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Enteral and parenteral nutrition: evidence-based approach

Published online by Cambridge University Press:  05 March 2007

Khursheed N. Jeejeebhoy
Khursheed N. Jeejeebhoy*
Affiliation:
University of Toronto and St Michael's Hospital, Toronto, Ontario M5B 1W8, Canada
*
Corresponding Author: Dr K. N. Jeejeebhoy, fax +1 416 864 5882, email khush.jeejeebhoy@utoronto.ca
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Abstract

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Nutrition support for patients in hospital has become an essential form of therapy. Total parenteral nutrition (TPN) was the preferred way of giving nutrition to hospital patients for many years but enteral nutrition (EN) is now the preferred route. EN is believed to promote gut function and prevent translocation of intestinal bacteria, thus reducing the incidence of sepsis in critically ill patients. In consequence, the use of TPN has been discouraged as a dangerous form of therapy. Critical review of the data suggests that in the human subject TPN does not cause mucosal atrophy or increase translocation of bacteria through the small intestine. However, overfeeding, which is easy with TPN, can explain the results of studies which have shown that TPN increases sepsis. Furthermore, the risks of TPN-induced complications have been exaggerated. When there is risk of malnutrition and EN is not tolerated, or there is gut failure, TPN is an equally effective and safe alternative.

Keywords

Total parenteral nutritionEnteral nutrition
Type
Symposium on ‘Evidence-based nutrition’
Information
Proceedings of the Nutrition Society , Volume 60 , Issue 3 , August 2001 , pp. 399 - 402
Copyright
Copyright © The Nutrition Society 2001

