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Glycemic Variation in Tumor Patients with Total Parenteral Nutrition.

ABSTRACT: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients.This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG.The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time.When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The ClinicalTrials.gov ID is NCT02024321.

SUBMITTER: Yang JC

PROVIDER: S-EPMC4717948 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Glycemic Variation in Tumor Patients with Total Parenteral Nutrition.

Yang Jin-Cheng JC Dai Yuan-Yuan YY Wang Li-Ming LM Xie Yi-Bin YB Zhou Hai-Yan HY Li Guo-Hui GH

Chinese medical journal 20150801 15

<h4>Background</h4>Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients.<h4>Methods</h4>This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutriti ...[more]

PMID: 26228214

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Project description:BACKGROUND:Total parenteral nutrition (TPN) provides all nutritional needs intravenously. Although lifesaving, enthusiasm is significantly tempered due to side effects of liver and gut injury, as well as lack of mechanistic understanding into drivers of TPN injury. We hypothesized that the state of luminal nutritional deprivation with TPN drives alterations in gut-systemic signaling, contributing to injury, and tested this hypothesis using our ambulatory TPN model. METHODS:A total of 16 one-week-old piglets were allocated randomly to TPN (n = 8) or enteral nutrition (EN, n = 8) for 3 weeks. Liver, gut, and serum were analyzed. All tests were two-sided, with a significance level of 0.05. RESULTS:TPN resulted in significant hyperbilirubinemia and cholestatic liver injury, p = 0.034. Hepatic inflammation (cluster of differentiation 3 (CD3) immunohistochemistry) was higher with TPN (p = 0.021). No significant differences in alanine aminotransferase (ALT) or bile ductular proliferation were noted. TPN resulted in reduction of muscularis mucosa thickness and marked gut atrophy. Median and interquartile range for gut mass was 0.46 (0.30-0.58) g/cm in EN, and 0.19 (0.11-0.29) g/cm in TPN (p = 0.024). Key gut-systemic signaling regulators, liver farnesoid X receptor (FXR; p = 0.021), liver constitutive androstane receptor (CAR; p = 0.014), gut FXR (p = 0.028), G-coupled bile acid receptor (TGR5) (p = 0.003), epidermal growth factor (EGF; p = 0.016), organic anion transporter (OAT; p = 0.028), Mitogen-activated protein kinases-1 (MAPK1) (p = 0.037), and sodium uptake transporter sodium glucose-linked transporter (SGLT-1; p = 0.010) were significantly downregulated in TPN animals, whereas liver cholesterol 7 alpha-hydroxylase (CyP7A1) was substantially higher with TPN (p = 0.011). CONCLUSION:We report significant alterations in key hepatobiliary receptors driving gut-systemic signaling in a TPN piglet model. This presents a major advancement to our understanding of TPN-associated injury and suggests opportunities for strategic targeting of the gut-systemic axis, specifically, FXR, TGR5, and EGF in developing ameliorative strategies.

Project description:BACKGROUND/OBJECTIVES:Abdominal surgery significantly affects the structure and function of the gastrointestinal system of patients, total parenteral nutrition (TPN) is an important nutrition support method for postoperative patients. However, in the process of TPN practice, the excessive fat emulsion and compound amino-acid prescriptions ratio are often prescribed by doctors. To address the problem, we developed the computerized TPN prescription management system to promote the personalized provision of TPN. The purpose of this study is to evaluate the intervention effects of the computerized TPN prescription management system, which is designed by pharmacists in the Surgical Department of Abdominal Oncology at Zhejiang Cancer Hospital in July 2015. SUBJECTS/METHODS:The computerized TPN prescription management system applied in Surgical Department of Abdominal Oncology on 1 July 2015. The computerized TPN prescription management system was evaluated by comparing the patients who were treated 3 months after the application of the system with the control subjects who were treated 3 months prior to the application of TPN prescription management system in Surgical Department of Abdominal Oncology. RESULTS:In total, 218 TPN prescription-treated patients with colorectal cancer received surgery treatment were analyzed, including 121 subjects who received the treatment 3 months prior to application of TPN prescription system (IPN period) and 97 subjects who received the treatment after 3 months of the system application (SPN period). The rates of optimized TPN prescriptions are 47.1% and 88.7% prior to and after application of TPN prescription review system, respectively (p?<?0.001). In detail, prior to application of TPN prescription review system, abnormal glucose-lipid ratio and nitrogen-calorie ratio are the most common problems, which accounted for 74.3 and 97.9%, respectively (p?<?0.01). Whereas the proportion of the insufficient dosage of amino acids is 62 and 96.9%, respectively (p?<?0.01). Other problems are insufficient dosage of insulin and excessive fat soluble vitamin supplement. After application of TPN prescription review system, as the glucose-lipid ratio and nitrogen-calorie ratio are set up in fixed range according to the nutrition treatment guidelines, only a small amount of TPN prescriptions have the problem of insufficient dosage of compound amino acid. Furthermore, before and after the application of TPN management software, the gender, age, performance status (PS) score and BMI index of the two groups of colorectal cancer patients were not statistically different (p?>?0.05). There were significant differences in albumin and prealbumin between the two groups after operation (p?<?0.05), and there was a significant difference in total protein (p?<?0.001). There were significant differences in alanine aminotransferase and indirect bilirubin between liver and kidney function (p?<?0.01), and there were significant differences in aspartate aminotransferase and total bilirubin (p?<?0.05). Other total cholesterol, L-?-glutamyl transferase, direct bilirubin and creatinine were not statistically different (p?>?0.05). Blood routine (WBC, Hb and lymphocyte), length of stay and recurrence rate were not statistically different (p?>?0.05). CONCLUSIONS:The application of TPN management software not only standardized the doctor's TPN medical advice, but also improved the qualified rate of TPN doctor's advice, thus ensuring the safety of the patient's medication. It also had a positive effect on postoperative recovery of colorectal cancer patients, and ensured the efficacy of the treatment of patients. In addition, it reduced the workload of the pharmacist's audit prescription and improved the efficiency of the audit prescription, and further emphasized the role and value of pharmacists.

Project description:BackgroundParenteral 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).MethodsA 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.ResultsFrom 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.ConclusionThe 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.

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Glycemic Variation in Tumor Patients with Total Parenteral Nutrition.

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Glycemic Variation in Tumor Patients with Total Parenteral Nutrition.

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