title: Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients.
abstract: BACKGROUND
  Patients with upper gastrointestinal (GI) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enteral feeding in upper GI cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enteral feeding and compared it with standard postoperative care (ie, intravenous fluid).
  
  
  METHODS
  Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, micromol leu/kg/min) protein kinetics.
  
  
  RESULTS
  Respiratory quotient and insulin (microU/mL) levels were significantly increased in patients receiving enteral feeding (0.85 +/- 0.02, 19.8 +/- 4.5 versus 0.78 +/- 0.02, 9.3 +/- 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 +/- 0.04) as compared with IVF group (0.85 +/- 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 +/- 0.01 versus 0.10 +/- 0.02) or synthesis (0.81 +/- 0.09 versus 0.68 +/- 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 +/- 0.10 versus 0.37 +/- 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (-0.10 +/- 0.01 versus 0.30 +/- 0.03, IVF versus FEED, P < 0.001).
  
  
  CONCLUSIONS
  Early enteral feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper GI cancer patients.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: L E
authors.initials: LE
authors.lastname: Harrison
authors.forename: M J
authors.initials: MJ
authors.lastname: Heslin
authors.forename: M E
authors.initials: ME
authors.lastname: Burt
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000368:Aged; D002149:Energy Intake; D004750:Enteral Nutrition; D005770:Gastrointestinal Neoplasms / Q000378:metabolism* / Q000601:surgery*; D005947:Glucose / Q000008:administration & dosage; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D010187:Pancreatic Hormones / Q000378:metabolism; D011182:Postoperative Care; D011446:Prospective Studies; D011506:Proteins / Q000378:metabolism*
chemical_list: D010187:Pancreatic Hormones; D011506:Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D005947:Glucose