UMR-S 1149 Centre de Recherche sur l'Inflammation Inserm, Université Paris Cité, 75018 Paris, France; Service de Biochimie Endocrinienne et Oncologique, Hôpital de la Pitié-Salpêtrière-Charles Foix, Sorbonne Université, 75013 Paris, France.
UMR-S 1149 Centre de Recherche sur l'Inflammation Inserm, Université Paris Cité, 75018 Paris, France.
Clin Nutr. 2023 Nov;42(11):2109-2115. doi: 10.1016/j.clnu.2023.09.003. Epub 2023 Sep 9.
Short Bowel Syndrome (SBS) is the major cause of chronic intestinal failure (IF) and requires parenteral nutrition (PN). After bowel resection, some patients develop spontaneous intestinal adaptations and hyperphagia. Since promoting oral energy intake contributes to PN weaning, this study aims to characterize hyperphagia in patients with SBS and identify its determinants.
This observational retrospective study included adult patients with SBS who were followed at an expert PN center between 2006 and 2019, with at least 2 separate nutritional assessments. Exclusion criteria were: active neoplasia, alternative treatment for IF or appetite-affecting medication. Resting energy expenditure (REE) was calculated for each patient using the Harris-Benedict equation. Food Intake Ratio (FIR) was calculated by dividing the highest caloric oral intake by REE and hyperphagia was defined as FIR >1.5.
Among the 59 patients with SBS included in this study, 82.6% had a FIR >1.5, including 15.5% with a FIR >3. Protein supplied approximately 16% of total energy intake while fat and carbohydrates provided 36% and 48%, respectively. The FIR was independent of gender and whether patients received oral nutrition alone (n = 28) or combined with PN (n = 31). The FIR was also not associated with residual small bowel length, nor the proportion of preserved colon. However, it was negatively correlated with the body mass index (BMI) of these patients (r = -0.533, p < 0.001), whether they had PN support or not. Patients with either a jejuno-colonic (n = 31) or a jejuno-ileal anastomosis (n = 9), had a significantly higher FIR compared to those with an end-jejunostomy (n = 18) (p < 0.05). However, no difference was found in the proportion of calories provided by protein, fat and carbohydrate between the 3 patients groups divided according to the SBS anatomical type.
A large majority of patients with SBS exhibited a hyperphagia regardless of PN dependence or bowel length, which was inversely correlated with BMI. The presence of the colon in continuity, thus in contact with the nutritional flow, seems to favor a higher oral intake which is beneficial for the nutritional autonomy of patients. This raises the question of a role of colonic microbiota and hormones in this behavior. Finally, this study also revealed an unexpected discrepancy between recommended energy intakes from protein, fat and carbohydrate and the actual intake of patients with SBS.
短肠综合征（SBS）是慢性肠衰竭（IF）的主要原因，需要肠外营养（PN）。在肠切除术后，一些患者会自发发生肠道适应性改变和食欲亢进。由于促进口服能量摄入有助于 PN 脱机，因此本研究旨在确定 SBS 患者的食欲亢进情况及其决定因素。
这是一项观察性回顾性研究，纳入了 2006 年至 2019 年期间在专家 PN 中心接受治疗的 SBS 成年患者，这些患者至少进行了 2 次独立的营养评估。排除标准为：活动性肿瘤、IF 的替代治疗或影响食欲的药物。每位患者的静息能量消耗（REE）均使用 Harris-Benedict 公式计算。通过将最高热量的口服摄入量除以 REE 来计算食物摄入比（FIR），并将 FIR＞1.5 定义为食欲亢进。
在这项研究中，纳入了 59 名 SBS 患者，其中 82.6%的患者 FIR＞1.5，包括 15.5%的患者 FIR＞3。蛋白质提供了大约 16%的总能量摄入，而脂肪和碳水化合物分别提供了 36%和 48%。FIR 与性别以及患者是否单独接受口服营养（n=28）或与 PN 联合治疗（n=31）无关。FIR 也与剩余的小肠长度或保留的结肠比例无关。然而，它与这些患者的体重指数（BMI）呈负相关（r=-0.533，p＜0.001），无论他们是否接受 PN 支持。与空肠结肠吻合术（n=31）或空肠回肠吻合术（n=9）的患者相比，有肠内造口术（n=18）的患者的 FIR 明显更高（p＜0.05）。然而，根据 SBS 解剖类型将患者分为 3 组后，在提供蛋白质、脂肪和碳水化合物的卡路里比例方面没有差异。
大多数 SBS 患者表现出食欲亢进，无论是否依赖 PN 或肠长度如何，这与 BMI 呈负相关。连续性结肠的存在，因此与营养流接触，似乎有利于更高的口服摄入，这有利于患者的营养自主性。这引发了关于结肠微生物群和激素在这种行为中的作用的问题。最后，本研究还揭示了 SBS 患者实际摄入的蛋白质、脂肪和碳水化合物的推荐能量摄入量与实际摄入量之间存在意外差异。
