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Determining the nutritional requirements of patients dependent on home parenteral nutrition: A longitudinal cohort study


   Faculty of Biology, Medicine and Health

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  Dr S Burden, Prof Simon Lal  Applications accepted all year round  Self-Funded PhD Students Only

About the Project

This exciting new project will provide training in dietetic and nutritional research in artificial nutritional support. Parenteral nutrition (PN) involves the intravenous administration of substrates directly into a vein, providing fluid, energy, nitrogen, micronutrients and electrolytes. Intestinal Failure (IF) is the reduction of gut function below the minimum necessary for the absorption of macronutrients, fluid and electrolytes, to such an extent that long-term PN is required to maintain health and sustain life(1). The project will develop the understanding of energy requirements for patients who are dependent on long-term home PN (this is termed type 3 IF). The focus of this project will be to measure energy expenditure in patients initiated on home PN and compare measurements from indirect calorimetry(2) with energy requirements calculated using different equations(3).

Energy requirements will then be measured over time at subsequent clinic visits. There will also be a possibility to look at energy expenditure over consecutive days for short periods in the real world setting using wearable technology (4).

Once energy requirements are assessed, using indirect calorimetry combined with wearable technology, an assessment will be made of dietary intake and nutrition administered from the PN. This will enable an assessment of total nutritional intake and energy requirements to determine overall energy balance. An estimate will then be made between actual absorptive capacity derived from comparing total nutritional intake to measured energy requirements. How this is affected by disease pathology and anatomical physiology will be examined.

Objectives

•           Systematic review of the literature of energy expenditure in patients with IF and a literature review to determine effectiveness of indirect calorimetry for the measurement of energy expenditure. 

•           Cohort study to determine energy expenditure and nutritional intake from diet and PN in patients on home PN.

•           Compare calculated requirements from standard equations to actual measured energy requirements

•           Compare measured energy expenditure and total nutritional intake required to maintain physiological homeostasis. 

•           Determine the association between energy balance and underlying pathophysiological mechanism and disease.

For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (https://www.bmh.manchester.ac.uk/study/research/apply/). Informal enquiries may be made directly to the primary supervisor. On the online application form select PhD Determining the nutritional requirements of patients dependent on home parenteral nutrition: A longitudinal cohort study

For international students we also offer a unique 4 year PhD programme that gives you the opportunity to undertake an accredited Teaching Certificate whilst carrying out an independent research project across a range of biological, medical and health sciences. For more information please visit www.internationalphd.manchester.ac.uk


Funding Notes

Candidates are expected to hold (or be about to obtain) a minimum of a 2:1 or a first class honours degree (or equivalent) in a related nutrition, dietetics or related subject area.
This project has a Band 1 fee. Details of our different fee bands can be found on our website (https://www.bmh.manchester.ac.uk/study/research/fees/)
Equality, diversity and inclusion is fundamental to the success of The University of Manchester, and is at the heart of all of our activities. The full Equality, diversity and inclusion statement can be found on the website https://www.bmh.manchester.ac.uk/study/research/apply/equality-diversity-inclusion/

References

1. Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, et al. ESPEN guidelines on chronic intestinal failure in adults. Clinical Nutrition. 2016;35(2):247-307.
2. Haugen HA, Chan LN, Li F. Indirect calorimetry: a practical guide for clinicians. Nutr Clin Pract. 2007;22(4):377-88.
3. Henry CJK. Basal metabolic rate studies in humans: measurement and development of new equations. Public Health Nutrition. 2005;8(7a):1133-52.
4. Murakami H, Kawakami R, Nakae S, Nakata Y, Ishikawa-Takata K, Tanaka S, et al. Accuracy of Wearable Devices for Estimating Total Energy Expenditure: Comparison With Metabolic Chamber and Doubly Labeled Water Method. JAMA Internal Medicine. 2016;176(5):702-3.
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