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      Current status of parenteral nutrition and enteral nutrition application: an assessment of nutritional prescriptions from 59 hospitals in the People’s Republic of China

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          Abstract

          Purpose

          The aim of the study reported here was to assess the use of parenteral nutrition (PN) and enteral nutrition (EN), and the prevalence of PN and EN formulas, in the People’s Republic of China.

          Methods

          Fifty-nine hospitals in the People’s Republic of China participated in a nutrition survey. The resulting information on nutritional support was analyzed.

          Results

          We received 379,584 nutritional-support prescriptions over 40 days in 2013. PN provided approximately 63.2% and EN provided approximately 36.8% of nitrogen intake. PN provided 63.5% and EN provided 36.5% of lipid intake. There were obvious differences in nitrogen and lipid intake between PN and EN in different regions, departments, and diseases. The percentage of nourishment provided by PN in different regions was highest in Chengdu, followed by the Beijing, Guangzhou, and Hangzhou areas. The percentage of nourishment provided by PN in different departments was highest in general surgery, followed by gastroenterology and the intensive care unit. The percentage of nourishment provided by PN in different diseases/conditions was highest in acute pancreatitis, followed by cancer, and burns. The main source of nitrogen in PN was balanced amino-acid preparations, and in EN, it was protein. The main source of lipids in PN was long- and medium-chain triglyceride lipid emulsion injection.

          Conclusion

          Despite recent improvements in the application of nutritional support in the People’s Republic of China, a much higher percentage of nitrogen and lipids is delivered through PN than through EN. Furthermore, there are marked regional, departmental, and disease-based differences in the selection of PN versus EN. The rationale for use of nutritional support needs to be improved.

          Most cited references17

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          ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation.

          A Weimann, M. Braga, L Harsányi … (2006)
          Enhanced recovery of patients after surgery ("ERAS") has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in surgical patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1980. The guideline was discussed and accepted in a consensus conference. EN is indicated even in patients without obvious undernutrition, if it is anticipated that the patient will be unable to eat for more than 7 days perioperatively. It is also indicated in patients who cannot maintain oral intake above 60% of recommended intake for more than 10 days. In these situations nutritional support should be initiated without delay. Delay of surgery for preoperative EN is recommended for patients at severe nutritional risk, defined by the presence of at least one of the following criteria: weight loss >10-15% within 6 months, BMI<18.5 kg/m(2), Subjective Global Assessment Grade C, serum albumin <30 g/l (with no evidence of hepatic or renal dysfunction). Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.
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            Enteral versus parenteral nutrition for acute pancreatitis.

            Mohammed Al-Omran, Zaina H Albalawi, Mariam F Tashkandi … (2010)
            Acute pancreatitis creates a catabolic stress state promoting a systemic inflammatory response and nutritional deterioration. Adequate supply of nutrients plays an important role in recovery. Total parenteral nutrition (TPN) has been standard practice for providing exogenous nutrients to patients with severe acute pancreatitis. However, recent data suggest that enteral nutrition (EN) is not only feasible, but safer and more effective.Therefore, we sought to update our systematic review to re-evaluate the level of evidence. To compare the effect of TPN versus EN on mortality, morbidity and length of hospital stay in patients with acute pancreatitis. Trials were identified by computerized searches of The Cochrane Controlled Trials Register, MEDLINE, and EMBASE. Additional studies were identified by searching Scisearch, bibliographies of review articles and identified trials. The search was undertaken in August 2000 and updated in September 2002, October 2003, November 2004 and November 2008. No language restrictions were applied. Randomized clinical trials comparing TPN to EN in patients with acute pancreatitis. Two reviewers independently abstracted data and assessed trial quality. A standardized form was used to extract relevant data. Eight trials with a total of 348 participants were included. Comparing EN to TPN for acute pancreatitis, the relative risk (RR) for death was 0.50 (95% CI 0.28 to 0.91), for multiple organ failure (MOF) was 0.55 (95% CI 0.37 to 0.81), for systemic infection was 0.39 (95% CI 0.23 to 0.65), for operative interventions was 0.44 (95% CI 0.29 to 0.67), for local septic complications was 0.74 (95% CI 0.40 to 1.35), and for other local complications was 0.70 (95% CI 0.43 to 1.13). Mean length of hospital stay was reduced by 2.37 days in EN vs TPN groups (95% CI -7.18 to 2.44). Furthermore, a subgroup analysis for EN vs TPN in patients with severe acute pancreatitis showed a RR for death of 0.18 (95% CI 0.06 to 0.58) and a RR for MOF of 0.46 (95% CI 0.16 to 1.29). In patients with acute pancreatitis, enteral nutrition significantly reduced mortality, multiple organ failure, systemic infections, and the need for operative interventions compared to those who received TPN. In addition, there was a trend towards a reduction in length of hospital stay. These data suggest that EN should be considered the standard of care for patients with acute pancreatitis requiring nutritional support.
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              A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients.

