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Abstract
Background: Corresponding to rising obesity rates, bariatric surgery is becoming a common intervention for obesity. Due to surgical or nutritional complications, some bariatric surgery patients may end up requiring nutritional support in the form of parental nutrition (PN). Historically, PN has been utilized by patients with intestinal failure to increase energy intake for weight gain or weight maintenance, and home parenteral nutrition (HPN) is indicated for patients requiring long-term PN.
Few studies have explored the characterization of bariatric patients receiving HPN. There is no established clinical guidelines or consensus on how to provide optimal nutrition support to this patient population. The primary aim of this study is to characterize the population of bariatric surgery patients on HPN. The secondary aim is to analyze nutrient provision in the bariatric patient on HPN and to determine if nutrient provision differs across BMI categories.
Methods: Data were accessed from the American Society for Parenteral and Enteral Nutrition’s (ASPEN) prospective HPN patient care data registry, the Sustain™ Registry. The Sustain™ Registry enrolled 1251 subjects from 29 academic medical center, hospital, and home care service sites between 2011 and 2014. Demographic and anthropometric data, indications for HPN, HPN prescriptions, medications, and other variables relating to the delivery of HPN were collected. This study will focus on the subset of patients who have undergone bariatric surgery. Descriptive statistics calculated for continuous variables included means and standard deviations, and for categorical variables, frequency and percentages. Total daily energy intake and macronutrient intake were compared across BMI classes with linear regression.
Results: Of the 1251 patients enrolled in A.S.P.E.N.’s Sustain™ Registry of patients receiving HPN, 82 (6.6%) had a history of bariatric surgery at baseline and were included in this study. Most of the patients were female (85%) and Caucasian (67%), and the average age at time of enrollment was 49 ± 10 years. Nearly half of the patients (45%) were obese. The most common indication for HPN was gastrointestinal fistula (20%) followed by intractable vomiting (16%), non-short bowel diarrhea (15%), and short bowel syndrome (12%).
Mean daily total energy intake ranged from 20.6 to 32.8 kcal/kg with protein comprising 1.56 to 1.96 g/kg. There was a significant negative association between daily total energy provision and increasing BMI category with a mean decrease in total energy provision of 1.96 kcal/kg/day with each increasing BMI category. There was a significant negative association between daily dextrose provision with a mean decrease of 0.52g/kg with increasing BMI category while no association was demonstrated between protein or fat provision and BMI category.
Conclusion: Nutrient provision for bariatric patients on HPN varies across BMI categories with a negative association between energy provision and increasing BMI category. Variations in dextrose provision comprise the difference in energy provision. Additional studies are needed to examine the effect of nutrition interventions in this population.
