Risk Of Micronutrient Deficiencies Research Articles

Potential Micronutrient Deficiencies in the First 1000 Days of Life: The Pediatrician on the Side of the Weakest.

This study is to examine potential micronutrient deficiencies and any need for supplementation in children following specific diet plans in the first 1000days of life. Optimal nutrition in the first 1000days of life has a lifelong positive impact on child development. Specific intrauterine and perinatal factors, pathological conditions, and dietary restrictions can represent potential risk factors for micronutrient deficiencies in the first 1000days of life, which can have negative systemic consequences. Preterm and low-birth-weight infants are intrinsically at risk because of immature body systems. Children affected by cystic fibrosis are prone to malnutrition because of intestinal malabsorption. The risk of micronutrient deficiency can increase in various situations, including but not limited to children following selective dietary regimens (vegetarian and vegan diets and children affected by specific neuropsychiatric conditions) or specific dietary therapies (children affected by food allergies or specific metabolic disorders and children following restricted diet as a part of therapeutic approach, i.e., ketogenic diet for epilepsy). In light of this situation, the micronutrient status in these categories of children should be investigated in order to tailor strategies specific to the individual's metabolic needs, with a particular focus on deficiencies which can impair or delay the physical and cognitive development of children, namely, vitamin B12, vitamin D and folic acid, as well as oligo-elements such as iron, zinc, calcium, sodium, magnesium, and phosphorus, and essential fatty acids such as omega-3. Identification of micronutrient deficiency in the first 1000days of life and timely supplementation proves essential to prevent their long-term consequences.

Parenteral support and micronutrient deficiencies in children with short bowel syndrome: A comprehensive retrospective study

Short bowel syndrome (SBS) is the leading cause of chronic intestinal failure. The duration of parenteral support (PS) and the long-term micronutrient needs in children with SBS vary, based on their clinical and anatomical characteristics. Our study aimed to review the clinical course and identify high risk patient groups for prolonged PS and long-term micronutrient supplementation. A retrospective review was conducted on electronic medical records of children with SBS and chronic intestinal failure who were enrolled in the multidisciplinary intestinal rehabilitation program at Manchester Children's Hospital, UK. Children were included in the review if they required PN for more than 60 days out of 74 consecutive days and had at least 3 years of follow-up. Statistical analysis was performed using IBM SPSS Statistics 24.0. 40 children with SBS achieved enteral autonomy (EA) and 14 remained dependent on PS after 36 months of follow up. Necrotizing enterocolitis was the most common cause for intestinal resection (38.9%) followed by gastroschisis (22.2%), malrotation with volvulus (20.4%), segmental volvulus (9.3%) and long segment Hirschsprung disease (1.9%). Those who achieved EA had significantly longer intestinal length 27.5% (15.0-39.3) than those who remained on PS 6.0% (1.5-12.5) (p<0.001). Type I SBS was only found in the PS cohort. Median PN dependence was 10.82 months [IQR 5.73-20.78]. Congenital diagnosis was associated with longer PN dependence (21.0±20.0) than acquired (8.7±7.8 months), (p=0.02). The need for micronutrient supplementation was assessed after the transition to EA; 87.5% children had at least one micronutrient depletion, most commonly Vitamin D (64.1%), followed by iron (48.7%), Vitamin B12 (34.2%), and vitamin E (28.6%). Iron deficiency and vitamin A depletion were correlated with longer PS after multivariate analysis (OR: 1.103, 1.006-1.210, p=0.037 and OR: 1.048, 0.998-1.102, p=0.062 respectively). In our cohort, small bowel length was the main predictor for EA. Children on longer PS, had more often a congenital cause of resection and were at risk for micronutrient deficiencies in EA.

