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. 2023 Jan 10;15(2):338.
doi: 10.3390/nu15020338.

Malnutrition with Low Muscle Mass Is Common after Weaning off Home Parenteral Nutrition for Chronic Intestinal Failure

Lucas Wauters  1   2   3 , Solène Dermine  2 , Brune de Dreuille  3 , Joanna Bettolo  2 , Coralie Hutinet  2 , Ashiq Mohamed  2 , Emilie Lecoq  2 , Lore Billiauws  2 , Alexandre Nuzzo  2   4 , Olivier Corcos  2   4 , Francisca Joly  2   3
Affiliations

Malnutrition with Low Muscle Mass Is Common after Weaning off Home Parenteral Nutrition for Chronic Intestinal Failure

Lucas Wauters et al. Nutrients. .

Abstract

The differences in outcomes after weaning off intravenous support (IVS) for chronic intestinal failure (IF) are unclear. Adult IF patients who are weaned off IVS at a tertiary care center (June 2019−2022) were included in this study, and nutritional and functional markers were assessed before, during, and after weaning. Short bowel syndrome (SBS) was present in 77/98 of the IF patients, with different outcomes according to the final anatomy. The body weight and the BMI increased during IVS in those with a jejunocolonic (JC) anastomosis (p < 0.001), but weight loss was significant during follow-up (p < 0.001). Malnutrition was present in >60%, with a reduced muscle mass, which was found using bioelectrical impedance analysis (BIA), in >50% of SBS-JC patients. Although reduced hand-grip strength and sarcopenia were less common, the muscle quality, or phase angle (BIA), decreased during follow-up, also correlating with serum albumin and muscle mass (p ≤ 0.01). The muscle quality and albumin were low in the patients restarting IVS, which was only the case with ≤60 cm of small bowel. Closer follow-up and earlier treatment with teduglutide (TED) should be considered in these patients, as none of the TED-treated patients were malnourished or sarcopenic. Studies on the potential benefits of nutritional and physical interventions for low muscle mass and associations with outcomes are needed in chronic IF patients.

Keywords: intestinal failure; malnutrition; parenteral nutrition; sarcopenia; short bowel syndrome; teduglutide.

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Conflict of interest statement

F.J. has received grants/research support/honoraria or consultation fees from Baxter, Fresenius Kabi, Nestlé Health Sciences, BBraun, Theradial, mobile3e Consulting, Carembouche, NPS Pharmaceuticals, Shire, Takeda, Therachon, VectivBio, and Zealand Pharma. All other authors declare no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of SBS patients during IVS and FU after weaning. Continuity surgery (RC) was performed in temporary and definite SBS patients with a colon-in-continuity. Patients weaned on TED (four SBS-JC, one SBS-I patients) were analyzed separately. Abbreviations: follow-up (FU), intravenous support (IVS), small bowel (SB), short bowel syndrome (SBS), ileostomy (SBS-I), jejuno-colic (SBS-JC) or jejuno-ileal anastomosis (SBS-JIC), restoration of continuity (RC), and teduglutide (TED).
Figure 2
Figure 2
Individual changes in albumin for SBS-JC and SBS-JIC patients during IVS and FU. (A) SBS-JC and (B) SBS-JIC patients restarting IVS during FU are indicated in red (albumin <30 g/L during FU). Abbreviations: follow-up (FU), short bowel syndrome (SBS), jejuno-colic anastomosis (SBS-JC), and jejuno-ileal anastomosis (SBS-JIC).
Figure 3
Figure 3
Prevalence of malnutrition in SBS-JC and SBS-JIC patients during FU after weaning. (A) SBS-JC and (B) SBS-JIC patients with malnutrition (GLIM-criteria), with prevalence of low muscle mass or FFMI in those with available BIA. Abbreviations: fat-free mass index (FFMI), short bowel syndrome (SBS), jejuno-colic anastomosis (SBS-JC), and jejuno-ileal anastomosis (SBS-JIC).
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