title: Australasian Society for Parenteral and Enteral Nutrition guidelines for supplementation of trace elements during parenteral nutrition.
abstract: BACKGROUND
  This work represents the first part of a progressive review of AuSPEN's 1999 Guidelines for Provision of Micronutrient Supplementation in Adult Patients receiving Parenteral Nutrition, in recognition of the developments in the literature on this topic since that time.
  
  
  METHODS
  A systematic literature review was undertaken and recommendations were made based on the available evidence and with consideration to specific elements of the Australian and New Zealand practice environment. The strength of evidence underpinning each recommendation was assessed. External reviewers provided feedback on the guidelines using the AGREE II tool.
  
  
  RESULTS
  Reduced doses of manganese, copper, chromium and molybdenum, and an increased dose of selenium are recommended when compared with the 1999 guidelines. Currently the composition of available multi-trace element formulations is recognised as an obstacle to aligning these guidelines with practice. A paucity of available literature and limitations with currently available methods of monitoring trace element status are acknowledged. The currently unknown clinical impact of changes to trace element contamination of parenteral solutions with contemporary practices highlights need for research and clinical vigilance in this area of nutrition support practice.
  
  
  CONCLUSIONS
  Trace elements are essential and should be provided daily to patients receiving parenteral nutrition. Monitoring is generally only required in longer term parenteral nutrition, however should be determined on an individual basis. Industry is encouraged to modify existing multi-trace element solutions available in Australia and New Zealand to reflect changes in the literature outlined in these guidelines. Areas requiring research are highlighted.
authors.affiliation: Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia. Emma.Osland@health.qld.gov.au.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Osland
authors.forename: Azmat
authors.initials: A
authors.lastname: Ali
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Isenring
authors.forename: Patrick
authors.initials: P
authors.lastname: Ball
authors.forename: Melvyn
authors.initials: M
authors.lastname: Davis
authors.forename: Lyn
authors.initials: L
authors.lastname: Gillanders
mesh_terms: D000328:Adult; D001315:Australia; D002857:Chromium / Q000008:administration & dosage; D003300:Copper / Q000008:administration & dosage; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D008345:Manganese / Q000008:administration & dosage; D018977:Micronutrients / Q000008:administration & dosage*; D008982:Molybdenum / Q000008:administration & dosage; D009520:New Zealand; D010288:Parenteral Nutrition / Q000379:methods*; D017410:Practice Guidelines as Topic; D012643:Selenium / Q000008:administration & dosage; D014131:Trace Elements / Q000008:administration & dosage
chemical_list: D018977:Micronutrients; D014131:Trace Elements; D002857:Chromium; D008345:Manganese; D003300:Copper; D008982:Molybdenum; D012643:Selenium