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Advances in Food and Nutrition Research 2023Clinical nutrition emulsions are important products that can be life-saving for many patients suffering from gastrointestinal tract disorders, swallowing impairment,... (Review)
Review
Clinical nutrition emulsions are important products that can be life-saving for many patients suffering from gastrointestinal tract disorders, swallowing impairment, cancer, liver diseases, and many other clinical conditions. The transfer of lipids to the human body can be either intravenously (Parenteral Nutrition, PN) or through the gastrointestinal tract (Enteral Nutrition, EN). PN emulsions are considered pharmaceuticals and thus regulated accordingly. On the other hand, EN emulsions are classified as Food for Specific Medical Purposes (FSMP) and do not follow pharmaceutical regulations. Regarding product design, PN emulsions must follow theoretical emulsion formulation and production aspects, but special requirements regarding droplet size distribution must be followed to comply with national pharmacopeia monographs. Furthermore, a full clinical program on clinical evidence to prove safety and efficacy must be provided for marketing approval. On the contrary, EN emulsions require limited clinical evidence to substantiate health or clinical benefits. A short introduction to clinical nutrition with a focus on lipid emulsions is presented in this chapter. Furthermore, a general overview of the composition and main ingredients of clinical nutrition lipid emulsions is reviewed. Main clinical aspects are also mentioned here, highlighting the difficulties of clinically proving the efficacy of these products. The manufacturing and control of clinical nutrition emulsions are also reviewed, focusing on PN products and the main regulatory requirements related to the safety of these intravenous emulsions. Finally, stability and physicochemical properties are reviewed, and examples of commercially available products are used to illustrate these properties linked to the stability of these products. Lipids in clinical nutrition is a moving field and we do hope this chapter may remain a valuable source to understand newly emerging research on this topic.
Topics: Humans; Emulsions; Parenteral Nutrition; Gastrointestinal Tract; Lipids
PubMed: 37516466
DOI: 10.1016/bs.afnr.2022.12.003 -
Seminars in Fetal & Neonatal Medicine Jun 2022Nutritional support is a fundamental component of the care of the extremely preterm infant, including the "micro preemie" (here defined as a baby born weighing less than... (Review)
Review
Nutritional support is a fundamental component of the care of the extremely preterm infant, including the "micro preemie" (here defined as a baby born weighing less than 500 g), but goes beyond considerations of milk as a food. This is because milk from an infant's own mother, unlike currently available substitutes, additionally provides invaluable non-nutritive benefits. Nutritional support requires suitable devices or techniques to administer nutrients enterally or intravenously, products shown to be safe in preterm populations, and efficacy demonstrated in respect of important functional outcomes. Sadly, preterm feeding remains characterised by a deficit of evidence. In this chapter, we will briefly describe the history of preterm nutrition, discuss current enteral and parenteral practice, important evidence gaps, a summary of approaches for evaluating nutritional practice, and key considerations for future endeavour. Our discussion refers to all extremely preterm infants and it not confined to the micro preemie.
Topics: Enteral Nutrition; Humans; Infant; Infant Formula; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Milk, Human; Nutritional Status; Parenteral Nutrition
PubMed: 35718688
DOI: 10.1016/j.siny.2022.101344 -
Zentralblatt Fur Chirurgie Dec 2021
Topics: Humans; Intestine, Small; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 34872110
DOI: 10.1055/a-1545-6801 -
Recenti Progressi in Medicina Jun 2020
Topics: Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Parenteral Nutrition
PubMed: 32573558
DOI: 10.1701/3394.33764 -
Nutrition (Burbank, Los Angeles County,... 2019
Topics: Enteral Nutrition; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Medical Oncology; Parenteral Nutrition
PubMed: 31561204
DOI: 10.1016/j.nut.2019.06.026 -
The Veterinary Clinics of North... Sep 2023Malnutrition and need for nutritive support are both very common in exotic animals requiring critical care. Assessment and monitoring of body condition, weight, protein... (Review)
Review
Malnutrition and need for nutritive support are both very common in exotic animals requiring critical care. Assessment and monitoring of body condition, weight, protein absorption, and catabolic loss is recommended to help guide restorative therapy. Several critical care diets are available based on digestive strategy. Fluid requirements and evaporative water loss can vary based on taxa; ectoderms suffer evaporative losses at a greater magnitude than endotherms. Enteral and parenteral nutrition strategies can be appropriate for patients, with natural history and anatomic and physiologic differences considered as much as possible.
