1. Home enteral nutrition and oral nutritional supplements in postoperative patients with upper gastrointestinal malignancy: A systematic review and meta-analysis
- Author
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Qiu Lihong, Liu li, He Xueting, Hong Yutong, Chen Yu-qing, Zhang Jun-e, and Yang Meng
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Administration, Oral ,Nutritional Status ,030209 endocrinology & metabolism ,Subgroup analysis ,Critical Care and Intensive Care Medicine ,Enteral administration ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,Postoperative Complications ,Quality of life ,Randomized controlled trial ,Weight loss ,law ,Internal medicine ,medicine ,Humans ,Gastrointestinal Neoplasms ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Parenteral nutrition ,Strictly standardized mean difference ,Relative risk ,Dietary Supplements ,Quality of Life ,medicine.symptom ,business - Abstract
The safety and potential benefits of home enteral route nutrition (HERN), referring specifically to home enteral nutrition (HEN) and oral nutritional supplements (ONS) in this article, after upper gastrointestinal (GI) resection are inconsistent.To evaluate the impact of HERN on nutritional status, complications, and quality of life (QOL) after upper GI resection.This systematic review was conducted in accordance with the PRISMA statement. Nine databases were searched from inception to October 2019. Randomized controlled trials (RCTs) comparing the impact of HERN after upper gastrointestinal resection were included. Relative risk/weighted mean difference/standardized mean difference (RR/WMD/SMD) and corresponding 95% confidence intervals (95% CI) were calculated using fixed- or random-effects models.Overall, 15 RCTs involving 1059 patients were included. Compared with normal oral diet, HERN significantly prevented weight loss (-3.95 vs -5.82 kg; SMD: 1.98 kg; 95% CI: 1.24-2.73); improved added-level of albumin (3.48 vs 2.41 g/L; SMD: 1.36 g/L; 95% CI: 0.81-1.91), hemoglobin (6.54 vs -1.29 g/L; WMD: 7.45 g/L; 95% CI: 5.05-9.86), pre-albumin (37.59 vs 7.35 mg/L; WMD: 21.6 mg/L; 95% CI: 5.96-37.24), and transferrin (63.08 vs 50.45 mg/L; WMD: 16.44 mg/L; 95% CI: 13.51-19.38); and reduced the incidence of malnutrition or latent malnutrition (RR = 0.54; P 0.01). Subgroup analysis based on the approach of HERN showed that weight loss in the HEN subgroup was significantly lower than that of the control group (WMD = 2.69, P 0.01), while there was no significant difference between the ONS subgroup and the control group (P = 0.1). The same results were found in albumin. Physical function (WMD: 5.29; 95% CI: 1.86-8.73) and fatigue (WMD: -8.59; 95% CI: -12.61, -4.58) dimensions in QOL were significantly better in the HERN group. No significant differences in gastrointestinal and tube-related complications.HERN improved nutritional status and some dimensions of QOL in upper GI malignancy patients after surgery, without increasing complications. Subgroup analysis showed that HEN experienced more benefits than ONS.
- Published
- 2020