title: Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients.
abstract: OBJECTIVE
  This study examined the risk of diarrhea as a result of providing enteral nutrition in the hospital setting, adjusting for other clinical and therapeutic factors.
  
  
  METHODS
  Adults admitted to a general tertiary care university hospital, in clinical or surgical units, were enrolled in the study between June 2004 and May 2005 and prospectively followed during their hospital stay. For each patient treated with enteral nutrition (n = 302), a comparable non-treated patient from the same ward (who also received antibiotics previously) and was similarly cared for by the same hospital staff was included in the study (n = 302), constituting a double-cohort study. All patients were seen three times per week, on alternating days, until the occurrence of diarrhea or hospital discharge. Cox's regression analyses were applied for adjustments.
  
  
  RESULTS
  The incidence of diarrhea was 18% for patients receiving enteral nutrition and 6% for non-treated patients (P < 0.01). In multivariate analyses, enteral nutrition was independently associated with diarrhea (hazard ratio 2.7, 95% confidence interval 1.6-4.7), even adjusting for age (hazard ratio 1.02, 95% confidence interval 1.00-1.03) and hospitalization during the summer months (hazard ratio 2.4, 95% confidence interval 1.5-3.9). Patients for whom strict adherence to delivery-set washing-and-changing procedures was observed (on >75% of days) presented a lower incidence of diarrhea (6.5% versus 20.3%, P = 0.02; and 5.9% versus 19.8%, P = 0.05, respectively).
  
  
  CONCLUSIONS
  Providing enteral nutrition to the hospitalized elderly during the summer months is associated with a higher risk of diarrhea. Strategies aimed toward improvement in the quality of enteral nutrition practices should be evaluated to minimize this deleterious clinical outcome.
authors.affiliation: Post-Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. vivi_luft@yahoo.com.br
authors.forename: Vivian Cristine
authors.initials: VC
authors.lastname: Luft
authors.forename: Mariur Gomes
authors.initials: MG
authors.lastname: Beghetto
authors.forename: Elza Daniel
authors.initials: ED
authors.lastname: de Mello
authors.forename: Carísi Anne
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012621:Seasons