The purpose of this study is to determine whether advancing the timing of home parenteral nutrition from overnight to daytime regimens leads to improved glucose profiles and sleep quality, and other changes in plasma metabolic signatures.
Emerging evidence suggests that considering the time-of-day in clinical care may optimize health, partly through limiting sleep disruption and circadian misalignment. Acute sleep and circadian rhythms disturbances are associated with cardiometabolic derangements, including persistent hyperglycemia, a significant contributor to life-threatening complications. However, it is currently considered standard practice for patients on parenteral nutrition to be fed for 12-hour periods overnight. Current guidelines lack explicit guidance regarding the time-of-day when nutrition support should be administered. Thus, the overall objective of the clinical trial is to comprehensively examine a novel dimension of clinical nutrition by determining whether advancing the timing of home parenteral nutrition from overnight to daytime regimens leads to improved glucose profiles and sleep quality, and other changes in plasma metabolic signatures. The study is a 2-week controlled cross-over feeding trial where 20 short bowel syndrome patients will follow their usual overnight parenteral nutrition regimen for one week, and then advance their feeds to daytime for a second week. Patients will be assessed objectively using non-invasive, novel technologies and 'omics techniques. The investigators hypothesize that advancing the timing of home parenteral nutrition feeds to a daytime regimen is a cost-efficient, effective, and feasible nutrition timing countermeasure against metabolic derangements, fragmented sleep, and decreased quality of life. Results of this study may provide evidence-based, cost-efficient, and effective nutrition support countermeasures against hyperglycemia and sleep disruption, and could potentially modify current widespread clinical nutrition support practice.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
20
Parenteral nutrition will be provided during the nighttime followed by daytime.
Massachusetts General Hospital
Boston, Massachusetts, United States
Change in 24-hour average glucose from nighttime to daytime feeds
Glucose will be continuously measured using continuous glucose sensors. Blood glucose will be averaged during each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Average values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).
Change in number of interruptions of sleep by physical movement assessed by actigraphy from nighttime to daytime feeds
Sleep will be objectively measured from actigraphy. The number of interruptions of sleep by physical movement will be calculated as 100 × the number of groups of consecutive mobile 30-s epochs/by the total number of immobile epochs. This measure will reflect sleep quality.
Time frame: Actigraphy data from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).
Change in area under-the-curve of glucose from nighttime to daytime feeds
Glucose will be continuously measured using continuous glucose sensors. Area under-the-curve of blood glucose during the 12-hour feeds will be calculated using the trapezoid method and adjusted for baseline glucose values. Area under-the-curve of glucose will be averaged for each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Glucose values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds) during 12-hour cycled feeds.
Change in average daily duration of glucose levels above 140 mg/dl from nighttime to daytime feeds
Glucose will be continuously measured using continuous glucose sensors. Duration of glucose levels above 140 mg/dl will be averaged during each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Average values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).
Change in fasting insulin concentration from nighttime to daytime feeds
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Serum insulin will be measured from fasting blood samples collected on day 8 and 15.
Time frame: Blood draw scheduled on days 8 and 15.
Change in sleep duration from nighttime to daytime feeds
Sleep duration will be objectively measured from actigraphy and sleep logs. Duration will be averaged will be averaged during each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Average values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).
Change in sleep midpoint from nighttime to daytime feeds
Sleep midpoint will be objectively measured from actigraphy and sleep logs. Midpoint will be averaged will be averaged during each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Average values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).
Change in midpoint of least-active 5h timing from nighttime to daytime feeds
Measure of sleep timing as determined from actigraphy. Timing will be averaged will be averaged during each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Average values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).
Change in midpoint of most-active 10h timing from nighttime to daytime feeds
Measure of sleep timing as determined from actigraphy. Timing will be averaged will be averaged during each of the two 1-week feeding regimens (nighttime and daytime).
Time frame: Average values from days 1 to 7 (nighttime feeds) and days 8 to 14 (daytime feeds).