Fungal diversity in the gut microbiome of young South African children

BackgroundThe fungal microbiome, or mycobiome, is a poorly described component of the gut ecosystem and little is known about its structure and development in children. In South Africa, there have been no culture-independent evaluations of the child gut mycobiota. This study aimed to characterise the gut mycobiota and explore the relationships between fungi and bacteria in the gut microbiome of children from Cape Town communities.MethodsStool samples were collected from children enrolled in the TB-CHAMP clinical trial. Internal transcribed spacer 1 (ITS1) gene sequencing was performed on a total of 115 stool samples using the Illumina MiSeq platform. Differences in fungal diversity and composition in relation to demographic, clinical, and environmental factors were investigated, and correlations between fungi and previously described bacterial populations in the same samples were described.ResultsTaxa from the genera Candida and Saccharomyces were detected in all participants. Differential abundance analysis showed that Candida spp. were significantly more abundant in children younger than 2 years compared to older children. The gut mycobiota was less diverse than the bacterial microbiota of the same participants, consistent with the findings of other human microbiome studies. The variation in richness and evenness of fungi was substantial, even between individuals of the same age. There was significant association between vitamin A supplementation and higher fungal alpha diversity (p = 0.047), and girls were shown to have lower fungal alpha diversity (p = 0.003). Co-occurrence between several bacterial taxa and Candida albicans was observed.ConclusionsThe dominant fungal taxa in our study population were similar to those reported in other paediatric studies; however, it remains difficult to identify the true core gut mycobiota due to the challenges set by the low abundance of gut fungi and the lack of true gut colonising species. The connection between the microbiota, vitamin A supplementation, and growth and immunity warrants exploration, especially in populations at risk for micronutrient deficiencies. While we were able to provide insight into the gut mycobiota of young South African children, further functional studies are necessary to explain the role of the mycobiota and the correlations between bacteria and fungi in human health.

Micronutrient Deficiency Prediction via Publicly Available Satellite Data

Micronutrient deficiency (MND), which is a form of malnutrition that can have serious health consequences, is difficult to diagnose in early stages without blood draws, which are expensive and time-consuming to collect and process. It is even more difficult at a public health scale seeking to identify regions at higher risk of MND. To provide data more widely and frequently, we propose an accurate, scalable, low-cost, and interpretable regional-level MND prediction system. Specifically, our work is the first to use satellite data, such as forest cover, weather, and presence of water, to predict deficiency of micronutrients such as iron, Vitamin B12, and Vitamin A, directly from their biomarkers. We use real-world, ground truth biomarker data collected from four different regions across Madagascar for training, and demonstrate that satellite data are viable for predicting regional-level MND, surprisingly exceeding the performance of baseline predictions based only on survey responses. Our method could be broadly applied to other countries where satellite data are available, and potentially create high societal impact if these predictions are used by policy makers, public health officials, or healthcare providers.

SPECIAL NUTRIONAL NEEDS FOR ATHLETES AND EXERCISERS

The main goal of this narrative review was to incorporate the recent scientific knowledge on the special nutritional needs that are necessary for specific populations of athletes and exercisers (e.g., children, females, vegans) under several training conditions and sports, in addition to proper recommendations for safe administration. The association between nutrition, exercise, and health is an essential part of athletes' and exercisers' competitive and training programs. The quality, quantity, composition, and timing of food consumption are significant to make sure that athletes could train more efficiently to decrease the risk of illness and injury. Athletes who deteriorate their energy intake or use uncontrolled weight loss practices, eliminate certain food groups from their diet, or follow other extreme nutritional philosophies, are at greater risk for micronutrient deficiencies. Fluid intake before, during, and after exercise training or/and competition is significant, particularly in specific circumstances such as hot climates, altitude, etc. Vegetarian and vegan athletes may be at higher risk for low energy, protein, fat, creatine, carnosine, omega-3 fatty acids, as well as essential micronutrients such as iron, calcium, riboflavin, zinc, and β12. Athletes should be adequately informed about the proper use of sports nutrition and ergogenic supplements. These products should only be used after careful evaluation for safety, efficacy, effectiveness, and compliance with relevant legislation. The most significant point to achieving complete and effective nutrition among travelling athletes is planning and preparation while eating properly and hydrated could decrease the potential adverse effects of jet lag and long flights. An effective, healthy, targeted, and complete diet among athletes of different sports should make available sufficient amounts of energy, protein, and carbohydrates depending on the specific sport to make certain sustained exercise training performance and to maintain and improve exercise performance.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0937/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Overcoming barriers to sustainable, healthy diets

Overcoming barriers to sustainable, healthy diets

Micronutrient status in patients with intestinal failure on home parenteral nutrition

Rationale: Intestinal failure (IF) patients are at risk for micronutrient deficiencies and the ESPEN guideline for patients on home TPN (HPN) suggests to assess micronutrient status on a regular basis. This study aims to describe the period prevalence of micronutrient deficiencies or excess in IF type II and III patients.

