PP011 - METABOLIC REST PRESERVES FUNCTIONAL RESERVE: ALTERNATE-DAY PARENTERAL NUTRITION IN PALLIATIVE GASTRIC CANCER

PP011

METABOLIC REST PRESERVES FUNCTIONAL RESERVE: ALTERNATE-DAY PARENTERAL NUTRITION IN PALLIATIVE GASTRIC CANCER

Z. Irmak Kaya^1,*, A. Sağdıç¹, H. Hamarat¹, S. Gürcü², B. Yalınbaş Kaya³, A. Türkel⁴, P. Yildiz⁵, I. B. Karakaya⁶, I. Zengin⁶, F. Altuntaş Kaya⁷

¹Internal Medicine Department, ²Pharmacy, ³Gastroenterology, ⁴Medical oncology, Eskişehir City Hospital, ⁵Internal Medicine Department, Eskişehir Osmangazi University, ⁶General Surgery, ⁷Intensive Care, Eskişehir City Hospital, Eskişehir, Türkiye

Rationale: Palliative oncology prioritizes functional preservation over survival, yet daily parenteral nutrition (PN) may induce "metabolic fatigue" and functional decline. We hypothesized that alternate-day PN provides intermittent metabolic rest, maintaining physical function and metabolic flexibility better than daily regimens without compromising safety.

Methods: This single-center retrospective cohort included 106 stage IV gastric adenocarcinoma patients.

Group 1 (n=38): Trophic enteral nutrition (EN) (≥500 kcal/d) + daily PN.

Group 2 (n=36): Trophic EN (≥500 kcal/d) + alternate-day PN.

Group 3 (n=32): Daily PN only.

Outcomes included 60-day mortality and 30-day changes in metabolic flexibility (TyG index), inflammation (Neutrophil-to-Lymphocyte Ratio [NLR], C-reactive protein-to-albumin ratio [CAR]), and functional status (Handgrip Strength, ECOG-PS). Multivariate regression adjusted for age, baseline ECOG, albumin, CRP, and chemotherapy.

Results: 60-day mortality was comparable (p=0.84), confirming safety. Group 3 showed progressive TyG elevation(p=0.009) and increased NLR/CAR. Group 2 maintained stable TyG and preserved ECOG-PS in 72.2% of patients, vs 55.3% in Group 1 (p=0.039) and 44.0% in Group 3 (p=0.006). Handgrip decline was greatest in Group 3 (-5.2 kg,p=0.012 vs Group 2). Multivariate analysis identified daily PN (Groups 1+3) as an independent risk factor for ECOG deterioration (OR:2.45,p=0.028) and muscle loss (OR:2.45,p=0.036). Total caloric intake did not independently predict functional decline (p=0.884).

Conclusion: Alternate-day PN safely preserved metabolic flexibility and functional status despite lower weekly calories. The TyG index proved a sensitive surrogate for nutrition-induced metabolic stress. Daily PN, especially without EN, linked to metabolic intolerance and functional loss. PN frequency is thus a modifiable determinant of functional preservation in palliative care.

Disclosure of Interest: None declared