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. 2023 Dec 22;32(1):52.
doi: 10.1007/s00520-023-08218-z.

High-protein home parenteral nutrition in malnourished oncology patients: a systematic literature review

Paolo Cotogni  1 , Clare Shaw  2 , Paula Jimenez-Fonseca  3 , Dominic Partridge  4 , David Pritchett  4 , Neil Webb  4 , Amy Crompton  4 , Pilar Garcia-Lorda  5 , Julian Shepelev  6
Affiliations

High-protein home parenteral nutrition in malnourished oncology patients: a systematic literature review

Paolo Cotogni et al. Support Care Cancer. .

Abstract

Introduction: Up to 83% of oncology patients are affected by cancer-related malnutrition, depending on tumour location and patient age. Parenteral nutrition can be used to manage malnutrition, but there is no clear consensus as to the optimal protein dosage. The objective of this systematic literature review (SLR) was to identify studies on malnourished oncology patients receiving home parenteral nutrition (HPN) where protein or amino acid delivery was reported in g/kg bodyweight/day, and to compare outcomes between patients receiving low (< 1 g/kg bodyweight/day), standard (1-1.5 g/kg/day), and high-protein doses (> 1.5 g/kg/day).

Methods: Literature searches were performed on 5th October 2021 in Embase, MEDLINE, and five Cochrane Library and Centre for Reviews and Dissemination databases. Searches were complemented by hand-searching of conference proceedings, a clinical trial registry, and bibliographic reference lists of included studies and relevant SLRs/meta-analyses.

Results: Nineteen publications were included; sixteen investigated standard protein, two reported low protein, and one included both, but none assessed high-protein doses. Only one randomised controlled trial (RCT) was identified; all other studies were observational studies. The only study to compare two protein doses reported significantly greater weight gain in patients receiving 1.15 g/kg/day than those receiving 0.77 g/kg/day.

Conclusion: At present, there is insufficient evidence to determine the optimal protein dosage for malnourished oncology patients receiving HPN. Data from non-HPN studies and critically ill patients indicate that high-protein interventions are associated with increased overall survival and quality of life; further studies are needed to establish whether the same applies in malnourished oncology patients.

Keywords: High protein; Malnutrition; Oncology; Parenteral nutrition.

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Conflict of interest statement

Paolo Cotogni, Clare Shaw, and Paula Jimenez-Fonseca received no sponsorship for participation in this study and declare that they have no competing interests in relation to this study. Paolo Cotogni reports previous speakers’ honoraria from Baxter International. Clare Shaw had received honoraria from BSNA, Boehringer Ingelheim and Eli Lilly. Dominic Partridge, David Pritchett, Neil Webb, and Amy Crompton are employees of Source Health Economics, the company that conducted the systematic literature review. Julian Shepelev and Pilar Garcia Lorda are employees of Baxter Healthcare.

Figures

Fig. 1
Fig. 1
PRISMA diagram. Abbreviations: CRD, Centre for Reviews and Dissemination; PRISMA, Preferred Reporting Items for Systematic literature reviews and Meta-analyses; SLR, systematic literature review
See this image and copyright information in PMC

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