Parenteral Nutrition in Patients with Inflammatory Bowel Disease Systematic Review, Meta-Analysis and Meta-Regression

Comeche, Jose Miguel; Comino, Iris; Altavilla, Cesare; Tuells, José; Gutiérrez-Hervás, Ana; Caballero, Pablo

doi:10.3390/nu11122865

“…This study examined quality‐of‐life metrics in patients receiving home PN and found the scores comparable to those of patients on chronic hemodialysis 31 . Finally, a recent meta‐analysis has also demonstrated that home PN is associated with improved markers of disease activity and nutrition status in IBD patients, including CRP, serum albumin level, and Crohn's Disease Activity Index 32 …”

Section: Discussionmentioning

confidence: 77%

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Kurin

¹

,

Anderson

²

,

Rivers

³

et al. 2020

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Background Despite advances in the medical management of inflammatory bowel disease (IBD), a subset of patients may require extensive surgery, leading to short‐bowel syndrome/intestinal failure requiring long‐term home parenteral nutrition (PN) or customized intravenous fluid (IVF) support. Our aim was to further define the characteristics of IBD patients requiring home PN/IVF. Methods This is an observational study from a prospective IBD research registry. Patients receiving long‐term home PN/IVF support during 2009–2015 were identified and compared with remaining IBD patients. Demographics, surgical history, smoking, narcotic use, IBD treatment, healthcare charges, and presence of biomarkers were reviewed. The IBD‐PN group was stratified into 3 groups based on median healthcare charges. Results Of 2359 IBD patients, there were 25 (1%, 24 with Crohn's disease) who required home PN/IVF, and 250 randomly selected IBD patients matched for disease type formed the control population. Median duration of PN use was 27 months (interquartile range, 11–66). PN use was significantly associated with smoking, narcotic use, IBD‐related operations, and lower quality‐of‐life scores. Among IBD‐PN patients, 7 of 25 (28%, 3 after use of teduglutide) were able to successfully discontinue this modality. Median healthcare charges in the IBD‐PN group were $51,456 annually. Median charges in the controls were $3427. Period prevalence mortality was 11.5% in IBD‐PN and 3.8% in controls. Conclusions IBD patients requiring long‐term home PN/IVF support are a small minority in the present era of immunomodulator/biologic therapy. These refractory patients have a 15‐fold increase in annual median healthcare charges compared with control IBD patients.

show abstract

“…A number of studies have been conducted to identify the risk factors for patients with CD undergoing surgery. Several risk factors, such as age, hypoalbuminemia, and anemia, are associated with postoperative outcomes [8][9][10][11]. However, the role of sarcopenia was not described well in these studies.…”

Section: Introductionmentioning

confidence: 93%

Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn’s Disease

Zhang

¹

,

Yu

²

,

Hong

³

et al. 2021

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Background and Aims. Sarcopenia is a prognostic factor of outcomes for various diseases, but reports on sarcopenia in patients with Crohn’s disease (CD) are few. We aim to determine the prevalence of sarcopenia and assess the role of sarcopenia in postoperative complications in patients with CD at a tertiary referral center. Methods. Patients who underwent intestinal surgery for CD from January 2013 to October 2019 were retrospectively enrolled. The L3 skeletal muscle mass index (SMI) was used to identify sarcopenia. Demographic data, preoperative laboratory data, surgical details, and hospital outcomes were recorded. The factors associated with postoperative complications were evaluated through univariate and multivariate analyses. Results. One hundred and twenty-four patients were enrolled. Thirty-four of them (27.4%), including 11 males, were diagnosed with sarcopenia. Compared with patients without sarcopenia, sarcopenic patients had a significantly lower BMI ( P < 0.001 ); lower preoperative serum albumin ( P = 0.006 ), prealbumin ( P = 0.030 ), and hemoglobin levels ( P < 0.001 ); longer hospital stay ( 34.4 ± 26.8 days vs. 22.8 ± 15.6 days, P = 0.003 ); and more occurrences of complications (41.2% vs. 23.3%, P = 0.049 ). The overall incidence of postoperative complications was 28.2%. Infection (51.4%) and intestinal fistula (22.9%) were the most common among such complications. Through the multivariate analysis, sarcopenia was identified as an independent risk factor for major postoperative complications ( odds ratio = 3.974 , 95 % CI = 1.171 –13.489, P = 0.027 ). Conclusion. Sarcopenia is common in patients with CD requiring bowel resection, and it significantly increases the risk of major postoperative complications.

show abstract

“…The PC does not change after the intervention. COM using NP was observed, although the proportion is low [16].…”

Section: Vol 16 Iss 1 Year 2023 International Journal Of Nutrologymentioning

confidence: 88%

Major clinical approaches to macro and micronutrients in enteral therapy according to international guidelines and clinical studies: a systematic review

Ribeiro¹

2023

IJN

View full text Add to dashboard Cite

Introduction: In the context of Nutritional Therapy (NT), critically ill patients are associated with a state of catabolic stress and a systemic inflammatory response. Patients admitted to intensive care units (ICU) have a prevalence of malnutrition greater than 35%. The main objective of parenteral nutrition (PN) is to provide a nutrient mix closely related to requirements safely and avoid complications. However, PN poses a considerable risk of overfeeding, which can be just as harmful as underfeeding. Long-term survival data (expressed as 6-month survival) will also be considered a relevant outcome measure. Objective: It was performed a systematic review to evaluate the main clinical approaches of macro and micronutrients in enteral therapy according to international guidelines and clinical studies. Methods: The present study followed a concise systematic review model, following the systematic review rules (PRISMA). The literary search process was carried out from August to October 2022 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2011 to 2022. The low quality of evidence was attributed to case reports, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: It was found 118 studies that underwent eligibility analysis, and then 20 of the 22 total studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with I2 =97.7% >50%. Standard crystalline amino acid solutions, while devoid of side effects, remain incomplete regarding their composition (eg glutamine). Lipid emulsions have come a long way and are now included in bi- and tri-compartment feeding bags, allowing for true total PN as long as daily micronutrients are prescribed. The issue of exact individual needs for energy, macro, and micronutrients has not yet been resolved. Many complications attributed to total PN are the consequence of under or overfeeding. Total PN indications have evolved towards its use alone or in combination with enteral nutrition. The start time varies by country between admission (Australia and Israel), day 4 (Swiss), and day 7 (Belgium, USA). The most important issue may be an individualized and time-dependent prescription of the feeding pathway, energy, and substrates.

show abstract

Parenteral Nutrition in Patients with Inflammatory Bowel Disease Systematic Review, Meta-Analysis and Meta-Regression

Cited by 20 publications

References 65 publications

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn’s Disease

Major clinical approaches to macro and micronutrients in enteral therapy according to international guidelines and clinical studies: a systematic review

Contact Info

Product

Resources

About