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Abstract
Background: Home parenteral nutrition (HPN) involves the administration of parenteral nutrition (PN) therapy outside of the institutional setting. Recipients of HPN are generally patients who do not have acute medical conditions and require long-term nutritional support. The use of HPN has increased in the US. Historically, most patients receiving HPN were underweight or malnourished. However, in response to the rapidly increasing adult obesity rate, nutrition support clinicians are now encountering a substantial number of obese HPN patients in their practice. Unfortunately, research in HPN use in obese patients is essentially nonexistent, and there is no consensus or established guidelines on nutrition care for obese HPN patients. The aims of the study were to evaluate patient characteristics and clinical indications for HPN among obese adult HPN patients, and to investigate the effectiveness of HPN, defined as the attainment of predefined weight goal for them.
Methods: This study analyzed data drawn from Sustain™, the national HPN registry in the US. The data were collected between August 2011 and February 2014. Obese adults were included. Variables that were relevant to the study aims were assessed. In addition, ideal body weight (IBW) and adjusted body weight were calculated using established methods. This study used a descriptive approach to evaluate patient characteristics and clinical indications for HPN. Effectiveness of HPN, defined as meeting the pre-defined goal in weight changes, was determined by comparing the patient’s baseline weight with the weights at follow-up visits. Excel and paired Student’s t-test were used for data analysis.
Results: Of the 1,251 patients available in the registry, a total of 154 obese adult HPN patients were included in the study. The cohort included 39 (25%) men and 115 (75%) women; the mean age was 52.77 years. The majority of the study cohort was Caucasians. The mean actual body weight at baseline was 99.76 kg with a mean body mass index (BMI) of 35.80 kg/m 2. The most common diagnosis was bariatric surgery, and the most common indication for HPN was gastrointestinal (GI) fistula. The mean serum albumin concentration was low at 2.97 g/dL, but other laboratory results related to renal and hepatic functions were within the normal range at baseline. The mean daily caloric provision was 20 kcal/kg (actual body weight) or 29 kcal/kg (adjusted body weight) and the mean protein intake was 1.2 g/kg (actual body weight) or 1.7 g/kg (adjusted body weight) at baseline. The primary initial goal for the majority of these patients (66%) was to lose weight. Longitudinal data were available for 54 of the 154 patients to assess whether their pre-defined goal in weight change was achieved. The attainment of a pre-defined weight goal was assessed in three sub-groups according to their pre-defined weight goals at baseline, including “weight loss” (WL), “weight maintenance” (WM), and “weight gain” (WG). Patients in the WL group achieved their weight goals with an average weight loss of 5.83 kg (p = 0.001) at the first follow-up. Patients in the WM group had a slight decrease in weight by 0.87 kg at the first follow-up, but the difference in weights was not statistically significant (p = 0.66). Patients in the WG group achieved their weight goal with an average weight gain of 1.50 kg at the first follow-up. There were no statistically significant differences in nutrient provision between baseline and the first follow-up for each group.
Conclusion: The clinical characteristics that are unique for obese adult HPN patients include the most common diagnosis of bariatric surgery and normocaloric HPN regimen. In addition, HPN is effective among obese adult HPN patients in achieving the pre-defined weight goal.
