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Total parenteral nutrition: potion or poison?
1University of Toronto and St Michael's Hospital, Toronto, Ontario, Canada. jeebhoy@utoronto.ca
The American Journal of Clinical Nutrition
|July 27, 2001
Summary
Total parenteral nutrition (TPN) is a safe and effective alternative to enteral nutrition (EN) when malnutrition risk is present. TPN does not cause harm and its complications are often exaggerated.
Area of Science:
- Clinical Nutrition
- Medical Therapy
- Gastroenterology
Background:
- Nutritional support has evolved significantly over 40 years.
- Total parenteral nutrition (TPN) was initially standard, later supplanted by enteral nutrition (EN).
- Concerns existed that TPN posed risks like mucosal atrophy and bacterial translocation.
Purpose of the Study:
- To critically review the evidence regarding TPN safety and efficacy.
- To compare TPN with EN in patients at risk of malnutrition.
- To re-evaluate the perceived dangers of TPN.
Main Methods:
- Literature review and critical analysis of existing data on TPN and EN.
- Evaluation of human studies investigating TPN's effects on gut function.
- Assessment of factors contributing to sepsis in patients receiving TPN.
Main Results:
- Evidence does not support TPN causing mucosal atrophy or increased bacterial translocation in humans.
- Increased sepsis associated with TPN is primarily linked to overfeeding, not the therapy itself.
- The risks attributed to TPN have been overstated.
Conclusions:
- TPN is an equally effective alternative to EN for patients with malnutrition risk, intolerance to EN, or gut failure.
- TPN is a viable and safe therapeutic option when indicated.
- Clinical practice should reflect the evidence-based safety profile of TPN.