The use of metabolic balance studies in the objective discrimination between intestinal insufficiency and intestinal failure

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 - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 3

ER -