait
- Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France
| | - Cécile Chambrier
- Unité de nutrition clinique intensive, Hospices Civils de Lyon, Lyon, France
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Braga CBM, Ferreira IMDL, Marchini JS, Cunha SFDCD. Copper and magnesium deficiencies in patients with short bowel syndrome receiving parenteral nutrition or oral feeding. ARQUIVOS DE GASTROENTEROLOGIA 2016; 52:94-9. [PMID: 26039825 DOI: 10.1590/s0004-28032015000200004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/28/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with short bowel syndrome have significant fluid and electrolytes loss. OBJECTIVE Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. METHODS Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. RESULTS The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. CONCLUSION Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.
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Moreira DC, de Sá JS, Cerqueira IB, Oliveira AP, Morgano MA, Quintaes KD. Evaluation of iron, zinc, copper, manganese and selenium in oral hospital diets. Clin Nutr 2014; 33:808-14. [DOI: 10.1016/j.clnu.2013.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 10/22/2013] [Accepted: 10/27/2013] [Indexed: 11/15/2022]
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Luo M, Estívariz CF, Schleicher RL, Bazargan N, Leader LM, Galloway JR, Ziegler TR. Prospective analysis of serum carotenoids, vitamin A, and tocopherols in adults with short bowel syndrome undergoing intestinal rehabilitation. Nutrition 2008; 25:400-7. [PMID: 19081706 DOI: 10.1016/j.nut.2008.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 08/15/2008] [Accepted: 10/03/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Carotenoids, vitamin A, and tocopherols serve important roles in many key body functions. However, availability of these compounds may be decreased in patients with short bowel syndrome (SBS) due to decreased oral intake of fruits and vegetables and/or decreased intestinal absorption. Little information is available on serum concentrations of carotenoids, vitamin A, and tocopherols during chronic parenteral nutrition (PN) or during PN weaning. The aim of this study was to prospectively examine serum concentrations of a wide variety of carotenoids, vitamin A, and tocopherols in patients with SBS undergoing an intensive 12-wk intestinal rehabilitation program. METHODS Twenty-one PN-dependent adult patients with SBS were enrolled in a 12-wk intestinal rehabilitation program, which included individualized dietary modification, multivitamin supplementation, and randomization to receive subcutaneous placebo (n = 9) or human growth hormone (0.1 mg . kg(-1) . d(-1); n = 12). PN weaning was initiated after week 4 and advanced as tolerated. Serum concentrations of carotenoids, vitamin A, and tocopherols were determined at baseline and at weeks 4 and 12. RESULTS A significant percentage of subjects exhibited low serum concentrations for carotenoids and alpha-tocopherol at study entry, and a few subjects had low concentrations of retinol (5%). Carotenoid and vitamin A valves did not improve over time, while alpha-tocopherol levels rose. Serum alpha-tocopherol concentration was negatively associated with PN lipid dose (r = -0.34, P < 0.008). CONCLUSION Patients with SBS are depleted in diet-derived carotenoids despite oral and intravenous multivitamin supplementation and dietary adjustment during intestinal rehabilitation and PN weaning. Reduction of PN lipid infusion may improve serum alpha-tocopherol concentrations.
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Affiliation(s)
- Menghua Luo
- Nutrition and Health Science Program, Graduate School of Arts and Sciences, Emory University, Atlanta, Georgia, USA
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