Some metabolic and hormonal aspects of enteral nutrition

Enteral nutrition is popular in intensive care. Keeping the intestine in function by feeding stimulation helps to treat intensive care patients. We aimed to find metabolic and hormonal differences between enteral and parenteral feeding.

Design

Twenty cardiopulmonary stable patients hospitalised at the Metabolic Department of Teaching Hospital in Hradec Králové were monitored in a prospective study.

Interventions

The patients, who were fed more than 2 weeks parenterally without enteral feeding due to their disease (mostly uncomplicated intestinal fistula after surgical intervention with possibility to start enteral feeding), where studied after obtaining informed consent. The parenteral nutrition was fortified by 4200 kJ parenterally in days 0–2 and next enterally in the same contents (Nutrison 1000 ml) in days 7–14. The local Ethics committee approved this research project.

Measurement and methods

Comparisons between parenteral + parenteral period and parenteral + enteral period in several serologic and urine parameters were calculated. Wilcoxon's pair t-test was used for statistical analysis.

Results

HDL cholesterol (0.61 vs 0.72 mmol/l), apoprotein A (0.63 vs 0.71 g/l) and insulin like growth factor (IGF-1) (291.7 vs 321.4 ng/ml) were significantly higher in enteral period (P < 0.05). The urinary output of urea (551 vs 489 mmol/day), P (31 vs 24 mmol/day), Na (418 vs 220 mmol/day) were significantly lower during enteral period (P < 0,05).

Conclusion

Enteral nutrition application is associated also with some anabolic effects in comparison to application of parenteral nutrition alone. The higher level of IGF-1 is main anabolic marker of enteral nutrition in our study. The decline of urea output means an enhanced proteosynthesis (probably most in intestine mass). Higher level of HDL cholesterol and apo A during enteral feeding we explain by the enhanced synthesis of cholesterol in the intestine. The metabolic function of intestine may be important for intensive care patients. Because tolerance of enteral feeding is changing quickly during the critical situation, we prefer combination of parenteral and enteral nutrition in unstable intensive care patients.

Supported by Grant IGA-MZ-CR-4788-3/98.