Do data support nutrition support? Part I: intravenous nutrition

Area of Science:

• Clinical Nutrition
• Evidence-Based Medicine
• Gastroenterology

Background:

• Intravenous (parenteral) nutrition is widely used but often based on expert opinion.
• Randomized controlled trials (RCTs) are crucial for assessing treatment efficacy.

Purpose of the Study:

• To review RCTs comparing parenteral nutrition (PN) or protein-sparing therapy (PST) against no artificial nutrition.
• To evaluate the impact of intravenous nutrition on mortality, morbidity, and hospitalization duration.

Main Methods:

• Systematic search for RCTs comparing PN/PST with no artificial nutrition.
• Stratification of trials by underlying disease state.
• Analysis of clinical outcomes including mortality, complications, and hospital stay.

Main Results:

• Over 100 RCTs largely failed to demonstrate clinical benefits of intravenous nutrition.
• Potential benefit observed in preoperative PN for upper GI cancer surgery, but in low-quality trials.
• Harmful effects noted when PN was used during cancer radiation/chemotherapy.
• Conflicting evidence for acute pancreatitis and bone marrow transplant patients.

Conclusions:

• RCTs indicate that parenteral nutrition offers minimal clinical benefit for most patient populations.
• Intravenous nutrition is not generally superior to standard care or no artificial nutrition.
• Further research may be needed for specific indications like short bowel syndrome.