Low-dose enteral feeding is beneficial during total parenteral nutrition.
BACKGROUND
Enteral support is the preferred feeding route for stressed patients due in part to the provision of gut-specific fuels. In those patients who must be maintained parenterally, small amounts of enteral stimulation might blunt gut atrophy and lead to improvement in host defense mechanisms decreasing macromolecular and/or bacterial translocation (BT).


METHODS
Forty-eight rats were infused with TPN for 9 days, and were randomized to receive 0%, 6%, 12%, or 25% of their calories as partial enteral nutrition (PEN) in an isocaloric, isonitrogenous fashion. Twenty-four hours before harvest animals were gavaged with lactulose and urinary excretion quantified. At harvest, mesenteric lymph nodes were cultured to assess BT and intestinal histology determined.


RESULTS
Provision of as little as 25% of total calories PEN improved nitrogen balance and reduced BT, in a dose dependent fashion. It did not alter TPN-associated increased macromolecular lactulose permeability (4.4% +/- 1.0%).


CONCLUSIONS
Concurrent small amounts of PEN, aimed to support the gut's metabolic needs, are beneficial during periods of prolonged TPN.
Sax
H C
HC
Department of Surgery, University of Rochester Medical Center, New York 14642-8410, USA.
Illig
K A
KA
Ryan
C K
CK
Hardy
D J
DJ
D000818:Animals; D018988:Bacterial Translocation; D004750:Enteral Nutrition / Q000379:methods*; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D010289:Parenteral Nutrition, Total; D051381:Rats; D017207:Rats, Sprague-Dawley