Impact of nationwide essential trace element shortages: A before‐after, single‐center analysis of hospitalized adults receiving home parenteral nutrition therapy

Abstract

Background: Recent data on the prevalence of essential trace element (ETE) deficiencies in home parenteral nutrition (HPN) patients are scarce. We investigated whether ETE deficiencies are still an important issue for HPN patients and whether the prevalence of such deficiencies may be influenced by nationwide drug shortages. Methods:We conducted a single-institution, retrospective analysis from 2006 to 2015 of hospitalized HPN patients who continued PN during and in between hospitalizations. In subgroup analysis, patients were dichotomized as those with HPN duration <1 vs ≥1 year. Zinc (Zn), copper (Cu), and selenium (Se) levels were abstracted for patients over the study period. Prevalence of ETE deficiency was compared using chi-squared test for patients hospitalized during nonshortage vs shortage (2011-2014) periods.Results: Ninety-six patients were included in the analysis. Prevalence of ETE deficiency during nonshortage vs shortage periods was 48% vs 54% (Zn), 15% vs 21% (Cu), and 24% vs 48% (Se; P = .01), respectively. When comparing patients who received HPN <1 year vs ≥1 year, the prevalence of Se deficiency doubled during shortage in both subgroups (24% to 42% vs 26% to 49%); and Cu deficiency tripled during shortage period in the group receiving HPN ≥1 year (5% to 16%). Conclusion:ETE deficiency is prevalent in hospitalized HPN patients and was exacerbated during nationwide shortages of parenteral supplements. Statistical significance may be limited by small sample size. Future studies are needed to determine optimal ETE supplementation strategies for minimizing the impacts of nationwide drug shortages on HPN patients.

ESPEN micronutrient guideline

“…It is also important to note the problem of shortage of parenteral micronutrients in many countries, that may occur as a result of reprioritisation of the industrial production lines. Occasional transient shortages have occurred during the last decades for both vitamins and trace elements [29], and have recured during the recent years during the COVID-19 pandemic. The scarcity of multivitamin and multi-trace element products for patients receiving PN (both in the hospital and at home) can induce depletion and deficiency through the lack of provision or decrease in frequency of administration [29e31].…”

Pitfalls in the interpretation of blood tests used to assess and monitor micronutrient nutrition status

“…The shortage of multivitamin and trace element preparations has become a potentially serious issue, upon which Zhang et al 70 have recently drawn attention. In case of a shortage, it is even more important to determine the status of the MNs at risk and increase the frequency of monitoring 71 …”

About micronutrient shortage and definition of deficiency

“…To the Editor, We congratulate Zhang et al 1 on their publication drawing attention to recurrent trace element (TE) shortage in recent decades. This shortage is of great importance to patients because micronutrients-that is, TEs and vitamins-are essential and must be provided with any parenteral nutrition (PN).…”