title: Hypocaloric home parenteral nutrition and nutrition parameters in patients following bariatric surgery.
abstract: BACKGROUND
  Surgical intervention is considered an acceptable treatment for morbid obesity. Complications following bariatric surgery procedures (BSPs) may necessitate home parenteral nutrition (HPN). No studies have been published on patients receiving HPN following BSP complications. The study aim was to determine if hypocaloric HPN has an effect on body mass index (BMI), albumin, and HPN complications.
  
  
  METHODS
  A historic cohort of patients was identified from a clinical database. Obese patients (BMI ≥35 kg/m(2)) who underwent BSP and received HPN for an anastomotic leak/fistula or bowel obstruction were included. Comparisons for start and end of therapy were made for calorie and protein intake, BMI, white blood cell count, and serum albumin level. Readmissions and metabolic and infectious complications were recorded. Obese patients received hypocaloric feeds to promote weight loss and protein for wound healing.
  
  
  RESULTS
  Twenty-three patients were included for an average study length of 1.5 months. Patients received an average of 1.2 g of protein and a median of 13.6 kcal per kg actual body weight (ABW) per day. BMI decreased by 7.1% ± 5.2%, from a median of 39.8 to 37.1, and serum albumin increased by 12.5%, from 2.8 ± 0.5 to 3.2 ± 0.6 g/dL. Readmissions occurred in 52.2% of patients with 40.0% of complications related to HPN.
  
  
  CONCLUSIONS
  Hypocaloric HPN is efficacious in maintaining adequate nutrition while allowing for weight loss in morbidly obese patients following complications of bariatric surgery. Frequency of HPN complications was comparable to those reported in the literature.
authors.affiliation: Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA. hamiltoc@ccf.org
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hamilton
authors.forename: Vijaya
authors.initials: V
authors.lastname: Dasari
authors.forename: Abdullah
authors.initials: A
authors.lastname: Shatnawei
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Ezra
authors.initials: E
authors.lastname: Steiger
authors.forename: Douglas
authors.initials: D
authors.lastname: Seidner
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D031204:Caloric Restriction; D015331:Cohort Studies; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery / Q000628:therapy*; D016331:Parenteral Nutrition, Home; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy; D012709:Serum Albumin / Q000378:metabolism; D015431:Weight Loss
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin