title: Nutritional strategies to enhance adaptation in intestinal failure.
abstract: OBJECTIVE
  This article summarizes the current and potential future nutritional approaches to stimulate adaptation in intestinal failure. Adaptation in this context usually refers to intestinal adaptation but also involves changes in whole body physiology as well as in eating/drinking behavior.
  
  
  RESULTS
  Adaptation largely depends on residual functional anatomy. Luminal exposure to complex nutrients is the most important trigger for intestinal adaptation. Enteral fat as well as enteral or parenteral short chain fatty acids have a specific stimulatory effect. Zinc and vitamin A status need to be optimized for adaptation to proceed and be maintained. In the context of maintaining sodium and water homeostasis, flushing the remnant intestine because of uncontrolled thirst/drinking must be avoided. Complications of nutritional care such as malnutrition, intestinal failure-associated liver disease, and recurrent line sepsis also need optimal management.
  
  
  CONCLUSIONS
  Stimulation by luminal nutrients as well as prophylaxis against and treatment of (nutritional) complications are the cornerstones of adaptation to the short bowel situation. Based on ample data from animal studies but only limited evidence in humans specific nutritional stimulators need to be studied more rigorously. As long as such data are missing they can be tried on an individual basis.
authors.affiliation: Division of Gastroenterology and Endocrinology, University Medical Center Rostock, Rostock, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Lamprecht
authors.forename: Peggy
authors.initials: P
authors.lastname: Bodammer
mesh_terms: D000222:Adaptation, Physiological; D000818:Animals; D004032:Diet; D004750:Enteral Nutrition; D006801:Humans; D007410:Intestinal Diseases / Q000503:physiopathology*; D010288:Parenteral Nutrition