Nutrient intake from habitual oral diet in patients with severe short bowel syndrome living in the southeastern United States

Abstract

Objectives Little data are published on the habitual home oral diet of patients with short bowel syndrome (SBS). Methods We assessed nutrient intake from oral food and beverages in 19 stable patients with severe SBS who live in the southeastern United States. Intestinal absorption of energy, fat, nitrogen (N), and carbohydrate (CHO) was determined in a metabolic ward. Results We studied 12 women and 7 men, age 48 ± 3 y of age (mean ± SE) receiving parenteral nutrition for 31 ± 8 mo following massive small bowel resection (118 ± 25 cm residual small bowel). The patients demonstrated severe malabsorption of energy (59 ± 3% of oral intake), fat (41 ± 5%), N (42 ± 5%) and CHO (76 ± 3%). Oral energy intake was 2656 ± 242 kcal/d (39 ± 3 kcal/kg/d) and oral protein intake was 1.4 ± 0.1 g/kg/d. Food/beverage intake constituted 49 ± 4% of total (enteral plus parenteral) daily fluid intake, 66 ± 4% of total daily kcal and 58 ± 5% of total daily N intake. Oral fat intake averaged 92 ± 11 g/day (≈35% of total oral energy). Oral fluid intake averaged 2712 ± 240 ml/d, primarily from water, soft drinks, sweet tea and coffee. Simple sugars comprised 42 ± 3% of oral CHO intake. Usual dietary intake of multiple micronutrients were below the Recommended Dietary Allowances (RDA) in a large percentage of patients: vitamin A (47%), vitamin D (79%), vitamin E (79%), vitamin K (63%), thiamine (42%), vitamin B6 (68%), vitamin B12 (11%), vitamin C (58%), folate (37%), iron (37%), calcium (63%), magnesium (79%) and zinc (68%). Only seven patients (37%) were taking oral multivitamin-mineral supplements and only six subjects (32%) were taking oral iron and calcium supplements, respectively. Conclusion In these SBS patients, an oral diet provided a significant proportion of daily nutrient intake. The types of foods and fluids consumed are likely to worsen malabsorption and thus increase PN requirements. Oral intake of essential micronutrients was very low in a significant proportion of these individuals.