              Jennifer L. Moran, Robert J Hughes, John Victor Peter (2004)
              Nutritional support as enteral or parenteral nutrition (PN) is used in hospitalized patients to reduce catabolism. This study compares outcomes of early enteral nutrition (EN) with early PN in hospitalized patients. The authors conducted a metaanalysis of randomized, controlled trials (RCT) comparing early EN with PN. Studies on immunonutrition were excluded. Studies were categorized as medical, surgical, or trauma. RCTs of early EN/PN were identified by search of 1) MEDLINE (1966-2002), 2) published abstracts from scientific meetings, and 3) bibliographies of relevant articles. Thirty RCTs (ten medical, 11 surgical, and nine trauma) compared early EN with PN. The effect of nutrition type on hospital mortality and complication rates was reported as risk difference (RD%) and hospital length of stay (LOS) as mean weighted difference (MWD days). Missing data, by outcomes, varied from 20% to 63%. As a result of heterogeneity of treatment effects, the DerSimonian-Laird random-effects estimator was reported. There was no differential treatment effect of nutrition type on hospital mortality for all patients (0.6%, p = .4) and subgroups. PN was associated with increases in infective complications (7.9%, p = .001), catheter-related blood stream infections (3.5%, p = .003), noninfective complications (4.9%, p = .04), and hospital LOS (1.2 days, p = .004). There was no effect of nutrition type on technical complications (4.1%, p = .2). EN was associated with a significant increase in diarrheal episodes (8.7%, p = .001). Publication bias was not demonstrated. Metaanalytic regression analysis did not demonstrate any effect of age, time to initiate treatment, and average albumin on mortality estimates. Cumulative metaanalysis showed no change in the mortality estimates with time. There was no mortality effect with the type of nutritional supplementation. Although early EN significantly reduced complication rates, this needs to be interpreted in the light of missing data and heterogeneity. The enthusiasm that early EN, as compared with early PN, would reduce mortality appears misplaced.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ther Clin Risk Manag
                Journal ID (iso-abbrev): Ther Clin Risk Manag
                Journal ID (publisher-id): Therapeutics and Clinical Risk Management
                Title: Therapeutics and Clinical Risk Management
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6336
                ISSN (Electronic): 1178-203X
                Publication date Collection: 2015
                Publication date (Electronic): 10 February 2015
                Volume: 11
                Pages: 201-207
                Affiliations
                Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
                Author notes
                Correspondence: Ke Ma, 3 East Qingchun Road, Hangzhou, People’s Republic of China, Tel +86 571 8600 6800, Fax +86 571 8600 6800, Email makeali2003@ 123456163.com
                Article
                Publisher ID: tcrm-11-201
                DOI: 10.2147/TCRM.S76636
                PMC ID: 4332311
                PubMed ID: 25709462
                SO-VID: f251b646-4a1c-47ae-92e0-cc38d93c5720
                Copyright © © 2015 Han et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License
                License:

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: nutrition survey,prescription,nutritional support,amino-acid preparations,lipid emulsion
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: nutrition survey, prescription, nutritional support, amino-acid preparations, lipid emulsion

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