Parenteral nutrition (PN) represents a critical therapeutic approach for patients unable to meet nutritional needs through oral or enteral routes. In recent years, the development of advanced PN formulations has accelerated, driven by improvements in lipid emulsion design, compound amino acid and micronutrient preparations, and multichamber bag (MCB) technologies. These innovations not only enhance safety, stability, and metabolic efficiency but also expand the capacity of PN to address increasingly complex clinical scenarios. Novel lipid emulsions derived from mixed-oil systems, structured triglycerides, and omega-3 polyunsaturated fatty acids provide both energy support and immunomodulatory effects. Advances in mixed micelles and nanoemulsion-based delivery systems have improved the solubility and chemical stability of labile vitamins and trace elements, whereas modern MCB systems reduce infection risk and simplify compounding procedures. Despite these advancements, significant challenges remain in translating laboratory progress into standardized clinical practice. Variability in formulation selection criteria, limited physicochemical stability in all-in-one systems, insufficient adaptability for pediatric and home parenteral nutrition populations, and inconsistencies in manufacturing quality and regulatory oversight all restrict broader clinical adoption. Moreover, the absence of unified evaluation standards for stability, compatibility, and clinical safety continues to hinder evidence-based optimization. This review summarizes the current progress and unresolved issues associated with advanced PN formulations, with particular focus on lipid emulsions, amino acids, vitamins, trace elements, and MCB technologies. Future directions include establishing multidimensional evaluation frameworks, promoting individualized and precision nutrition strategies, improving formulation processes, and strengthening global regulatory harmonization.

Purpose: To investigate the association between serum amino acid changes and alopecia in patients with obesity before and after bariatric surgery, and identify risk factors for postoperative alopecia.Methods: This prospective cohort study (ChiCTR2300074104) included patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG), categorized into non-mild alopecia (NM group, n = 24) and moderate–severe alopecia (MS group, n = 43) groups. Clinical data and serum amino acid concentrations were analyzed to: (1) compare preoperative and postoperative amino acid profiles; (2) evaluate amino acid differences between groups at various timepoints and correlate with alopecia severity; (3) perform logistic regression to identify alopecia risk factors.Results: Among 67 patients analyzed, LSG significantly decreased serum concentrations of arginine, alanine, threonine, glutamic acid, branched-chain amino acids (valine, isoleucine, leucine), and aromatic amino acids (tyrosine, phenylalanine, tryptophan) (p < 0.05), while serine and glycine increased (p < 0.05). At 3 months postoperatively, leucine levels were higher in the MS group compared to the NM group. Spearman’s correlation analysis revealed threonine, γ-aminobutyric acid, and leucine levels were associated with alopecia severity (p < 0.05). Logistic regression identified serum leucine as an independent risk factor for postoperative alopecia (OR = 1.119, 95% CI 1.006-1.245, p = 0.038).Conclusion: LSG surgery alters the serum amino acid profile in patients with obesity, and serum leucine concentration at 3 months postoperatively is an influential factor in postoperative alopecia.

This study investigated the effects of oral multivitamin supplementation on vitamin levels in Chinese gastric cancer patients after gastrectomy, aiming to provide a basis for postoperative vitamin supplementation strategies. A total of 78 patients who underwent radical gastrectomy were divided into an experimental group (41 patients, receiving oral multivitamins) and a control group (37 patients). Levels of folic acid, vitamin B₁₂, vitamin B₁, and 25-hydroxyvitamin D were compared before and one month after surgery. Results showed that the level of vitamin B₁ in the experimental group was substantially higher than that in the control group when comparing the difference value between the preoperative and 1-month postoperative periods (P < 0.05). Although the deficiency rates of 25-hydroxyvitamin D and vitamin B₁ were relatively high in both groups, the vitamin B₁ deficiency rates of the experimental group 1 month postoperatively were significantly lower than preoperative rates (P < 0.05). Subgroup analysis revealed that partial gastrectomy patients in the experimental group had increased vitamin B₁ levels and decreased deficiency rates compared to the control group (P < 0.05). The study suggests that systematic multivitamin supplementation should be routinely administered to Chinese gastric cancer patients following gastrectomy, with particular emphasis on initiating vitamin B₁ and vitamin D supplementation upon resumption of semi-solid oral intake. Patients after total gastrectomy may require additional vitamin B₁ supplementation. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

Postoperative complications of gastrectomy severely impact patient prognosis and impose a substantial economic burden. This study aims to assess the effect of adding omega-3 fish oil emulsion to parenteral nutrition on clinical outcomes and cost-effectiveness in gastric cancer populations after gastrectomy. This retrospective cohort study included 150 gastric cancer patients after gastrectomy at Nanjing Drum Tower Hospital between September 2022 and September 2023. Patients were assigned to an omega-3 group and a control group based on whether they received postoperative omega-3 fish oil fat emulsion injection, with 53 matched pairs after propensity score matching (PSM). The primary outcome was the incidence of Grade II or higher complications. An economic evaluation was conducted from a hospital perspective, considering only direct medical costs over a 90-day horizon without discounting, using the incremental cost-effectiveness ratio (ICER). To evaluate the robustness of the primary findings, sensitivity analyses were performed using both one-way and probabilistic methods. After PSM, the omega-3 group demonstrated markedly lower incidences of both Grade II or higher complications (1/53 [1.9%] vs 9/53 [17.0%]; OR = 0.143, 95% CI: 0.015-0.656; P = 0.001) and intra-abdominal infection (0/53 [0%] vs 6/53 [11.3%]; OR = 0.073, 95% CI: 0.001-0.642; P = 0.014) than the control group. The white blood cell count on postoperative day 3 was significantly lower in the omega-3 group (P = 0.034). The cost-effectiveness analysis showed that the omega-3 group incurred an additional cost of 5,217.4 Chinese Yuan but achieved a 15.1% risk reduction in Grade II or higher complications, resulting in an ICER of 345.5. The probabilistic sensitivity analysis indicated a probability exceeding 98% that this strategy was more costly but more effective. This retrospective single-center study observed an association between omega-3 fish oil emulsion and attenuated postoperative inflammation and complications. Although the intervention involved higher direct medical costs, these findings provide localized evidence for optimizing perioperative nutrition support.