title: Minimal enteral nutrient requirements for intestinal growth in neonatal piglets: how much is enough?
abstract: BACKGROUND
  Parenterally nourished preterm infants commonly receive minimal enteral feedings, the aim being to enhance intestinal function. Whether this regimen increases intestinal growth has not been established.
  
  
  OBJECTIVE
  Our objective was to determine the minimal enteral nutrient intakes necessary to stimulate and to normalize neonatal intestinal growth.
  
  
  METHODS
  Intestinal growth and cell proliferation were quantified in neonatal pigs given equal amounts of an elemental nutrient solution for 7 d. Different groups (n = 5-7 per group) received 0%, 10%, 20%, 40%, 60%, 80%, or 100% of total nutrient intake enterally, with the remainder given parenterally.
  
  
  RESULTS
  In the jejunum, wet weight, protein mass, and villus height were significantly greater at enteral intakes >40%. Stimulation of ileal protein mass required a higher enteral intake (60%). In both segments, abrupt increases in DNA mass, crypt depth, ornithine decarboxylase activity, and crypt cells in S-phase occurred between enteral intakes of 40% and 60%. Circulating concentrations of glucagon-like peptide-2 and peptide YY, but not gastrin, increased significantly between enteral intakes of 40% and 60% and closely paralleled indexes of cell proliferation.
  
  
  CONCLUSIONS
  The minimal enteral nutrient intake necessary to increase mucosal mass was 40% of total nutrient intake, whereas 60% enteral nutrition was necessary to sustain normal mucosal proliferation and growth. Our results imply that providing <40% of the total nutrient intake enterally does not have significant intestinal trophic effects.
authors.affiliation: US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. dburrin@bcm.tmc.edu
authors.forename: D G
authors.initials: DG
authors.lastname: Burrin
authors.forename: B
authors.initials: B
authors.lastname: Stoll
authors.forename: R
authors.initials: R
authors.lastname: Jiang
authors.forename: X
authors.initials: X
authors.lastname: Chang
authors.forename: B
authors.initials: B
authors.lastname: Hartmann
authors.forename: J J
authors.initials: JJ
authors.lastname: Holst
authors.forename: G H
authors.initials: GH
authors.lastname: Greeley
authors.forename: P J
authors.initials: PJ
authors.lastname: Reeds
mesh_terms: D000818:Animals; D000831:Animals, Newborn / Q000254:growth & development*; D002455:Cell Division; D004247:DNA / Q000032:analysis; D004750:Enteral Nutrition; D005526:Food, Formulated; D005755:Gastrins / Q000097:blood; D053767:Glucagon-Like Peptide 2; D004763:Glucagon-Like Peptides; D007082:Ileum / Q000254:growth & development; D007422:Intestines / Q000254:growth & development*; D007583:Jejunum / Q000254:growth & development; D009751:Nutritional Requirements; D009929:Organ Size; D019894:Peptide YY / Q000097:blood; D010455:Peptides / Q000097:blood; D011506:Proteins / Q000032:analysis; D013552:Swine; D015430:Weight Gain
chemical_list: D005755:Gastrins; D053767:Glucagon-Like Peptide 2; D010455:Peptides; D011506:Proteins; D019894:Peptide YY; D004763:Glucagon-Like Peptides; D004247:DNA