Evaluation of factors associated with the nutritional mixture leading to liver complications in patients treated by means of parenteral nutrition at home
Languages of publication
The major problem of total parenteral treatment consists in the balancing of the source and dose of the nutritional mixture, so as to not deepen malnutrition with a positive impact on the patients’ organism. The aim of the study was to evaluate selected factors that induce hepato-billiary complications in patients treated by means of parenteral nutrition at home. Material and methods. The retrospective study comprised 70 patients with biochemistry performed every three months. Considering statistical analysis patients were allocated to four groups, depending on the period of treatment. Group A analysis results were based on the activity of aminotransferases, group B on the activity of bilirubin. Both groups A and B were additionally divided into group I where we assigned normal values of control lab results, and group II with improper results after treatment. Results. Differences between groups Ia vs IIa were presented on the basis of the daily supply of glucose: mean- 2.52 vs 3.49 g/kg (p=0.000003), glucose/lipids ratio: mean- 3.76 vs 4.90 g/kg (p=0.0001), daily non-protein energy: mean- 16.73 vs 21.06 kcal/kg (p=0.0001). Differences between groups Ib vs IIb were presented on the basis of the daily supply of glucose: mean- 2.76 vs 3.46 g/kg (p=0.0007), glucose/lipids ratio: mean- 3.98 vs 5.13 g/kg (p=0.01), daily non-protein energy: mean-17.96 vs 20.36 kcal/kg (p=0.04). Based on the above-mentioned analysis the main goal in the prevention of hepatic complications should lead to the reduction of the dose of glucose. Increased glucose supply leads to increased number of hepato-billiary complications. Conclusions. Based on obtained results we were able to conclude that in case of liver complications associated with parenteral nutrition, proper management consists in the modification of nutritional mixtures (reduction in the daily glucose supply and change in the proportions of extra-protein energy). Such management has the greatest clinical effect. When determining the composition of the nutritional mixture one should adjust the glucose supply, so as to offset both sources of extra-protein energy
1 - 12 - 2013
25 - 01 - 2014
- 1. Siedlecka K, Snarska J, Szajda S D i wsp.: Żywienie pozajelitowe a zmiany w układach enzymatycznych. Postępy Żywienia Klinicznego 2007; 3(5): 16-21.
- 2. Łyszkowska M: Where complications of nutritional treatment come from? Latentsideeffects. Standardy Medyczne/Pediatria 2009; 6: 241-44.
- 3. Braunschweig CL , Levy P, Sheeann PM et al.: Enteralcompared with parenteral nutrition: a meta- analysis 1,2. Amer Society for Clinical Nutrition 2001; 74(4): 534-42.
- 4. DibbM, Teubner A, Theis V et al.: The management of long-term parenteral nutrition. Alimentary Pharmacology and Therapeutics 2013; 37: 587-603.[WoS]
- 5. Maroulis J, Kalfarentzos F: Complication of parenteralnutritionat the end of the century. Clinical Nutrition 2000; 19(5): 295-304.[Crossref]
- 6. Kłęk S: Complications of nutritional therapy caused by primary and coexisting diseases. Standardy Medyczne/Pediatria 2009; 6: 81-85.
- 7. Korta T: Powikłania metaboliczne żywienia pozajelitowego i dojelitowego. Postępy Żywienia Klinicznego 2008; 2(8): 20-23.
- 8. Calder P, Jensen G, Koletzko B et al.: Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions.Intensive Care Med 2010; 36(5): 735-49.[WoS]
- 9. Grygiel-Górniak B. Grzmisławski M: Hepatobiliary complications in intensive nutrition therapy.Postępy Nauk Med 2010; 1: 92-98.
- 10. Ciszewska-Jędrasik M, Pertkiewicz M: Mieszaniny do żywienia pozajelitowego. Wyd. Lek. PZWL, Warszawa 2004, s. 10-12.
- 11. Buchman AL , Iyer K, Fryer J: Parenteral Nutrition - associated liver disease and the role for isolated intestine and intestine/liver transplantation.Hepatology 2006; 43: 9-19.[PubMed][Crossref]
- 12. Guglielmi FW , Boggio-Bertinet D, Federico A et al.: Total parenteral nutrition-related gastroenterological complications. Dig Liver Dis 2006; 38(9): 623-42.[Crossref]
- 13. Zagara G, Locati L: Role of total parenteral nutrition in determining liver insufficiency in patients with cranial injuries. Glucose vs glucose + lipids. Minerva Anestesiol 1989; 55(12): 509-12.[PubMed]
- 14. Boulétreau P, Chassard D, Allaouchiche B et al.: Glucose-lipid ratio is a determinant of nitrogen balance during total parenteral nutrition in critically ill patients: a prospective, randomized, multicenter blind trial with an intention-to-treat analysis. Intensive Care Med 2005; 31(10): 1394-400.
- 15. Cober MP, Killu G, Brattain A et al.: Intravenous fat emulsions reduction for patients with parenteral nutrition-associated liver disease. J Pediatrics 2012; 160(3): 421-27.[Crossref][WoS]
- 16. Braga M, Ljungqvist O, Soeters P: ESPEN Guidelines on Parenteral Nutrition: Surgery Clin Nutr 2009; 28: 378-86.[Crossref]
- 17. Kumpf VJ: Parenteral nutrition-associated liver disease in adult and pediatric patients. Nutr Clin Pract 2006; 21(3): 279-90.[PubMed][Crossref]
- 18. Oshitaa M, Takeharaa H, Yamaguchi M: Significance of administration of fat emulsion: hepatic changes in infant rats receiving total parenteral nutrition with and without fat. Clinical Nutrition 2004; 23: 1060-68. [Crossref]
Publication order reference