Malnutrition with Low Muscle Mass Is Common after Weaning off Home Parenteral Nutrition for Chronic Intestinal Failure

• Published in: Nutrients Vol. 15; no. 2; p. 338
• Main Authors: Wauters, Lucas, Dermine, Solène, de Dreuille, Brune, Bettolo, Joanna, Hutinet, Coralie, Mohamed, Ashiq, Lecoq, Emilie, Billiauws, Lore, Nuzzo, Alexandre, Corcos, Olivier, Joly, Francisca
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 10-01-2023; MDPI
• Subjects: Adaptation; Adult; Albumin; Anastomosis; Bioelectricity; Body composition; Body mass index; Body weight; Body weight loss; Colon; Creatinine; Disease; Electrolytes; Fistula; Gastrointestinal Agents - therapeutic use; Grip strength; Humans; Intestinal Diseases - chemically induced; Intestinal Failure; Intravenous administration; Malnutrition; Malnutrition - drug therapy; Muscles; Narcotics; Nutrition; Nutritional status; Ostomy; Parenteral nutrition; Parenteral Nutrition, Home - adverse effects; Radiation; Reconstructive surgery; Sarcopenia; Serum albumin; Short bowel syndrome; Short Bowel Syndrome - therapy; Small intestine; Surgical outcomes; teduglutide; Weaning; Weight loss; Womens health; France; malnutrition; intestinal failure; parenteral nutrition; short bowel syndrome; teduglutide; sarcopenia
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu15020338

The differences in outcomes after weaning off intravenous support (IVS) for chronic intestinal failure (IF) are unclear. Adult IF patients who are weaned off IVS at a tertiary care center (June 2019−2022) were included in this study, and nutritional and functional markers were assessed before, during, and after weaning. Short bowel syndrome (SBS) was present in 77/98 of the IF patients, with different outcomes according to the final anatomy. The body weight and the BMI increased during IVS in those with a jejunocolonic (JC) anastomosis (p < 0.001), but weight loss was significant during follow-up (p < 0.001). Malnutrition was present in >60%, with a reduced muscle mass, which was found using bioelectrical impedance analysis (BIA), in >50% of SBS-JC patients. Although reduced hand-grip strength and sarcopenia were less common, the muscle quality, or phase angle (BIA), decreased during follow-up, also correlating with serum albumin and muscle mass (p ≤ 0.01). The muscle quality and albumin were low in the patients restarting IVS, which was only the case with ≤60 cm of small bowel. Closer follow-up and earlier treatment with teduglutide (TED) should be considered in these patients, as none of the TED-treated patients were malnourished or sarcopenic. Studies on the potential benefits of nutritional and physical interventions for low muscle mass and associations with outcomes are needed in chronic IF patients.