TY - JOUR
T1 - The use of metabolic balance studies in the objective discrimination between intestinal insufficiency and intestinal failure
AU - Prahm, August P
AU - Brandt, Christopher F
AU - Askov-Hansen, Carsten
AU - Mortensen, Per B
AU - Jeppesen, Palle B
N1 - © 2017 American Society for Nutrition.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: In research settings that use metabolic balance studies (MBSs) of stable adult patients with short bowel syndrome, intestinal failure (IF) and dependence on parenteral support (PS) have been defined objectively as energy absorption <84% of calculated basal metabolic rate (BMR), wet weight (WW) absorption <23 g · kg body weight-1 · d-1, or both. Objective: This study aimed to explore and validate these borderlines in the clinical setting. Design: Intestinal absorption was measured from April 2003 to March 2015 in 175 consecutive patients with intestinal insufficiency (INS) in 96-h MBSs. They had not received PS 3 mo before referral. Results: To avoid the need for PS, the minimum absorptive requirements were energy absorption of ≥81% of BMR and WW absorption of ≥21 g · kg body weight-1 · d-1, which were equivalent to findings in research settings (differences of 3.6% and 8.7%; P = 0.65 and 0.60, respectively). Oral failure defined as energy intake <130% of calculated BMR orWWintake <40 g · kg body weight-1 · d-1 was seen in 71% and 82% of the 10% of patients with the lowest energy absorption and WW absorption, respectively. Conclusions: In clinical settings, the borderlines between INS and IF were not significantly different from those in research settings, even in an unselected patient population in which oral failure was also a predominant cause of nutritional dyshomeostasis. MBSs may be recommended to identify the individual patient in the spectrum from INS to IF, to objectivize the cause of nutritional dyshomeostasis (oral failure, malabsorption, or both), and to quantify the effects of treatment.
AB - Background: In research settings that use metabolic balance studies (MBSs) of stable adult patients with short bowel syndrome, intestinal failure (IF) and dependence on parenteral support (PS) have been defined objectively as energy absorption <84% of calculated basal metabolic rate (BMR), wet weight (WW) absorption <23 g · kg body weight-1 · d-1, or both. Objective: This study aimed to explore and validate these borderlines in the clinical setting. Design: Intestinal absorption was measured from April 2003 to March 2015 in 175 consecutive patients with intestinal insufficiency (INS) in 96-h MBSs. They had not received PS 3 mo before referral. Results: To avoid the need for PS, the minimum absorptive requirements were energy absorption of ≥81% of BMR and WW absorption of ≥21 g · kg body weight-1 · d-1, which were equivalent to findings in research settings (differences of 3.6% and 8.7%; P = 0.65 and 0.60, respectively). Oral failure defined as energy intake <130% of calculated BMR orWWintake <40 g · kg body weight-1 · d-1 was seen in 71% and 82% of the 10% of patients with the lowest energy absorption and WW absorption, respectively. Conclusions: In clinical settings, the borderlines between INS and IF were not significantly different from those in research settings, even in an unselected patient population in which oral failure was also a predominant cause of nutritional dyshomeostasis. MBSs may be recommended to identify the individual patient in the spectrum from INS to IF, to objectivize the cause of nutritional dyshomeostasis (oral failure, malabsorption, or both), and to quantify the effects of treatment.
KW - Adult
KW - Basal Metabolism
KW - Diagnosis, Differential
KW - Dietary Fats/metabolism
KW - Disease Progression
KW - Energy Intake
KW - Female
KW - Homeostasis
KW - Humans
KW - Intestinal Absorption
KW - Intestinal Diseases/diagnosis
KW - Intestines/metabolism
KW - Malabsorption Syndromes/etiology
KW - Male
KW - Middle Aged
KW - Parenteral Nutrition
KW - Retrospective Studies
KW - Short Bowel Syndrome/complications
U2 - 10.3945/ajcn.117.158386
DO - 10.3945/ajcn.117.158386
M3 - Journal article
C2 - 28768655
SN - 0002-9165
VL - 106
SP - 831
EP - 838
JO - The American Journal of Clinical Nutrition
JF - The American Journal of Clinical Nutrition
IS - 3
ER -