Finding rhythm: Individualizing the timing of home nutrition support

While overnight cyclic infusions are considered standard clinical practice for home nutrition support therapy, particularly for parenteral nutrition, there is growing recognition that the optimal timing of infusion may vary among patients. A key clinical dilemma is determining the optimal timing of infusion schedules, which vary based on modality, tolerance, metabolic needs, and patient preference. Guidance from the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) offers flexibility in selecting between daytime and nighttime infusion schedules. Overnight infusions largely reflect hospital-based cyclic regimens and offer advantages such as improved daytime independence and mobility, discretion, and potentially enhanced adherence and better tolerance with longer infusion cycles. However, advances in portable technology and a growing understanding of the role of the circadian system in governing metabolism, appetite, immune and inflammatory function, and aging have increased consideration of daytime infusions, which may better align with circadian rhythms and improve sleep quality by reducing nighttime disruptions. Selecting an optimal infusion schedule requires a patient-centered approach that balances clinical goals with quality of life, psychosocial factors, sleep, daily routines, and safety. Infusion schedule changes should be carefully monitored for tolerance, nutrition adequacy, and safety. Infusion timing should be tailored through ongoing collaboration between patients and interdisciplinary teams, with regular reassessment to ensure safety, effectiveness, and alignment with evolving patient needs.