Topics: Animals; Nutritional Requirements; Malnutrition; Parenteral Nutrition; Critical Illness
PubMed: 37516460
DOI: 10.1016/j.cvex.2023.05.009 -
Supportive Care in Cancer : Official... Sep 2020Although nutritional interventions are becoming widely used in cancer patients, purposes and results of such treatment are not always well-defined. This is because... (Review)
Review
PURPOSE
Although nutritional interventions are becoming widely used in cancer patients, purposes and results of such treatment are not always well-defined. This is because nutrition is traditionally considered a palliative treatment to be confined to the area of palliative cares, whereas the modern approach includes nutrition as an early supplemental support to improve compliance of patients with the oncologic therapies and total parenteral nutrition may be recommended in patients who would be destined to succumb prior from starvation-malnutrition than from tumour progression. Purpose of this paper if to define the potential as well as the limitations of nutritional interventions on both the survival and the quality of life of the advanced cancer patients.
RECENT FINDINGS
Some RCT on the use of oral, enteral and supplemental parenteral nutrition in patients on oncologic therapy show some benefit on compliance with therapy and in some domains of quality of life. Some malnourished (hypo)aphagic incurable cancer patients may survive longer thanks to parenteral nutrition, while few data suggest that quality of life may be maintained for a limited period of time. With a few exceptions, oncology and nutrition have till recently travelled on parallel tracks without talking each other. The oncologist who knows the natural history of the patients should understand which risk of complication and of poor tolerance to the treatment can malnourished patients carry and which is the potential of parenteral nutrition in hypophagic incurable patients.
Topics: Female; Humans; Male; Nutritional Status; Palliative Care; Parenteral Nutrition; Quality of Life
PubMed: 32417968
DOI: 10.1007/s00520-020-05505-x -
Pediatric Blood & Cancer Dec 2019Multiple disease and treatment-related factors contribute to intestinal insult and influence the nutritional status of children with cancer. Many children with cancer... (Review)
Review
Multiple disease and treatment-related factors contribute to intestinal insult and influence the nutritional status of children with cancer. Many children with cancer will experience intestinal dysfunction during their cancer journey and children with cancer are a common referral group for inpatient parenteral nutrition. Appropriate use of parenteral nutrition in children with cancer and intestinal failure may alleviate malnutrition and associated risks. However, proper selection of patients, correct parenteral nutrition prescription, and close monitoring is important to avoid unnecessary intestinal failure or parenteral nutrition-related complications, minimize long-term nutritional sequelae or additional costs to health services, and optimize intestinal rehabilitation.
Topics: Child; Humans; Malnutrition; Neoplasms; Nutritional Support; Parenteral Nutrition
PubMed: 31535458
DOI: 10.1002/pbc.28000 -
American Journal of Health-system... Jun 2024Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert... (Review)
Review
PURPOSE
Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit.
SUMMARY
Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages.
CONCLUSION
This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.
Topics: Humans; Parenteral Nutrition; Patient Safety; Fat Emulsions, Intravenous; United States; Internationality; Europe
PubMed: 38869257
DOI: 10.1093/ajhp/zxae079 -
Advances in Nutrition (Bethesda, Md.) Mar 2022
Topics: Humans; Copper; Parenteral Nutrition; Parenteral Nutrition, Total; Nutritional Status
PubMed: 34940824
DOI: 10.1093/advances/nmab157