Serum Vitamins in Adult Patients With Short Bowel Syndrome Receiving Intermittent Parenteral Nutrition

Abstract

Background: Short bowel syndrome (SBS) occurs after massive intestinal resection, and parenteral nutrition (PN) therapy may be necessary even after a period of adaptation. The purpose of this study was to determine the vitamin status in adults with SBS receiving intermittent PN. Methods: The study was conducted on hospitalized adults with SBS who were receiving intermittent PN therapy (n = 8). Nine healthy volunteers, paired by age and sex, served as controls. Food ingestion, anthropometry, plasma folic acid, and vitamins B12, C, A, D, E, and K were evaluated. Results: The levels of vitamins A, D, and B12 in both groups were similar. SBS patients presented higher values of folic acid (21.3 ± 4.4 vs 14.4 ± 5.2, P = .01) and lower values of vitamin C (0.9 ± 0.4 vs 1.2 ± 0.3 mg/dL, P = .03), α‐tocopherol (16.3 ± 3.4 vs 24.1 ± 2.7 µmol/L, P < .001), and phylloquinone (0.6 ± 0.2 vs 1.0 ± 0.5 nmol/L, P < .03). Eight‐seven percent of patients had vitamin D deficiency, and all patients presented with serum vitamin E levels below reference values. Conclusions: Despite all efforts to offer all the nutrients mentioned above, SBS patients had lower serum levels of vitamins C, E, and K, similar to those observed in patients on home PN. These findings suggest that the administered vitamins were not sufficient for the intermittent PN scheme and that individual adjustments are needed depending on the patient's vitamin status.

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

“…Although there are several degrees of anatomical and functional adapta tion in the remaining bowel, some patients are unable to keep a satisfactory nutritional status by oral route, thus becoming dependent on parenteral nutrition (PN) (1). Recently, we showed that SBS patients present deficien cies in vitamins E, D (3,4) and K (3), regardless of venous infusion. Within this context, efforts are primarily devo ted to intestinal adaptation to oral route nutrition (5).…”

“…Pa tients with severe malabsorption need home PN (5), but it is not a therapeutic option provided by the Brazilian public health system. In our service, these patients receive intermittent PN in periodic hospital admissions (3,4).…”

Copper and Magnesium Deficiencies in Patients With Short Bowel Syndrome Receiving Parenteral Nutrition or Oral Feeding

“…In this situation, the therapy is focused on nutrient replacement, patient rehabilitation and the return to social activities, providing an improved quality of life (44) . Since home PN is not a therapeutic option provided by the Brazilian public health system, patients with severe malabsorptive states receive intermittent PN in our service at the Clinical Hospital of Ribeirão Preto of the University of São Paulo (7,32) . These patients are hospitalized every 10-40 days to receive PN cycles (3-8 days), depending on symptoms such as diarrhea, dehydration, and poor nutritional status (7) .…”

“…Since home PN is not a therapeutic option provided by the Brazilian public health system, patients with severe malabsorptive states receive intermittent PN in our service at the Clinical Hospital of Ribeirão Preto of the University of São Paulo (7,32) . These patients are hospitalized every 10-40 days to receive PN cycles (3-8 days), depending on symptoms such as diarrhea, dehydration, and poor nutritional status (7) . Patients with SBS have significant fluid loss, which is a difficult and common problem, especially in those with a minimal residual intestine.…”

Vitamins During Cycles of Intermittent Parenteral Nutrition

“…Due to limitations to the use of intravenous access in a home environment, the medical nutrition team, composed of physicians and dietitians, advises patients to follow an appropriate oral diet (Nonino et al 2001) and vitamin and mineral supplements on a daily basis at the time of discharge. Although the patients receive intravenous vitamin administration according to the current recommendations, IPN infusion may not be adequate to ensure serum vitamin levels within normal values (Braga et al 2011;Ferreira et al 2013).…”