Nutritional deficiency contributing to refractory erythroderma in hematopoietic cell transplant patients: Distinctive clinical and histopathologic findings

To the Editor: In cases of steroid-refractory cutaneous graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (aHCT), presence of additional or alternative diagnoses may contribute to recalcitrant skin symptoms. Hospitalized patients are at risk for micronutrient deficiencies, including the period following aHCT.1,2 Underrecognition of nutritional deficiency may contribute to persistent dermatitis, presumed to represent steroid-refractory cGVHD and unnecessary immunosuppression.

Metabolic Support for Elderly, Severe COVID-19 Patients With Acute Respiratory Failure: A Case Series

ObjectivesSevere COVID-19 (SvC19) is a syndrome of acute lung injury, respiratory failure, cytokine storm, distributive shock, multi-system organ failure and high mortality. SvC19 disproportionately impacts the elderly, who are also at risk for micronutrient deficiency. After observing a beneficial response to micronutrient repletion (MR) in a 69 year-old male with SvC19, we hypothesized that nutritional deficiencies were linked to the pathogenesis and that correcting them could be beneficial. In this report we detail a case series of 18 older patients with SvC19 treated with MR.MethodsAll patients had SvC19 requiring mechanical ventilation, elevated levels of CRP, D-dimer and neutrophil to lymphocyte ratio. MR consisted of daily parenteral ascorbate, thiamine, pyridoxine and multivitamins, as well as daily ergocalciferol, zinc and carnitine via nasogastric tube.ResultsThe average age was 63.3 years. Six patients were male, 12 female. Disease severity was comparable based on SOFA score. A partial response was observed in 10 of the 18 patients (55.5%). Six (33.3%) were able to wean off blood pressure support. Five (27.7%) had improvement in gas exchange. Four (22.2) were able to wean off ventilator support. Three patients (37.5%) showed improvement in renal dysfunction.ConclusionsMR shows potential promise as an adjunctive treatment for severe COVID-19, particularly in older patients or those with chronic illness in whom nutritional deficiencies are more probable.Funding SourcesNone

Prevalence and risk factors for micronutrient deficiencies during pregnancy in Cayenne, French Guiana.

BackgroundInvolved in physical and brain development, immunity and metabolism, micronutrients have profound health effects. The nutritional status of pregnant women is a major determinant of foetal health. French Guiana has a rapid population growth. Social inequalities, cultural practices and gastrointestinal nematode infections in French Guiana could affect the prevalence of these deficiencies. The main objective of the present study was to estimate the prevalence of micronutrient deficiency among pregnant women in French Guiana. The secondary objective was to identify socio-demographic, dietary, obstetrical and neonatal risk factors associated with deficiencies.MethodsPregnant women over 22 weeks of pregnancy hospitalized for delivery at the Obstetrical Emergency Department of the Hospital Center in Cayenne from May 2018 to March 2019 were included. A socio-demographic and food questionnaire was administered. Medical data were collected from the medical records. Blood and urine samples were taken. The descriptive analysis used Student and chi-squared tests.ResultsA total of 341 women were included. The majority were born in Haiti (39%) and French Guiana (34%). At least one micronutrient deficiency was observed in 81% of women. Precarious women had a significantly greater risk of micronutrient deficiency during pregnancy compared to those with both normal and complementary health insurance.ConclusionsMicronutrient deficiencies in pregnant women in French Guiana are a public health problem, a fact that was previously overlooked in the context of rising obesity. With over half the women overweight or obese, and 81% with at least 1 micronutrient deficiency, balanced nutrition should be a major focus.

Age- and sex-matched comparison of diet quality in patients with heart failure to similarly aged healthy older adults.

