Conclusions: the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.

Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018–1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%—neurovascular, 13.7%—neurodegenerative), 33.9% cancer (20.2%—head and neck, 11.7%—gastrointestinal cancer), 2.5%-gastroenterology, 1.5%—inherited diseases. Of new registrations in 2018—cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m2, NRS 2002 score—4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.

Total parenteral nutrition (TPN) is essential for patients with postoperative impairing gastrointestinal function who are unable to receive and absorb oral/enteral feeding for at least 7 days. Oxidative stress plays a major role in the ethiopathogenesis of cancers. In this study, total antioxidant status (TAS), glutathione peroxidase (GPx), superoxide dismutase, malondialdehyde and ascorbic acid were studied in patients operated because of small intestine, colorectal or pancreatic cancer and subsequently receiving TPN in comparison with patients receiving standard nutrition after the operation. TAS level and GPx activity were decreased in patients with small intestine cancer but did not differ in patients with colorectal and pancreatic cancer before and after surgery. In all patient groups receiving TPN, superoxide dismutase activity after the surgery was kept at the same level as before. On the fifth day after the surgery, malondialdehyde concentration in each group was restored to the value observed before surgery. On the fifth day of TPN treatment, ascorbic acid concentration was increased in every group of patients. TPN applied during the postoperative period alleviates oxidative stress resulting from surgery. In the case of small intestine cancer, the addition of vitamins and antioxidants to the nutrition mixture seems to result in depletion of antioxidant enzymes' activities.

Objectives Patients on home parenteral nutrition (HPN) are prone to severe complications of SARS-COV-2 infection. The pandemic requires adaptation of the health care standards, including epidemiological surveillance, logistics of home supply and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of the analysis was to evaluate the medical staff resources in HPN units. Results The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first three months of the pandemic (March-May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for HAN (home artificial nutrition) was estimated. 14 of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75 per million citizens. 344 HCW are involved in patients’ care in Polish HPN units; 18.9% are physicians (49%-surgeons, 18.46%-internal medicine specialists, 15.38%-Anesthesiologists, 7.69%-Pediatricians, 1.54%- Palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN Patient to HCW ratios for physicians, nurses, pharmacists, dietitians were respectively: 49.5; 29.15; 111.6; 181.6. Medium age of physicians and nurses was: 45.6 and 44.15. 53.8% of physicians and 31.53% of nurses work parallelly in hospital wards. 31 Pharmacists overall are working in all HPN units (2.21 per unit) and 18 dietitians (1.3 per unit). 9 patients had a confirmed COVID-19 infection (4- HPN, 5-HEN). All the units introduced telemedical solutions in the first months of the pandemic. The number of new qualifications for HPN and HEN in the units did not significantly decline in March-May in comparison with a similar period in 2019. Conclusions A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health system may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental impact on HPN including serious issues with access to professional HCW.

BackgroundEnteral nutrition (EN) with foods for special medical purposes (FSMP) is recommended for most patients on home enteral nutrition (HEN). Although there are disease-specific guidelines for energy, protein, and micronutrient provision, only a few studies are showing real-life experience in the long-term use of FSMP.MethodsIn a multicenter study, the influence of the FSMP composition and administration technique (bolus vs. continuous) on protein and energy provision in HEN was analyzed. Provision of vitamins and minerals was compared to recommended daily allowance (RDA) and upper tolerable limit (UL).ResultsApproximately, 772 patients on HEN, mostly (88.6%) with oncological and neurological diseases, were enrolled. The patients on standard FSMP received less protein and energy than those on hypercaloric and protein enriched despite receiving higher volumes of EN (p < 0.05). No differences were observed in jejunal feeding with oligomeric vs. polymeric FSMP in terms of energy, protein, and volume. Continuous gastric feeding provided more protein, energy, and volume vs. bolus feeding (p < 0.05). Significant number of patients received less than 100% RDA of vitamin D (50.5%), vitamin B3 (49%), vitamin K (21.8%), vitamin B5 (64.3%), vitamin B9 (60%). Majority of the patients received less than 100% RDA of sodium (80.2%), potassium (99%), chloride (98%), calcium (67%), magnesium (87%), fluoride (99%), and iodine (43%). Approximately, 43.63% of cancer and 49.9% of neurological patients received less than 1 g/kg/day of protein and 51.7% of cancer and 55.5% of neurological patients received less than 25 kcal/kg/day.ConclusionAwareness of the available compositions of FSMP and advantageous profiles of specific diets may lead to the implementation of recommendations for EN. HEN professionals need to analyze all the patient’s needs and requirements to provide more tailored matching of nutritional support.

The role of glutamine in metabolic processes has been quite extensively researched and described, though no consensus exists as to its role in treatment. It is considered significant mainly for ICU patients; though no clear criteria for including glutamine in treatment have been defined. It is known that glutamine should be administered as a complement to nutritional treatment, and not independently. The purpose of the paper was to identify practical criteria for determining the clinical benefits of glutamine supplementation. The study was performed in the years 2007-2015 at the 1st Department of General and Transplantation Surgery and Nutritional Therapy of the Lublin Medical University in Lublin, Poland. It included patients scheduled for surgery due to a gastrointestinal cancer. The final study group included 105 patients, 48 female and 57 male. We found that low blood concentration of glutamine was correlated with a higher incidence of postoperative complications. ROC analysis allowed for identification of glutamine concentration below which there is a very high risk of complications. The threshold glutamine value identified was 205.15 nmol/ml. Low total lymphocyte count and serum albumin concentration can help identify patients in whom glutamine supplementation can decrease postoperative complication incidence, especially in the case of malnourished patients. Glutamine supplementation before a scheduled surgical procedure may benefit patients with a preoperative glutamine concentration below 205.15 nmol/ml. Glutamine supplementation can benefit malnourished patients.