Enteral and parenteral nutrition in patients with cancer: complication rates compared-updated systematic review and meta-analysis.

IF 2 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2025-04-30 DOI:10.1136/spcare-2024-005244

Ronald Chow, James H B Im, Jann Arends, Egidio Del Fabbro, Lukas Mortensen-Truscott, Denis Qeska, Shilpa Balaji, Chris Walsh, Geoffrey Watson, Michael Lock, Elizabeth Prsic, Lawson Eng, Camilla Zimmermann, Eduardo Bruera

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引用次数: 0

Abstract

Background: The aim of this systematic review and meta-analysis is to compare the complication rates of enteral nutrition (EN) (oral or tube feeding (TF)) and parenteral nutrition (PN) in patients with any cancer.

Methods: A systematic review of the literature until 2024 was conducted, including randomised controlled trials comparing EN and PN with respect to one or more of four endpoints: (1) infection, (2) nutrition support complications, (3) major complications and (4) mortality. A meta-analysis was conducted to generate summary effect estimates. Analysis was stratified by paediatric (≤21 years old) versus adults (>21 years old) patients. Subgroup analyses were conducted, based on including patients with (vs without) protein-energy malnutrition (PEM) and type of EN. Cumulative meta-analysis and leave-one-out analysis was conducted. Type I error was set at 0.05.

Results: 49 studies reporting on 6361 patients were included: 41 reported on adults and 8 on children. Among adults, the infection rate was higher for PN compared with EN (risk ratio=1.07, 95% CI: 1.00 to 1.14), with no differences in rates of nutrition support complications, major complications or mortality. Among children, there were no differences in all four endpoints. On cumulative meta-analysis, EN was overall marginally superior to PN for infection, although results fluctuated over time between superiority and no difference. Subgroup analysis found no differences in effects among patients with (vs without) PEM and patients provided with EN options of standard care versus TF.

Discussion: From the perspective of complications, EN and PN are equivalent, with EN demonstrating marginal superiority for infection among adults.

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癌症患者的肠内和肠外营养：并发症发生率的比较——更新的系统评价和荟萃分析

背景：本系统综述和荟萃分析的目的是比较任何癌症患者肠内营养（EN）（口服或管饲（TF））和肠外营养（PN）的并发症发生率。方法：对截至2024年的文献进行了系统回顾，包括随机对照试验，比较EN和PN在四个终点中的一个或多个：(1)感染，(2)营养支持并发症，(3)主要并发症和(4)死亡率。进行了荟萃分析以产生综合效应估计。对儿童（≤21岁）和成人（bb0 ~ 21岁）患者进行分层分析。根据蛋白质能量营养不良（PEM）和EN类型进行亚组分析。进行累积荟萃分析和留一分析。I型误差设为0.05。结果：纳入了49项研究，报告了6361例患者：41例成人，8例儿童。在成人中，与EN相比，PN的感染率更高（风险比=1.07,95% CI: 1.00至1.14），营养支持并发症、主要并发症或死亡率没有差异。在儿童中，所有四个终点均无差异。在累积荟萃分析中，EN在感染方面总体上略优于PN，尽管结果在优势和无差异之间随时间波动。亚组分析发现，在PEM患者（与不PEM）和提供EN选项的标准治疗与TF患者之间，效果没有差异。讨论：从并发症的角度来看，EN和PN是相等的，在成人感染中，EN表现出边际优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.