title: Jejunal feeding is followed by a greater rise in plasma cholecystokinin, peptide YY, glucagon-like peptide 1, and glucagon-like peptide 2 concentrations compared with gastric feeding in vivo in humans: a randomized trial.
abstract: BACKGROUND
  Jejunal feeding is preferred instead of gastric feeding in patients who are intolerant to gastric feeding or at risk of aspiration. However, the impact of gastric feeding compared with that of jejunal feeding on postprandial circulating plasma glucose and amino acid concentrations and the associated endocrine response in vivo in humans remains largely unexplored.
  
  
  OBJECTIVE
  We compared the impact of administering enteral nutrition as either gastric feeding or jejunal feeding on endocrine responses in vivo in humans.
  
  
  METHODS
  In a randomized, crossover study design, 12 healthy young men (mean ± SD age: 21 ± 2 y) received continuous enteral nutrition that contained noncoagulating proteins for 12 h via a nasogastric tube or a nasojejunal tube placed 30-40 cm distal to the ligament of Treitz. Blood samples were collected during the 12-h postprandial period to assess the rise in plasma glucose, amino acid, and gastrointestinal hormone concentrations.
  
  
  RESULTS
  No differences were observed in the postprandial rise in circulating plasma amino acid and glucose concentrations between regimens. Jejunal feeding resulted in higher peak plasma insulin concentrations than did gastric feeding (392 ± 53 compared with 326 ± 54 pmol/L, respectively; P < 0.05). The postprandial rise in plasma cholecystokinin, peptide YY (PYY), glucagon-like peptide 1 (GLP-1), and glucagon-like peptide 2 (GLP-2) concentrations was greater after jejunal feeding than after gastric feeding, with higher peak concentrations and a greater postprandial incremental AUC for GLP-1 and cholecystokinin (all P < 0.05). Plasma ghrelin concentrations did not differ between regimens.
  
  
  CONCLUSIONS
  Enteral nutrition with gastric or jejunal feeding in healthy young men results in similar postprandial plasma amino acid and glucose concentrations. However, the endocrine response differs substantially, with higher peak plasma cholecystokinin, PYY, GLP-1, and GLP-2 concentrations being attained after jejunal feeding. This effect may result in an improved anabolic response, greater insulin sensitivity, and an improved intestinotropic effect. Nevertheless, it may also lead to delayed gastric emptying. This trial was registered at trialregister.nl as NTR2801.
authors.affiliation: Nutricia Research, Utrecht, Netherlands; Departments of Surgery and j.luttikhold@vumc.nl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Luttikhold
authors.affiliation: Nutrition and Pharmacology Group, Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
authors.forename: Klaske
authors.initials: K
authors.lastname: van Norren
authors.affiliation: Department of Surgery, Spaarne Gasthuis, Haarlem, Netherlands;
authors.forename: Herman
authors.initials: H
authors.lastname: Rijna
authors.affiliation: Departments of Surgery and.
authors.forename: Nikki
authors.initials: N
authors.lastname: Buijs
authors.affiliation: Departments of Surgery and.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Ankersmit
authors.affiliation: Clinical Chemistry, VU University Medical Center, Amsterdam, Netherlands;
authors.forename: Annemieke C
authors.initials: AC
authors.lastname: Heijboer
authors.affiliation: Atalmedial Diagnostic Center, Hoofddorp, Netherlands;
authors.forename: Jeannette
authors.initials: J
authors.lastname: Gootjes
authors.affiliation: The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark; and.
authors.forename: Bolette
authors.initials: B
authors.lastname: Hartmann
authors.affiliation: The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark; and.
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Holst
authors.affiliation: NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
authors.forename: Luc Jc
authors.initials: LJ
authors.lastname: van Loon
authors.affiliation: Departments of Surgery and.
authors.forename: Paul Am
authors.initials: PA
authors.lastname: van Leeuwen
mesh_terms: D000596:Amino Acids / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002766:Cholecystokinin / Q000097:blood* / Q000378:metabolism; D018592:Cross-Over Studies; D004063:Digestion; D004750:Enteral Nutrition; D005753:Gastric Mucosa / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000097:blood* / Q000378:metabolism; D053767:Glucagon-Like Peptide 2 / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism; D000078790:Insulin Secretion; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism*; D007441:Intubation, Gastrointestinal; D007583:Jejunum; D008297:Male; D019894:Peptide YY / Q000097:blood* / Q000378:metabolism; D019518:Postprandial Period; D013270:Stomach; D015854:Up-Regulation
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D053767:Glucagon-Like Peptide 2; D007328:Insulin; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1; D002766:Cholecystokinin
keywords: enteral nutrition; gastric feeding; gastrointestinal hormones; jejunal feeding; malnutrition