Nutritional status of adult patients with Crohn's disease receiving total parenteral nutrition in the home vs. in the hospital

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Virginia Polytechnic Institute and State University


The number of patients who are receiving home total parenteral nutrition (TPN) is increasing. This phenomenon is a result of rising hospital costs and legislation which encourages shorter hospital stays. Previous research has not demonstrated thoroughly change in nutritional status associated with TPN given over a long period of time to patients with singular disease entities such as Crohn's disease. Therefore, this study was undertaken. Two groups of patients were obtained: a sample of five hospitalized patients from a veterans' hospital, and a sample of fifteen home patients followed by a hospital-based nutritional support team. Both groups had Crohn's disease and were receiving TPN. The following parameters were measured: serum albumin, percentage of ideal body weight, and total iron binding capacity. Mean levels and standard deviations of each parameter per time period measured were obtained. These means were plotted across time periods. For each parameter, slopes for each time period were compared using a t-test. For the hospital group, time periods consisted of 20 day periods. For the home patients, time periods were 12 months in length. Mean levels of each parameter remained within normal limits within nearly all time periods for both groups. However, significant changes in each parameter in the home group occurred at the following time periods: 60- 72 months and 72-84 months for serum albumin; and 0-48 months and 48-120 months for total iron binding capacity. (No periods of significance occurred for changes in percentage of ideal body weight.) These changes might indicate periods of significant response to TPN. Other factors which also might have influenced these results include level of compliance by patient, other major illness, iron status, hydration status, effects of sample size, and protein-losing enteropathy.