Suppression of appetite by parenteral nutrition in humans.

Abstract

The effects of parenteral nutrition on appetite during and after therapy are unclear. Previous studies done in animals, as well as in humans, are inconclusive. The purpose of this study was to investigate the effects of parenteral nutrition on voluntary oral intake of food. The study was done on ten stable patients receiving parenteral nutrition for transient dysfunction of their gastrointestinal tract. For each patient, a calorie count of the ingested food was obtained for 3 consecutive days. Parenteral calories were then decreased without the patient's knowledge. A calorie count for 3 more days was obtained following the day of change. The mean daily oral intake was 823 kcal when the mean daily parenteral nutrition intake was 2,902, providing a total of 3,723 kcal. When parenteral nutrition calories were decreased to a mean of 1,550, the mean daily oral intake increased to 1,396. This difference in oral and parenteral calorie intake was statistically significant (P less than .001). It can be concluded from this data that parenteral nutrition decreases voluntary oral intake of food. It is therefore suggested that if the gastrointestinal tract is functionally satisfactory, parenteral nutrition can be rapidly weaned off, provided oral consumption is monitored to assure adequacy.

Prognostic Factors in the Resumption of Oral Dietary Intake After Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Children

“…The group that received hydration alone resumed oral intake that met ≥85% estimated energy requirements 6 days sooner than the group that received PN. Among 10 stable patients with limited gastrointestinal disease, a reduction in parenteral energy intake was associated with a significant increase in oral dietary intake, 27 suggesting that PN may interfere with appetite. It is not yet understood how PN induces satiety.…”

Biomarcadores para la insuficiencia intestinal en Síndrome de intestino corto: ¿Una nueva era en la rehabilitación gastrointestinal?

“…The last stage is determined by the degree of intestinal functionality during the second phase. The presence of the large intestine is important in this phase since it allows the maintenance of fluid balance, electrolyte stability and may determine parenteral nutrition weaning and whether the patient will be able to tolerate oral feeding permanently, remain on artificial nutrition or require intestinal transplantation [8][9][10][11][12][13] .…”

“…Once an adequate oral feeding has been established with proper tolerance, anti-diarrheal therapy should be implemented and parenteral nutrition may be cycled. Other elements in the medical management at this point include gastric protection, bile acid sequesters, and somatostatin analogs [9][10][11][12][13] . When patients start approaching the second phase of intestinal adaptation, and have tolerated oral feeding along with a moderate diarrheal output, the following step includes the use of hyperplasic treatments such as growth hormone and Teglutide (GLP-2 analog produced by the terminal ileum and proximal colon).…”

Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo?

“…The authors cited similar studies which demonstrate that amino-acid infusions delay oral intake in other patient populations. [12][13][14] The mechanisms of these interactions are not well understood. These investigators recommended that TPN not be given routinely upon discharge but only used in patients who are unable to tolerate even minimal oral intake.…”