Metabolic impact of high lipid low dextrose parenteral nutrition.

BACKGROUND: Parenteral nutrition (PN) containing 100% soybean oil lipids and high amounts of dextrose may lead to liver dysfunction and hyperglycemia. Mixed lipids have less pro-inflammatory components, so higher doses may be given to decrease the amount of dextrose provided. The purpose of this study is to provide a descriptive analysis of patients who received PN with high mixed lipid and low dextrose content versus PN with lower 100% soybean oil lipid and high dextrose content. METHODS: We retrospectively reviewed 62 patients aged ≥18 years receiving PN ≥ 7 days from 2016 to 2021 in an acute care hospital. Participants were divided into two groups: high lipid low dextrose (HLLD) containing a four-oil lipid (>30% kcal or ≥1 g/kg) vs adequate lipid high dextrose (ALHD) containing a 100% soybean oil lipid (<30% kcal or <1 g/kg SO-ILE). RESULTS: Patients in the HLLD group (n = 31) had 64.1% lower incidence of blood glucose levels >180 mg/dL, decreased insulin requirements, 52.7% lower alkaline phosphatase levels, 40.6% higher prealbumin levels, and 42.6% lower c-reactive protein levels while maintaining similar calorie targets compared to the ALHD group (n = 31). CONCLUSION: Changing from 100% soybean oil to a mixed lipid in PN is helpful to reduce soybean oil intake. However, it is also important to increase the mixed lipid dose to decrease the amount of dextrose provided. PNs containing higher amounts of mixed lipids (40-45% kcal) with lower amounts of dextrose (20-30% kcal) may have clinical benefits that warrant further exploration.

High lipid, low dextrose parenteral nutrition allows patient to achieve nutritional autonomy: A case report.

INTRODUCTION: Prolonged use of parenteral nutrition can eventually lead to liver abnormalities. Causative factors include decreased enteral stimulation, high intakes of intravenous dextrose, proinflammatory 100 % soybean oil-based lipids, and increased burden on liver through 24-h infusions. We present a case report of a patient who received parenteral nutrition modifications to address liver dysfunction. PRESENTATION OF CASE: Our patient was a 37-year-old African American male with a past medical history including refractory Crohn's disease complicated by multiple small bowel obstructions, several bowel surgeries, left lower quadrant colostomy placement, short bowel syndrome, severe protein calorie malnutrition, parenteral nutrition dependence, and elevated liver function tests. He was admitted for nutritional optimization before a planned takedown of multiple chronic enterocutaneous and perianal fistulas. His home parenteral nutrition order contained high amounts of dextrose (69 % kcal), and low amounts of 100 % soybean oil (11 % kcal). DISCUSSION: Due to an elevated alkaline phosphatase level at baseline (1746 U/L), the Registered Dietitian maximized protein, decreased the dextrose by 62.5 %, and changed to SMOFlipid (a fish-oil containing lipid) at >1 g/kg/day to address liver abnormalities. Within 1.5 months of changing parenteral nutrition to high SMOFlipid (>30 % kcal) with low dextrose (<30 % kcal) content, alkaline phosphatase levels declined by 62 %, prealbumin levels increased by 56 %, and c-reactive protein levels decreased by 62 %. CONCLUSION: Parenteral nutrition modifications led to reversal of chronic liver dysfunction. This patient ultimately underwent a successful high-risk fistula takedown procedure, allowing for complete weaning of parenteral nutrition and achievement of sustained nutritional autonomy.

Resistant starch improves cardiometabolic disease outcomes: A narrative review of randomized trials.

Healthy dietary patterns with adequate fiber improve cardiometabolic (CM) outcomes and attenuate disease progression. Resistant starch (RS) is a fermentable fiber that affects CM outcomes; however, studies are heterogeneous and inconsistent. Thus, the purpose of this narrative review is to assess the impact of RS intake by type and amount on CM outcomes while considering subject characteristics and trial duration. Randomized crossover or parallel studies (n = 31) were selected and compared according to acute (1 day; n = 12), medium (>1-30 days; n = 8), or long (>30 days; n = 11) duration. Most acute trials in healthy adults showed improvements in postprandial glycemic outcomes irrespective of RS type or amount. However, a more pronounced reduction occurred when test meals did not match for available carbohydrate. Daily RS intake had a minimal effect on CM outcomes in medium duration trials, but insulin resistant adults had better glycemic control at 4 weeks. Several longer duration trials (8-12 weeks) showed favorable CM outcomes with daily RS intake in adults with type 2 diabetes (T2D), but not in those at risk for T2D. Furthermore, some studies reported improved lipids, inflammatory biomarkers, and heart rate. Future studies should consider matching for available carbohydrates between the RS and control groups to understand the gut microbiome's role. Furthermore, energy and fiber should be considered. Overall, the acute intake of RS improves glycemic outcomes, and consuming RS at for least 4 and up to 8 to 12 weeks in adults with prediabetes and T2D, respectively, appears to improve CM outcomes.