Effect of adequate calories and amino acids supplementation delivered via parenteral nutrition on muscle mass maintenance in patients with type I or II intestinal failure: a retrospective study

Muscle mass depletion caused by hypercatabolism and inappropriate nutritional support in patients with intestinal failure (IF) is associated with poor clinical outcomes and reduced quality of life. This retrospective study evaluated the correlation between nutritional support factors (type and composition) and muscle mass. In this cohort study, two hundreds and twenty-three eligible patients with type I or II IF were included at a clinical nutrition center between September 2013 and September 2017. Muscle mass was measured <i>via</i> Bioelectrical Impedance Analysis. Statistical analyses included paired-samples <i>T</i> test, Pearson’s or Spearman’s rank correlation, univariate and multivariate regressions. The mean age was 46.1 ± 18.6 years, the mean nutritional risk screening -2002 score was 3.5 ± 0.8, and the median hospitalization duration was 19.5 days. Multivariate linear regression analysis revealed that Δsoft lean mass (ΔSLM) and Δskeletal muscle mass (ΔSMM) were significantly correlated with calories delivered <i>via</i> parenteral nutrition (PN) (<i>β</i> = 0.051, 95%CI [0.014, 0.008], <i>p</i> &lt; 0.05 and <i>β</i> = 0.041, 95%CI [0.010, 0.072], <i>p</i> &lt; 0.05). Among the PN composition variables, daily glucose intake <i>via</i> PN showed a significant correlation with ΔSLM (<i>β</i> = 0.350, 95%CI [0.091, 0.609], <i>p</i> &lt; 0.01) and ΔSMM (<i>β</i> = 0.254, 95%CI [0.027, 0.481], <i>p</i> &lt; 0.01). Subgroup analysis revealed that daily glucose intake <i>via</i> PN was associated with ΔSMM, especially at ≥1.2 g/kg/day of amino acid intake (<i>r</i> = 0.328, <i>p</i> &lt; 0.01). Adequate calories and amino acids supplementation delivered <i>via</i> parenteral nutrition play an important role in promoting muscle mass maintenance in patients with type I or II intestinal failure, who were under metabolically unstable or enteral nutrition intolerance condition.

肠道功能衰竭（Intestinal Failure, IF）患者因高分解代谢与不规范营养支持所致的肌肉量丢失，与不良临床结局及生活质量降低显著相关。本项回顾性研究探讨了营养支持相关因素（包括类型与组成）与肌肉量之间的关联。本队列研究于2013年9月至2017年9月间，在某临床营养中心纳入了223例符合纳入标准的I型或II型肠道功能衰竭患者。肌肉量通过生物电阻抗分析（Bioelectrical Impedance Analysis）完成测定。统计分析方法包括配对样本t检验、Pearson相关分析或Spearman秩相关分析、单因素与多因素回归分析。患者平均年龄为46.1±18.6岁，平均营养风险筛查2002（Nutritional Risk Screening 2002）评分为3.5±0.8，住院时长中位数为19.5天。多因素线性回归分析结果显示，软组织瘦体重变化量（Δsoft lean mass, ΔSLM）与骨骼肌量变化量（Δskeletal muscle mass, ΔSMM）均与肠外营养（Parenteral Nutrition, PN）供给的热量呈显著相关性（β=0.051，95%置信区间[0.014, 0.008]，P<0.05；β=0.041，95%置信区间[0.010, 0.072]，P<0.05）。在肠外营养组成相关变量中，肠外营养每日葡萄糖摄入量与ΔSLM（β=0.350，95%置信区间[0.091, 0.609]，P<0.01）及ΔSMM（β=0.254，95%置信区间[0.027, 0.481]，P<0.01）均呈显著相关性。亚组分析结果显示，当每日氨基酸摄入量≥1.2g/kg/d时，肠外营养每日葡萄糖摄入量与ΔSMM呈显著相关（r=0.328，P<0.01）。对于代谢不稳定或无法耐受肠内营养的I型或II型肠道功能衰竭患者，通过肠外营养供给充足的热量与氨基酸，在维持其肌肉量方面发挥着重要作用。