Impact of parenteral nutrition on oral intake and eating pleasure in advanced cancer patients: A sub-analysis of a multicenter randomized controlled trial.

BACKGROUND

Malnutrition is highly prevalent in advanced cancer patients, contributing to reduced quality of life, impaired physical function, and decreased survival. Although parenteral nutrition (PN) is used to supplement oral intake, its effect on oral feeding behaviors and eating pleasure remains unclear. We therefore aimed to evaluate the impact of supplemental PN on oral food intake and eating pleasure in malnourished advanced cancer patients with an intact bowel function.

METHODS

This study presents a sub-analysis of data from a larger, multicenter, randomized controlled trial. In this trial, advanced cancer patients with malnutrition and a functional gastrointestinal tract were assigned (1:1) to receive either supplemental PN plus standard oral feeding or oral feeding alone. Dietary intake was assessed at baseline and one month using a 24 h dietary recall, and eating pleasure was measured with the Self-Evaluation of Food Intake (SEFI) score.

RESULTS

Eighty-nine patients were analyzed. In the overall cohort, mean daily energy intake assessed by 24 h recall increased significantly from 986 ± 475 kcal at baseline to 1082 ± 420 kcal at one month (p = 0.02), whereas SEFI score remained stable. At baseline, a significant positive correlation was found between the SEFI score and the ratio of calorie intake to estimated energy requirements (Spearman's ρ = 0.55, P < 0.001). In arm-specific analyses using paired t-test, patients in the oral-feeding arm experienced a significant rise at one month in mean energy intake (1009 ± 476 to 1224 ± 474 kcal; p = 0.045) with no significant change for patients in the PN arm (859 ± 437 to 856 ± 234 kcal, p = 0.71). Using McNemar's test, patients from the oral-feeding arm experienced a significant rise in oral nutritional supplement use ate one month compared with patients from the PN arm (6/19 % to 20/65 %, p = 0.01). Meal frequency, snack consumption, and pleasure to eat did not change in the overall population and in either arm.

CONCLUSION

Supplemental PN does not negatively impact oral food intake or eating pleasure in malnourished advanced cancer patients with intact bowel function. These findings support the use of PN as a nutritional support option without compromising oral feeding behaviors.

REGISTRATION NUMBER OF CLINICAL TRIAL: NCT02151214.