Grains or veins: is enteral nutrition really better than parenteral nutrition? A look at the evidence.
BACKGROUND
Enteral nutrition is said to be better than parenteral nutrition for providing nutrition support to humans.


OBJECTIVE
To assess the literature documenting the assertions that enteral nutrition is superior to parenteral nutrition with respect to cost, safety, physiology, intestinal structure and function, bacterial translocation, and outcome.


METHODS
Sources included MEDLINE search, personal files, and references from human comparative studies of enteral vs parenteral nutrition.


METHODS
The goal was to include all human studies directly addressing questions of comparative efficacy of enteral and parenteral nutrition. Emphasis was given to prospective randomized controlled studies where available. Retrospective comparisons were not included.


METHODS
An attempt was made to briefly summarize methodology and findings of relevant studies. No general attempt was made to assess quality of individual studies.


RESULTS
Enteral nutrition appears to be less expensive than parenteral nutrition, but new economic analyses are needed given the newer aggressive access techniques for enteral nutrition. Enteral nutrition is associated with meaningful morbidity and mortality. The little comparative data existent suggest no differences in safety. Comparative studies of physiology and metabolism as well as comparative and noncomparative studies of intestinal function and structure do not support putative advantages of enteral nutrition. There is no evidence that enteral nutrition prevents bacterial translocation in humans. Enteral nutrition probably reduces septic morbidity compared with parenteral nutrition in abdominal trauma. Otherwise, there is no evidence that enteral nutrition consistently improves patient outcome compared with parenteral nutrition.


CONCLUSIONS
With the exception of decreased cost and probable reduced septic morbidity in acute abdominal trauma, the available literature does not support the thesis that enteral nutrition is better than parenteral nutrition in humans.
Lipman
T O
TO
Gastroenterology-Hepatology-Nutrition Section, Department of Veterans Affairs Medical Center, Georgetown University School of Medicine, Washington, DC 20422, USA.
D018988:Bacterial Translocation; D003365:Costs and Cost Analysis; D004750:Enteral Nutrition / Q000191:economics; D006801:Humans; D007422:Intestines / Q000502:physiology; D016239:MEDLINE; D010288:Parenteral Nutrition / Q000191:economics; D011182:Postoperative Care