References

Bozzetti, F, Gavazzi, C, Miceli, R, Rossi, N, Mariani, L, Cozzaglio, L, Bonfanti, G & Piacenza, S (2000) Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. Journal of Parenteral and Enteral Nutrition 24, 7–14.Google Scholar
Cerra, FB, McPherson, JP, Konstantinides, FN, Konstantinides, NN & Teasley, KM (1988) Enteral nutrition does not prevent multiple organ failure syndrome (MOSF) after sepsis. Surgery 104, 727–733.Google Scholar
Fan, ST, Lo, CM, Lai, EC, Chu, KM, Liu, CL & Wong, J (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. New England Journal of Medicine 331, 1547–1552.Google Scholar
Golden, SH, Linda Kao, WH, Peart-Vigilance, C & Brancati, FL (1990) Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 22, 1408–1414.Google Scholar
Gonzalez-Huix, F, Fernandez-Banares, F, Esteve-Comas, M, Abad-Lacruz, A, Cabre, E, Acero, D, Figa, M, Guilera, M, Humbert, P, de Leon, R & Gassul, MA (1993) Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis. American Journal of Gastroenterology 88, 227–232.Google Scholar
Greenberg, GR, Fleming, CR, Jeejeebhoy, KN, Rosenberg, IH, Sales, D & Tremaine, WJ (1998) Controlled trial of bowel rest and nutritional support in the management of Crohn's disease. Gut 29, 1309–1315.Google Scholar
Groos, S, Hunefeld, G & Luciano, L (1996) Parenteral versus enteral nutrition: morphological changes in human adult intestinal mucosa. Journal of Submicroscopic Cytology and Pathology 28, 61–74.Google Scholar
Guedon, C, Schmitz, J, Lerebours, E, Metayer, J, Audran, E, Hemet, J & Colin, R (1986) Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults. Gastroenterology 90, 373–378.Google Scholar
Heyland, DK, MacDonald, S, Keefe, L & Drover, JW (1998) Total parenteral nutrition in the critically ill patient. A meta-analysis. Journal of the American Medical Association 280, 2013–2019.Google Scholar
Howard, L & Hassan, N (1998) Home parenteral nutrition. 25 years later. Gastroenterology Clinics of North America 27, 481–512.Google Scholar
Jeejeebhoy, KN, Zohrab, WJ, Langer, B, Phillips, MJ, Kuksis, A & Anderson, GH (1973) Total parenteral nutrition at home for 23 months without complication and with good rehabilitation. A study of technical and metabolic features. Gastroenterology 65, 811–820.Google Scholar
Kalfarentzos, F, Kehagias, J, Mead, N, Kokkinis, K & Gogos, CA (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized trial. British Journal of Surgery 84, 1665–1669.Google Scholar
Klein, S, Kinney, J, Jeejeebhoy, KN, Alpers, D, Hellerstein, M, Murray, M & Twomey, P (1997) Nutritional support in clinical practice: review of published data and recommendations for future research directions. National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. American Journal of Clinical Nutrition 66, 683–706.Google Scholar
Kudsk, KA, Croce, MA, Fabian, TC, Minard, G, Tolley, EA, Poret, A, Kuhl, MR & Brown, RO (1992) Enteral versus parenteral feeding. Annals of Surgery 215, 503–513.Google Scholar
Lipman, TO (1998) Grains or veins: Is enteral nutrition really better than parenteral nutrition? A look at the evidence. Journal of Parenteral and Enteral Nutrition 22, 167–182.CrossRefGoogle Scholar
McLave, SA, Greene, LM, Snider, HL, Makk, LJ, Cheadle, WG, Owens, NA, Dukes, LG & Goldsmith, LJ (1997) Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. Journal of Parenteral and Enteral Nutrition 21, 14–20.Google Scholar
Matsui, J, Cameron, RG, Kurian, R, Kuo, GC & Jeejeebhoy, KN (1993) Nutritional, hepatic, and metabolic effects of cachectin/ tumor necrosis factor in rats receiving total parenteral nutrition. Gastroenterology 104, 235–243.Google Scholar
Messing, B, Crenn, P, Beau, P, Boutron-Ruault, MC, Rambaud, JC & Matuchansky, C (1999) Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology 117, 1043–1050.Google Scholar
Miura, S, Tanaka, S, Yoshioka, M, Serizawa, H, Tashiro, H, Shiozaki, H, Imaeda, H & Tsuchiya, M (1992) Changes in intestinal absorption of nutrients and brush border glycoproteins after total parenteral nutrition in rats. Gut 33, 484–489.Google Scholar
Moore, FA, Moore, EE, Jones, TN, McCroskey, BL & Peterson, VM (1989) TEN versus TPN following major abdominal trauma-reduced septic morbidity. Journal of Trauma 29, 916–923.Google Scholar
Moore, FA, Moore, EE, Poggetti, RS & Read, RA (1992) Postinjury shock and early bacteremia. A lethal combination. Archives of Surgery 127, 893–897.Google Scholar
Naber, THJ, Schermer, T, de Bree, A, Nusteling, K, Eggink, L, Kruimel, JW, Bakkeren, J, Van Heereveld, H & Katan, MB (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. American Journal of Clinical Nutrition 66, 1232–1239.Google Scholar
Pironi, L, Paganelli, GM, Miglioli, M, Biasco, G, Santucci, R, Ruggeri, E, Di Febo, G & Barbara, L (1994) Morphologic and cytoproliferative patterns of duodenal mucosa in two patients after long-term total parenteral nutrition: changes with oral refeeding and relation to intestinal resection. Journal of Parenteral and Enteral Nutrition 18, 351–354.Google Scholar
Rossi, TM, Lee, PC, Young, C & Tjota, A (1993) Small intestinal mucosa changes, including epithelial cell proliferative activity, of children receiving total parenteral nutrition (TPN). Digestive Diseases and Sciences 38, 1608–1613.Google Scholar
Sedman, PC, MacFie, J, Palmer, MD, Mitchell, CJ & Sagar, PM (1995) Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans. British Journal of Surgery 82, 1663–1667.Google Scholar
Sedman, PC, Macfie, J, Sagar, P, Mitchell, CJ, May, J, Mancey-Jones, B & Johnstone, D (1994) The prevalence of gut translocation in humans. Gastroenterology 107, 643–649.Google Scholar
VA TPN Cooperative study (1991) Perioperative total parenteral nutrition in surgical patients. New England Journal of Medicine 325, 525–532.Google Scholar
Windsor, AC, Kanwar, S, Li, AG, Barnes, E, Guthrie, JA, Spark, JI, Welsh, F, Guillou, PJ & Reynolds, JV (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42, 431–435.Google Scholar
Woodcock, NP, Zeigler, D, Palmer, MD, Buckley, P, Mitchell, CJ & Macfie, J (2000) Enteral versus parenteral nutrition: a pragmatic study. Nutrition 17, 1–12.Google Scholar
Yamazaki, K, Maiz, A, Moldawer, LL, Bistrian, BR & Blackburn, GL (1986) Complications associated with overfeeding of infected animals. Journal of Surgical Research 40, 152–158.Google Scholar
Zaloga, GP & Roberts, P (1994) Permissive underfeeding. New Horizons 2, 257–263.Google Scholar