The effect on body composition and exercise performance of home parenteral nutrition when given as adjunct to chemotherapy of testicular carcinoma

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Abstract
This study has evaluated whether long‐term and permanent total parenteral nutrition (TPN) can protect body composition and exercise capacity during iterated courses of chemotherapy (PVB) in men with testicular carcinoma. Thirty‐three men were randomly allocated by means of a computer based algorithm to receive either TPN (at hospital and home) during the entire chemotherapy period or to rely on spontaneous oral intake only. Nutrition status was assessed by measurements of whole body nitrogen (neutron activation), total body potassium, body water, urine creatinine excretion, loco‐regional body nutrition indexes (AMC, TSF) and biochemical plasma concentrations (albumin, thyroid hormones). Whole body respiratory gas exchanges were measured during resting, submaximal and maximal exercise. TPN was prescribed on an individual basis in all study patients to cover 150% of their measured caloric need; nitrogen was given as 0·2 g N kg‐1 day. All individuals were allowed to eat freely throughout the study.TPN patients were in overall positive energy balance (+850 Kcal day‐1), while the control group was in negative balance (‐532 Kcal day‐1). This led to weight gain in the TPN group (+2·2 ± 1·0 kg) while the control group lost significant weight (‐4·2±1·1 kg). The average spontaneous oral caloric intake was 1014±153 Kcal day‐1 in the TPN group and 1484 ± 200 Kcal day‐1 in the control group; total protein intake corresponded to 1·5 g protein kg day‐1 in the TPN group and 0·7 kg day‐1 in the control group. Weight gain in TPN‐treated patients consisted only of fat accumulation without significant water retention, and they lost body nitrogen to the same extent as the control patients. The adaptation to undernutrition was better preserved in the control patients determined by indirect calorimetry. Maximal exercise capacity decreased during chemotherapy in both groups to the same extent from around 180 watts to 137 watts (p<0·001), but the relationship between oxygen uptake and submaximal work was not significantly influenced by chemotherapy or TPN in either of the two groups.This study demonstrates that TPN was insufficient to protect body composition or even improve significantly the whole body nitrogen sparing and working capacity when given daily for more than eight weeks as adjunct to chemotherapy in patients with oral food intake reduced by 25–30%. Fat accumulation was the only measurable benefit. It is proposed that this is another example of the inefficiency of artificial nutrition to protect lean body mass in patients with light to pronounced negative caloric balance.