Search Results (4)

Background: Total parenteral nutrition (TPN) is widely used after major gastrointestinal surgery; however, its early systemic metabolic effects and temporal adaptation patterns remain incompletely characterized. This study applied a longitudinal plasma metabolomics approach to investigate time-dependent metabolic changes during early TPN administration. Methods: Plasma samples were collected from patients undergoing gastrointestinal surgery before TPN initiation (baseline, T0) and at 24 h (T1), 48 h (T2), and 72 h (T3). Untargeted metabolomic profiling was performed using complementary gas chromatography–mass spectrometry (GC–MS) and liquid chromatography–mass spectrometry (LC–MS) platforms. In total, 111 metabolites were detected. Analysis of variance (ANOVA) with baseline (T0) as the reference identified time-point–specific metabolic alterations during TPN administration. Results: At 24 h (T1), nominally significant increases were observed in glycine, tryptophan, isoleucine, and methionine, accompanied by decreases in sarcosine and oxalic acid. At 48 h (T2), elevated levels of glycine, isoleucine, valine, and phenylalanine persisted, while sarcosine, oxalic acid, and myo-inositol remained decreased. By 72 h (T3), sustained increases in glycine, isoleucine, valine, phenylalanine, proline, alanine, and tryptophan were accompanied by reduced levels of sarcosine, oxalic acid, and glucopyranose, reflecting coordinated alterations across multiple metabolite classes. Conclusions: Overall, the results demonstrated a distinct longitudinal metabolomic pattern characterized by increases in circulating amino acids and time-dependent changes in carbohydrate- and lipid-related metabolites within the first 72 h of TPN. This exploratory, time-resolved metabolomic study in 37 patients highlights the utility of untargeted metabolomics for characterizing early metabolic adaptation to parenteral nutrition and supporting postoperative metabolic monitoring. Full article

Background/Objectives: Patients who undergo gastrectomy for gastric adenocarcinoma and subsequently develop chronic intestinal failure requiring long-term home parenteral nutrition (HPN) represent a clinically vulnerable cohort in whom survival is shaped by profound nutritional depletion and systemic inflammation. Immuno-nutritional biomarkers may support improved risk stratification in this setting. Methods: This retrospective study included adults who underwent gastrectomy for gastric cancer and developed malignant chronic intestinal failure requiring HPN. Immuno-nutritional status at HPN qualification was evaluated using the Controlling Nutritional Status (CONUT) score and the lymphocyte-to-monocyte ratio (LMR). Overall survival was analysed using Cox proportional hazards models. LMR discrimination was assessed using receiver operating characteristic (ROC) analysis with a Youden-derived cut-off, and differences in AUC were tested using DeLong’s method. Results: Ninety-seven patients met the inclusion criteria. Median overall survival was 176 days. In multivariable analysis, CONUT and LMR were the only independent predictors of survival. Each one-point increase in CONUT was associated with an approximately 70% increase in mortality risk. LMR demonstrated good discriminative ability (AUC 0.795), and a cut-off of 2.083 differentiated survival trajectories. The combined CONUT–LMR model improved prognostic classification, and DeLong’s test confirmed a significant AUC difference compared with single-marker models. Kaplan–Meier curves showed clear separation across CONUT and LMR strata (log-rank p < 0.001). Conclusions: Among patients requiring long-term HPN after gastrectomy for gastric cancer, CONUT and LMR provide complementary prognostic information. Their combined use enhances survival stratification and may support earlier identification of patients with high-risk trajectories. Full article

Background: There is an insufficient knowledge base for optimal parenteral nutrition (PN) use for patients with incurable cancer, leading to vague guidelines and varied practices. The aim of the study is to describe the practices and actual outcomes of PN in patients with incurable cancer at Norwegian hospitals. Methods: This multicentre study retrospectively reviewed 507 deceased patients (>18 years) receiving PN between 2011 and 2017. Data were collected from PN initiation until death, and analyses were descriptive. Results: Fifty-one percent had upper and lower gastrointestinal cancers, and the main PN indications were insufficient intake (75%) and gastrointestinal malfunction (47%). Sixty-seven percent received no anticancer treatment. Forty-three (8%) received PN as temporary bridging to anticancer treatment, of whom fifteen (35%) resumed or initiated treatment. The median PN dose corresponded to 53% of estimated energy requirements, and 94% of the patients had complementary energy intake. The most common reason for discontinuation was expected imminent death (47%). While common symptoms during PN were nausea (52%), vomiting (46%), and oedema (37%), 15% reported improved wellbeing. Conclusions: In this real-world cohort, up to 80% of the patients would not meet the eligibility criteria of previous trials due to cancer diagnosis and treatment, gastrointestinal tract function, weight loss criteria or complications such as ascites. This study highlights the heterogeneity in how patients with incurable cancer receive PN, and emphasises the importance of individualised PN treatment, carefully and safely managed to meet the patients’ palliative care situation. Future real-world pragmatic patient-centred protocols bridging the gap between clinical trials and patients in clinical practice are warranted. Full article

Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PN-EN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94 ± 6.72 Kcal/kg/day) and protein (1.01 ± 0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95 ± 0.43 vs 1.17 ± 0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18–0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91–0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81–0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943. Full article