The aims of this study were to (1) compare diet quality between patients with heart failure (HF) and age- and sex-matched community-dwelling healthy older adults and (2) determine whether having HF was associated with a lower Healthy Eating Index-2015 (HEI-2015) score and risk of micronutrient deficiency. The HEI-2015 and macro- and micronutrient intakes of patients with HF were compared with healthy older adults (N 102; 55-92 years old; 53% female). A paired t-test or Wilcoxon singed-rank test, McNemar's test, and conditional logistic regression were used to assess the association between diet quality and HF status. Median values for HEI-2015 and the number of micronutrient deficiency were used to dichotomise into groups in the conditional logistic regression. There was no significant between-group difference in the HEI-2015 total score (P 0⋅059), whereas the whole grain component was lower in patients with HF than in healthy older adults (3⋅1 ± 3⋅5 v. 4⋅5 ± 3⋅1, P 0⋅037; respectively). Total caloric intake was lower in patients with HF than in healthy older adults (1683 ± 595 v. 2104 ± 670 kcal; P < 0⋅001). Patients with HF had a higher average number of micronutrient deficiencies than healthy older adults (4[2, 6] v. 1[0, 4], respectively, P < 0⋅001). Patients with HF had four times higher odds of being in a high micronutrient deficiency group than healthy older adults, controlling for socio-demographics and body mass index (adjusted odds ratio [95% confidence interval]: 4⋅04[1⋅06, 15⋅41]). Our findings demonstrate that diet quality measured by nutritional intake identifies patients with HF with lower caloric intake and higher micronutrient deficiencies compared with age- and sex-matched healthy older adults.

Prevalence of Micronutrient Deficiencies in Geriatric Bariatric Patients

Obese individuals have high prevalence of thiamine deficiency and hypovitaminosis D. Our hypothesis is that geriatric, bariatric surgery patients are at risk for micronutrient deficiencies. In this retrospective study, 3 males and 30 females (gastric bypass: n = 27; vertical sleeve gastrectomy: n = 6) individuals were evaluated. Eight micronutrients are measured using commercial blood testing. Mean age is 70 yr, mean body mass index is 35 kg/m2, with a mean of 11 years after bariatric surgery. Hypovitaminosis D is identified in 32 of 33 patients. Low vitamin B12 is identified in 32%, low vitamin A in 16%, low vitamin E in 31%, low zinc in 22%, and low iron in 35%. Twenty patients (61%) have clinical thiamine deficiency. Geriatric patients have multiple micronutrient deficiencies after bariatric surgery. Focusing on deficiencies of thiamine, vitamin B12, vitamin D, and iron in geriatric, bariatric patients could enforce treatments designed to prevent development of disabling deficiency syndromes.

Lack of nutritional knowledge among Norwegian medical students concerning vegetarian diets

AimVegetarian diets are increasingly popular, particularly among young women. However, exclusion of animal products from the diet increases the risk of micronutrient deficiencies, which is particularly unfortunate during pregnancy and childhood. A person needs a substantial amount of nutritional knowledge to achieve a nutritionally complete vegetarian diet. We have tested nutritional knowledge among well-educated young vegetarians and omnivores.Subjects and methodsIn October 2018, medical students at the University of Bergen, Norway (N = 880), were invited to take an anonymous survey to test their nutritional knowledge concerning micronutrients in vegetarian diets.ResultsThe responses from the students (n = 394, 45%) were categorized according to diet: former or current vegetarians (24%) versus always omnivores (76%). Forty-five percent of the vegetarians and 28% of the omnivores did not consider it necessary to take supplements while following a vegetarian diet. Sixty-one percent of vegetarians and 38% of omnivores considered it possible to have a well-balanced vegan diet. Plant foods were wrongly considered to be a dietary source of vitamin B12 by 33% and of iodine by 20% of the students.ConclusionNutritional knowledge concerning vegetarian diets was not optimal among Norwegian medical students, even if they had ever followed a vegetarian diet. As vegetarian diets are popular among the younger generation and pose a risk of micronutrient deficiencies, this is a public health concern. Nutrition education should be improved in the population. A more extensive integration of nutritional training in the medical curriculum must be implemented so doctors can give adequate nutritional guidance.

Serum Levels of Vitamin D, Calcium, Magnesium, and Copper, and their Relations with Mental Health and Sexual Function in Pregnant Iranian Adolescents.

