title: Recommendations for Manganese Supplementation to Adult Patients Receiving Long-Term Home Parenteral Nutrition: An Analysis of the Supporting Evidence.
abstract: BACKGROUND
  Manganese (Mn) toxicity is often observed in adult patients receiving long-term home parenteral nutrition (HPN), and differing recommendations on the safe level of Mn administration to these patients have been made in the literature over the past 10 years.
  
  
  METHODS
  This systematic review used the National Health and Medical Research Council (NHMRC) evidence hierarchy to assess the design and strength of individual studies (high I to low IV) and the overall grade of evidence (grade A high to grade D low).
  
  
  RESULTS
  Eight studies met the inclusion criteria. Levels of evidence ranged from high (NHMRC II) to mid-level (III-3). A widespread recommendation in the literature for patients receiving long-term HPN is 55 µg (1 µmol) Mn/d.
  
  
  CONCLUSIONS
  The recommendation of 55 µg (1 µmol) Mn/d is of moderate-strength evidence (NHMRC B grade). There is limited evidence to support not supplementing Mn to patients receiving long-term HPN. Further intervention studies providing high-level evidence (II and above) are required to determine the safety of not supplementing Mn to all patients receiving long-term HPN.
authors.affiliation: Centre for Dietetics Research, School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia bradley.baker@uqconnect.edu.au.
authors.forename: Bradley
authors.initials: B
authors.lastname: Baker
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Azmat
authors.initials: A
authors.lastname: Ali
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia.
authors.forename: Liz
authors.initials: L
authors.lastname: Isenring
mesh_terms: D000328:Adult; D016208:Databases, Factual; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D006801:Humans; D008345:Manganese / Q000008:administration & dosage*; D064887:Observational Studies as Topic; D016331:Parenteral Nutrition, Home
chemical_list: D008345:Manganese
keywords: home parenteral nutrition; hypermanganesemia; manganese; micronutrients; trace elements