Pregnant adolescents are at risk for micronutrient deficiency, psychological problems, and sexual dysfunction. We aimed to determine serum levels of vitamin D, calcium, magnesium, and copper, and also their relations with stress, anxiety, depression, and sexual function in pregnant adolescents. This cross-sectional study was conducted on two hundred 11-19-year-old healthy singleton pregnant women at gestational age of 26-32weeks, who were covered by public health centers in Tabriz, Iran. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), anxiety and stress using the Depression, Anxiety and Stress Scale-21 (DASS-21), and sexual function using the Female Sexual Function Index (FSFI). The independent t test was employed to determine the relations. Serum levels of vitamin D were found to be deficient (< 20ng/ml) in 59% of the participants and insufficient (20-29ng/ml) in 33%. Normal serum levels of calcium were observed in 67% of the participants, those of magnesium in 89.5%, and those of copper in 86%. Moreover, moderate-to-severe anxiety was observed in 38.5%, moderate-to-severe stress in 22.5%, depression in 30%, and sexual dysfunction in 68%. Mean serum level of copper was higher in women with depression compared with those with no depression (100.6 vs 93.0, P = 0.048). No other statistically significant associations were found between serum levels of any of the micronutrients and anxiety, stress, depression, and sexual dysfunction (P > 0.05). The present study indicates high prevalence of micronutrient (especially vitamin D) deficiency, psychological problems, and sexual dysfunction among the pregnant adolescents. It also indicates an association between high serum copper level and depression.

1122 Geriatric Bariatrics: Do Post-Operative Patients Remain at Risk for Micronutrient Deficiencies?

INTRODUCTION: We have previously described high prevalence of thiamine deficiency and gastrointestinal symptoms (Nath et al, Nutrition Res, 2017) and of hypovitaminosis D and IBS-like symptoms (Nath et al, Nutrition Res, 2019) in individuals with medically-complicated obesity. As individuals who have undergone bariatric surgery age, it becomes increasingly difficult to obtain blood tests to look for micronutrient deficiencies. Our hypothesis is that older bariatric patients seen for evaluation in gastrointestinal clinic remain at risk for micronutrient deficiencies. METHODS: From April 2018 to April 2019, 33 postoperative patients (Gastric Bypass: n = 27; Sleeve Gastrectomy: n = 6) were seen in gastrointestinal clinic in an urban, community teaching hospital. This study included 3 males and 30 females with a mean age of 70 years (SD: 3.4; range 66 to 79), mean body mass index of 35 kg/m 2 (SD: 6.3; range 25.9 to 55.1), and a mean of 11 years since bariatric surgery (SD: 6.7; range 1 to 30). Six patients (22%) had anemia; 5 patients (17%) had weekly or more frequent alcohol use; 12 patients (36%) had a history of diabetes mellitus; 11 patients (33%) were using a diuretic; and 5 patients (15%) were not taking a daily multivitamin. Nine micronutrients were evaluated using commercially available blood testing, but 2 patients did not complete the suggested blood tests. RESULTS: Serum folic acid level was elevated in 17 of 22 patients (77%), which supports the presence of small bowel bacterial overgrowth. Hypovitaminosis D was identified in 32 of 33 patients (97%). Low vitamin B12 was identified in 10 of 31 patients (32%). Low vitamin B12 was identified in 10 of 31 patients (32%). Low vitamin A was identified in 3 of 18 patients (16%). Low vitamin E was identified in 4 of 13 patients (31%). Low zinc was identified in 2 of 9 patients (22%) and low iron was identified in 9 of 26 patients (35%), while 10 patients had normal serum copper level. Clinical Vitamin B1 deficiency was identified in 27 of 33 patients (82%). CONCLUSION: This study supports our hypothesis that geriatric patients who have undergone bariatric surgery are at risk for multiple micronutrient deficiencies. These results support the notion that ordering of specific micronutrients should focus on thiamine, 25 hydroxy-vitamin D, and serum folic acid in patients evaluated in gastrointestinal clinic. These micronutrients may provide explanations for complaints of gastrointestinal symptoms in this patient population.

Micronutrient Deficiencies After Roux-en-Y Gastric Bypass: Long-Term Results.

Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) are under risk of micronutrient deficiencies. We aimed to assess the preoperative and postoperative micronutrient deficiencies in a sample of patients with obesity who underwent LRYGB. We evaluated 169 patients-satisfying the National Institute of Health criteria for bariatric surgery-who underwent a LRYGB from January 2014 to July 2017. Before surgery, we recorded a detailed medical history for every patient, and after surgery, we instructed them to return at 1, 6, 12, 24, 36, and 48months after surgery. Preoperatively, anemia was present in 4.24% of patients, iron deficiency in 5.33%, vitamin B12 deficiency in 12.3%, and vitamin D deficiency in 74.35%. Postoperatively, the deficiency rates of calcium, magnesium, folate, and vitamins A, B1, and B6 were markedly low at 1, 2, and 3years after surgery. In regard to anemia, iron, and vitamin B12, rates of deficiency were higher at 2 and 3years postoperatively versus preoperatively, but only anemia (4% vs 14% and 4% vs 27%, at 2 and 3years) and iron (5% vs 23% at 3years) reached statistical significance. Compared with the preoperative assessment, the rates of vitamin D deficiency decreased over time (74% vs 50% at 1year [p < 0.001], 74% vs 45% at 2years [p < 0.002] and 74% vs 41% at 3years [p < 0.04]). Vitamin D deficiency remains the most common preoperative deficiency. Anemia and deficiencies of iron and vitamin B12 are common before and after surgery. Deficiencies of calcium, magnesium, folate, and vitamins A, B1, and B6 are markedly low in the postoperative period.

Effect of micronutrient status on geriatric function and clinical outcome

Due to pathophysiological changes, the risk of micronutrient deficiency in geriatric increased. Currently, dietary intake of vitamin A, vitamin B1, vitamin B2, vitamin B12, vitamin C, vitamin E, folic acid, calcium, magnesium, zinc and selenium was still lower than the recommended dietary reference intake in the elderly. Geriatric micronutrient deficiencies may contribute to the decrease of physiological function, immune function and cognitive function. It may also result in frailty and increase the risk of adverse clinical outcomes. The appropriate supplementation of single or multiple micronutrients can improve physiological function, cognitive function, immune function and frailty, meantime, reduce the risk of cardiovascular disease and infection. Given there are still no generally accepted standards on the time and method of intervention, population-based randomized controlled studies are needed to provide the basis for promoting healthy ageing. Key words: Micronutrient; Elderly; Intervention; Function

Dietary Patterns and Risk of Micronutrient Deficiencies: their Implication for Nutritional Intervention in Ethiopia

Dietary Patterns and Risk of Micronutrient Deficiencies: their Implication for Nutritional Intervention in Ethiopia

Iodine Content of Enteral and Parenteral Nutrition Solutions

Iodine is essential for thyroid hormone synthesis, and iodine deficiency may result in thyroid disorders including goiter and hypothyroidism. Patients on long-term enteral nutrition (EN) or parenteral nutrition (PN) may be at risk for micronutrient deficiencies. The recommended daily allowance for iodine intake is 150 μg for nonpregnant adults. However, there is no current consensus among scientific societies regarding the quantity of iodine to be added in adult EN and PN formulations. The objective of this study was to determine the iodine content of U.S. adult enteral and parenteral nutrition solutions. This study also aimed to determine whether adult patients in the United States who are receiving long-term artificial nutrition may be at risk for iodine deficiency. Ten enteral nutrition solutions and 4 parenteral nutrition solutions were evaluated. The iodine contents of these solutions were measured spectrophotometrically and compared to the labeled contents. Measured and labeled EN iodine contents were similar (range 131-176 μg/L and 106-160 μg/L, respectively). In contrast, PN formulas were found to contain small, unlabeled amounts of iodine, averaging 27 μg/L. Typical fluid requirements are 30 to 40 mL/kg/day for adults receiving either total EN (TEN) or total PN (TPN). Adults on long-term TEN likely consume enough servings to meet their daily iodine requirements. However, patients on long-term TPN would require on average 5.6 L PN/day to meet the recommended daily allowance of iodine. This volume of PN is far in excess of typical consumption. Thus, U.S. patients requiring long-term TPN may be at risk for iodine deficiency. EN = enteral nutrition; PN = parenteral nutrition; TEN = total enteral nutrition; TPN = total parenteral nutrition; UIC = urinary iodine concentration.

Parenteral Nutrition and Intestinal Failure.

Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes.