Enteral Diet Research Articles

Pressure ulcer incidence in critically ill patients: Role of body mass index, nutrition therapy, and other non-nutritional factors

To assess the clinical and nutritional risk factors related to the occurrence of pressure ulcers (PUs) in patients admitted to an Intensive Care Unit (ICU). This is a cohort retrospective study, carried out by analyzing the medical records of patients admitted to the ICU of a hospital, containing information on sociodemographic, clinical, dietary, and anthropometric data, presence of mechanical ventilation, sedation, and use of noradrenaline. To verify the clinical and nutritional risk factors, multivariate Poisson's regression with robust variance was used to estimate the relative risk (RR) according to the explanatory variables. A total of 130 patients were evaluated from January 1 to December 31, 2019. The incidence of PUs in the study population was 29.2%. In univariate analysis, male sex, suspended or enteral diet, use of mechanical ventilation, and sedatives had a significant association with the PUs (p<0.05). However, when adjusted for potential confounders, only suspended diet remained associated with the PUs. Furthermore, in an analysis stratified by hospitalization time, it was observed that for each 1kg/m2 increase in body mass index, there is a 10% increased risk of PUs occurrence (RR: 1.10; 95%CI: 1.01-1.23). Patients with suspended diet, diabetics, with longer-time hospitalization, and overweight have a higher risk of presenting pressure ulcers.

Copper Deficiency Anemia Due to Low-Calorie, Blended Enteral Diet: Case Report.

Copper deficiency is an uncommon cause of hematologic abnormalities in children that is often overlooked or misdiagnosed. When found, specific recommendations on dose, duration, or frequency of copper repletion are lacking in the current literature. This report describes the case of a 4-year-old boy who presented to a university medical center in the midwestern United States with persistent macrocytic anemia found to be caused by copper deficiency secondary to a low-calorie, blended enteral diet. Intravenous copper supplementation was initiated at 40 μg/kg/d for a total of 6 days, followed by enteral supplementation of 2 mg cupric oxide. This repletion regimen ultimately improved the patient's copper deficiency and resolved anemia within 1 month.

The Sodium Concentration of Enteral Diets Does Not Influence Absorption of Nutrients but Induces Intestinal Secretion of Water in Miniature Pigs

Contradictory opinions exist as to whether the sodium concentration of enteral diets influences absorption of macronutrients and transepithelial movement of sodium and water. Therefore, we investigated the effects of various sodium concentrations of enteral diets on absorption of macronutrients and on net fluxes of sodium and water. In unanesthetized miniature pigs, a 150-cm jejunal segment was perfused with an oligopeptide (Peptisorb), an oligomeric and a polymeric diet. The polymeric diet was supplemented with pancreatic enzymes. The sodium concentrations varied between 30 and 150 mmol/L. The energy density was 3.4 MJ/L. The sodium concentration of the diets did not influence absorption of macronutrients and of total energy. However, increasing sodium concentrations of the diets were associated with increasing osmolality of the solutions, resulting in a linear increase in net secretion of water and flow rate of chyme. With all diets and sodium concentrations net secretion of sodium occurred. The sodium secretion was independent of the initial sodium concentration of the diets. It was linearly correlated with net flux of water and was largest in miniature pigs infused with the oligomeric diet. The sodium concentration of the jejunal effluent did not correspond to the initial sodium concentration of the diets. The present results indicate that enteral feeding of diets with high energy density inevitably increases net secretion of water and sodium as sodium concentration increases. Therefore, the sodium concentration of diets should be as low as possible to meet only the minimal daily requirement of sodium. Low sodium concentrations of diets have no negative effects on absorption of macronutrients.

P846 Epidemiological and Clinical Characteristics of Inflammatory Bowel Diseases in Patients from Greece

Abstract Background There are few reports from Greece about the epidemiological and clinical features of inflammatory bowel diseases (IBD), which were mainly evaluated in retrospective studies with data collection from hospital registries. We aimed to determine the epidemiological profile and clinical features as well as to detect any differences between patients with Crohn’s disease (CD) and ulcerative colitis (UC), based on retrospectively-prospectively collected data from a cohort of IBD patients followed in daily clinical practice. Methods Patients with biopsy-confirmed IBD aged 10–90 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2022. Logistic regression analysis and chi-squared test were used to compare the frequency of epidemiological and clinical characteristics between patients with UC and CD. Results We collected 300 patients diagnosed with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis). The median age of IBD patients was 42 years. The onset of disease in CD group was observed between 17 and 40 years of age in the majority of patients (58%). Ileocolonic location of CD was present in 70% of CD patients; 39% had stricturing behavior and 29% had perianal disease (abscesses and fistulas). CD patients developed more often aphthous stomatitis (34%) than patients with UC (13%, OR 3.45; 95% CI: 1.76-6.78; P&amp;lt; .001). Patients with CD had a 20-fold increased risk to undergo a surgical procedure (OR 19.87; 95% CI: 6.03-65.48; P&amp;lt; .001), mainly enterectomy (26%), as shown in table 1. At study entry, C-reactive protein (CRP) elevation was more frequently present in CD compared to UC patients (OR 1.93; 95% CI: 1.04-3.59; P&amp;lt; .05). Most patients with UC had extensive colitis (56%). Mesalamine was predominantly used in UC patients (81% vs 46% in CD, P&amp;lt; .005), and sulfasalazine and thiopurines in CD patients (60-70% vs 9-13% in UC, P&amp;lt; .005), as shown in table 2. The most commonly used anti-TNF agent was Infliximab, mainly in CD patients (24% vs 4% in UC, OR 0.12; 95% CI: 0.04-0.34; P&amp;lt; .001). Adalimumab was used in 12% of IBD patients and Vedolizumab in 8%. Around 4% of patients with complicated CD received Ustekinumab. Tofacitinib was used in 2% of patients with severe complicated UC and extraintestinal manifestations. Enteral diet (Modulen®) was used in 6% of CD patients and in only 2% of UC patients with severe UC pancolitis. Conclusion In this retrospective-prospective cohort study of 300 patients with IBD, CD patients had a significantly higher risk of developing aphthous stomatitis and increased levels of CRP. CD patients also required more often treatment with anti-TNF agents and immunosuppressants, and a surgical procedure, mainly enterectomy.

Large Variation in Diagnosis and Treatment of Chyle Leak after Pancreatic Surgery: A Nationwide Insight

Background: In the current literature different diagnosis and treatment strategies for chyle leak after pancreatic surgery are described. In 2017, the International Study Group for Pancreatic Surgery defined a consensus-based definition for diagnosis. However, consensus on the optimal treatment strategy is lacking. Aim: The aim of this multicenter study is to investigate the current treatment and diagnosis of chyle leak after pancreatic surgery in clinical practice in the Netherlands to gain insight into practical applications of chyle leak. Methods: A nationwide survey about the diagnosis and treatment of chyle leak was sent to specialized dieticians and pancreatic surgeons from all 16 pancreatic centers collaborating in the Dutch Pancreatic Cancer Group. Data was quantitative processed according to thematic content analysis and by using descriptive analysis. Results: In total, 16 dieticians from 16 centers and 20 surgeons from 12 centers completed the questionnaire. Analysis showed that the International Study Group for Pancreatic Surgery-definition for chyle leak was used in clinical practice by 31% (n=11) of the respondents. The results show also large nationwide variation in treatment of chyle leak after pancreatic surgery, as well between as within centers. The most common treatment was a step-up approach of nutritional therapies (44% (n=16)), which starts with an enteral fat restricted diet enriched with medium chain fatty acids followed by total parenteral nutrition. Conclusion This study shows that the current diagnosis and treatment strategies for chyle leak after pancreatic surgery in clinical practice on a nationwide scale are different. More comparable studies are needed to define the optimal treatment strategy for chyle leak. There is need for an international multidisciplinary (sub)working group to reach consensus on the treatment strategy of chyle leak and to discuss implementation strategies for clinical practice.

Enterocolite necrosante neonatal: relato de caso e revisão de literatura

Neonatal necrotizing enterocolitis (NEC) is a syndrome characterized by inflammation and ischemic necrosis of the gastrointestinal tract that can course with variable clinical manifestations: such as abdominal distension, bilious vomiting, hematoquezia, frequent gastric waste, decreased hydro-air noises, fecal changes. The condition is usually associated with systemic signs (pallor, apnea, hypoactivity, dysthermias). NEC can manifest with partial intestinal necrosis and have complete recovery, requiring only clinical treatment. Case report: newborn (NB) of T.A.A., female, premature (33 weeks and 5 days), extremely low weight (888g), APGAR 8/9, referred to the Neonatal Intensive Care Unit (ICU NEO). On the 1st day of life, he presented significant abdominal distension and bilious debt by the orogastric tube (SOG). It eliminated meconium after rectal stimulation, with 43 hours of life. He maintained abdominal distension until the 10th day of life, progressing, with progressive improvement (reduction of abdominal distension, change in the aspect of the debt by SOG), after the institution of adequate therapy. On the 11th day of life, he started a minimal enteral diet, progressing gradually, achieving success in diet progression. Enterocolitis is one of the most frequent gastrointestinal emergencies in neonates, most frequently affecting premature newborns, especially those born with very low birth weight. Studies indicate the recent increase in the incidence of NEC in NEO ICUs, in several countries, due to the increased survival of premature newborns. Therefore, there is a need for a greater dissemination of knowledge about the pathology; mainly among health professionals who work in these units.

Enterocolite necrosante neonatal: relato de caso e revisão de literatura

Neonatal necrotizing enterocolitis (NEC) is a syndrome characterized by inflammation and ischemic necrosis of the gastrointestinal tract that can course with variable clinical manifestations: such as abdominal distension, bilious vomiting, hematoquezia, frequent gastric waste, decreased hydro-air noises, fecal changes. The condition is usually associated with systemic signs (pallor, apnea, hypoactivity, dysthermias). NEC can manifest with partial intestinal necrosis and have complete recovery, requiring only clinical treatment. Case report: newborn (NB) of T.A.A., female, premature (33 weeks and 5 days), extremely low weight (888g), APGAR 8/9, referred to the Neonatal Intensive Care Unit (ICU NEO). On the 1st day of life, he presented significant abdominal Residência Pediátrica; 2023: Ahead of Print. DOI: 10.25060/residpediatr-2023-567 distension and bilious debt by the orogastric tube (SOG). It eliminated meconium after rectal stimulation, with 43 hours of life. He maintained abdominal distension until the 10th day of life, progressing, with progressive improvement (reduction of abdominal distension, change in the aspect of the debt by SOG), after the institution of adequate therapy. On the 11th day of life, he started a minimal enteral diet, progressing gradually, achieving success in diet progression. Enterocolitis is one of the most frequent gastrointestinal emergencies in neonates, most frequently affecting premature newborns, especially those born with very low birth weight. Studies indicate the recent increase in the incidence of NEC in NEO ICUs, in several countries, due to the increased survival of premature newborns. Therefore, there is a need for a greater dissemination of knowledge about the pathology; mainly among health professionals who work in these units.

Partially hydrolyzed guar gum alleviates hepatic steatosis and alters specific gut microbiota in a murine liver injury model.

The gut microbiota, via the gut-liver axis, plays an important role in the development of intestinal failure-associated liver disease. Here, we investigated whether partially hydrolyzed guar gum (PHGG), a dietary fiber could alleviate liver damage and modulate the gut microbiota in a murine liver injury (LI) model. Liver injury was induced in 6-week-old male C57BL/6 mice using an enteral liquid diet composed of parenteral nutrition (LI group) and treated with 5% PHGG (LI/PHGG group). Liver histopathology was examined using oil red O and a tumor necrosis factor-α (TNF-α) labeling. The gut microbiota was examined using 16S rRNA gene sequencing. Lipid accumulation was significantly decreased in the LI /PHGG group when compared with that of the LI group. The area of TNF-α-positive cells was significantly higher in the LI group when compared with that of the control. The principal coordinate analysis (PCoA) revealed pronounced changes in the gut microbiota after PHGG treatment. Linear discriminant analysis of effect size showed that PHGG treatment significantly increased cecal abundance of Parabacteroides. PHGG alleviated hepatic steatosis following liver injury in mice. The protective effect of PHGG treatment could be associated with increased abundance of Parabacteroides in the cecum.

The influence of different dietary patterns on changes in the intestinal microbiota and human body weight

The human gut microbiome responds dynamically to changes in diet, contributing to the diversity of the human diet. The composition of the diet can also influence the metabolic products that are ultimately present in the intestinal lumen and plasma. Observations in humans on vegan, omnivorous, or synthetic enteral diets deficient in fiber have demonstrated dramatic imbalances in the gut microbiome, accompanied by changes in carbohydrate and amino acid-derived bacterial metabolites. It has been established that diet plays a dominant role in the formation of interindividual variations in host-associated microbial communities. Given the impact of the microbial community on human health and its multiple mechanisms of action, establishing the impact of different dietary approaches and models is critical.

Lysine Dipeptide Enhances Gut Structure and Whole-Body Protein Synthesis in Neonatal Piglets with Intestinal Atrophy

BackgroundParenteral nutrition (PN) is often a necessity for preterm infants; however, prolonged PN leads to gut atrophy, weakened gut barrier function, and a higher risk of intestinal infections. Peptide transporter-1 (PepT1) is a di- or tripeptide transporter in the gut and, unlike other nutrient transporters, its activity is preserved with the onset of intestinal atrophy from PN. As such, enteral amino acids in the form of dipeptides may be more bioavailable than free amino acids when atrophy is present. ObjectivesIn Yucatan miniature piglets with PN-induced intestinal atrophy, we sought to determine the structural and functional effects of enteral refeeding with lysine as a dipeptide, compared to free L-lysine. MethodsPiglets aged 7-8 days were PN-fed for 4 days to induce intestinal atrophy, then were refed with enteral diets with equimolar lysine supplied as lysyl-lysine (Lys-Lys; n = 7), free lysine (n = 7), or Lys-Lys with glycyl-sarcosine (n = 6; to determine whether competitive inhibition of Lys-Lys uptake would abolish PepT1-mediated effects). The diets provided lysine at 75% of the requirement and were gastrically delivered for a total of 18 hours. Whole-body and tissue-specific protein synthesis, as well as indices for gut structure and barrier function, were measured. ResultsThe villus height, mucosal weight, and free lysine concentration were higher in the Lys-Lys group compared to the other 2 groups (P < 0.05). Lysyl-lysine led to greater whole-body protein synthesis compared to free lysine (P < 0.05). Mucosal myeloperoxidase activity was lower in the Lys-Lys group (P < 0.05), suggesting less inflammation. The inclusion of glycyl-sarcosine with Lys-Lys abolished the dipeptide effects on whole-body and tissue-specific protein synthesis (P < 0.05), suggesting that improved lysine availability was mediated by PepT1. ConclusionsImproved intestinal structure and whole-body protein synthesis suggests that feeding strategies designed to exploit PepT1 may help to avoid adverse effects when enteral nutrition is reintroduced into the compromised guts of neonatal piglets.

The impact of immunomodulatory enteral nutrition on patients submitted to elective gastrointestinal cancer surgery: integrative review

Objective: To carry out a review about the use of enteral nutrition composed of immunonutrients in cancer patients undergoing elective surgery in the gastrointestinal tract on surgical outcomes. Methods: The research was carried out in the Medline, Lilacs and Pubmed databases. Results: The administration of enteral diet in both groups was well tolerated, there was no significant difference in the mortality rate and in the Intensive Care Unit or postoperative hospital stay. The immunomodulatory nutritional therapy was favorable to decrease the TNFα values and increase the total lymphocyte count in the postoperative period. Perioperative enteral immunonutrition has no significant effects on mortality rate, length of hospital stay and complications in gastrointestinal tract surgeries. Final considerations: Immunonutrition appears to be promising in terms of modulating the immune response. More randomized studies are needed regarding the effects of immunonutrients on abdominal surgical cancer patients.

A Preliminary Study of Modulen IBD Liquid Diet in Hospitalized Dogs with Protein-Losing Enteropathy.

Simple SummaryModulen IBD is an oral liquid food that results in remission rates similar to immunosuppressive drugs in children with inflammatory bowel disease. This diet has not been previously investigated in dogs. We aimed to describe the use of Modulen IBD in hospitalized dogs with inflammatory protein-losing enteropathy (PLE) when combined with whey powder and a multivitamin/mineral blend to ensure this was complete and balanced for dogs. Five dogs hospitalized for PLE that had an esophagostomy feeding tube placed were eligible and prospectively enrolled. All dogs received Modulen IBD without concurrent immunosuppressive drugs and tolerated tube feedings. All dogs had resolution of anorexia, three had stable or improved serum albumin concentrations, four had improved or normalized serum globulin concentrations, and four dogs had improved or normalized serum cholesterol concentrations 2–3 days after initiating the diet. In conclusion, the Modulen IBD liquid diet was well-tolerated in-hospital and resolved anorexia in all dogs and helped to improve selected biochemical parameters in some dogs. Further studies are needed to assess the long-term effects of feeding this diet to dogs with inflammatory PLE. Modulen IBD is an enteral liquid diet that can induce remission rates similar to glucocorticoids in children with inflammatory bowel disease. The Modulen IBD liquid diet has not been previously investigated in dogs. Our study aimed to describe the use of the Modulen IBD liquid diet in hospitalized dogs with inflammatory protein-losing enteropathy (PLE), including its tolerance and effects on appetite and gastrointestinal signs, and laboratory parameters during hospitalization. Of the 14 dogs hospitalized for PLE that had an esophagostomy feeding tube placed at the time of endoscopy, 5 were eligible and prospectively enrolled. The Modulen IBD liquid diet was supplemented with whey powder isolate and a multivitamin/mineral blend to ensure the diet was complete and balanced for canine adult maintenance and had a macronutrient profile desirable for PLE. All five dogs tolerated tube feedings with the Modulen IBD liquid diet, allowing an increase of 75 to 100% of the resting energy requirement (RER) by day 3 to 4. The diet was administered without glucocorticoid in all five dogs. All five of these dogs had a resolution of anorexia allowing the voluntary intake of a commercial hydrolyzed protein diet prior to the use of glucocorticoids. Of these five dogs, three (60%) had stable or improved serum albumin concentrations (median % increase: 10.3, range: 0–31.1), four (80%) had improved or normalized serum globulin concentrations (median % increase: 12.9, range: 5.1–66.2) and four (80%) had improved or normalized serum cholesterol concentrations (median % increase: 31.5, range: 4.8–63) 2–3 days after initiating the diet. However, there were no significant differences in these selected biochemical parameters pre- and post-feeding with the diet (p > 0.080). In conclusion, the Modulen IBD liquid diet, fed via an esophagostomy feeding tube was well-tolerated in-hospital and resolved anorexia in all dogs and helped to improve selected biochemical parameters in some dogs. Further studies are needed to assess the long-term effects of feeding this diet on the rate of serum albumin increase and remission in dogs with inflammatory PLE.

Outcomes of Standardized Protocols in Supercharged Pedicled Jejunal Esophageal Reconstruction

BackgroundThis study evaluated clinical and patient-reported outcomes (PROs) of long-segment supercharged pedicled jejunal (SPJ) interposition after implementation of a dedicated multidisciplinary pathway and technical refinements. MethodsThis study was a 6-year review of consecutive patients who underwent complex esophageal reconstruction with SPJ interposition. Clinical data were abstracted, and PRO data were collected prospectively by using the Upper Digestive Disease mobile application (UDD App). This standardized questionnaire comprised domains for mental and physical health, pain, dysphagia, reflux, hypoglycemia dumping, and gastrointestinal dumping symptoms. Operative refinements were comprehensively established by 2018. ResultsA total of 19 patients were included in the study, 15 of whom had a history of esophageal malignant disease and neoadjuvant chemoradiation. Most patients (18; 95%) underwent delayed reconstruction after diversion. There was no 90-day mortality or flap loss. Most patients (18; 95%) achieved an enteral diet. Seven patients (37%) experienced early complications (<90 days) requiring procedural intervention. The incidence of any medical or surgical complication was similar in the earlier (2015-2017) and late (2018-2020) cohorts, but aspiration events, surgical site infections, anastomotic leak rates, and median hospital stay (reduced from 15 days [IQR, 10-21 days] to 9 days [IQR, 9-13 days]) improved in the contemporary cohort. PRO data were collected in 14 of 15 (93%) living patients. Severe symptoms in at least 1 domain were reported by most patients (11; 79%) and improved over time. ConclusionsDedicated care pathways allow standardization of complex procedures, and targeted modifications may optimize recovery and patient outcomes. This cohort of patients may report severe symptoms that require ongoing monitoring and intervention.

Clinical and nutritional characteristics on overall survival impact in patients with gastrointestinal cancer.

Weight loss is present in most cancer patients, being even more frequent in gastrointestinal tract tumors (GIT). Malnourished patients may be at greater toxicity risk during treatment, which may interfere with survival. Tumor-triggered hypercatabolism can lead to impaired nutritional status. In addition, other factors such as the presence of nutritional impact symptoms (NIS) can lead to decrease food consumption, influencing weight loss. The purpose of this study was verify nutritional status and understand which factors are related to survival and weight loss in patients with gastrointestinal tract cancers. This study is a retrospective cross-sectional, with data collected from patient's medical records with the gastrointestinal tract cancers, between the years 2012-2019. Data were classified of tumor location, disease staging, weight change, number of nutritional impact symptoms and diet at the treatment beginning. Survival was calculated using the start of treatment and death dates. A total of 388 medical patient's records were analyzed, most of which presented weight loss (82.5%) with an average weight loss of 9.0kg representing 12.2% of body weight. The main NIS presented by the patients were dry mouth, abdominal pain, constipation and esophagitis. According to predetermined groups, the highest weight loss percentages were for patients with stomach and pancreatic cancer, Stage 4, the presence of 3 or more NIS and enteral diet. The lowest survival and highest death risk were observed at the univariable analysis to patients that have the presence of 3 or more NIS 8.3 months and HR 1.51 (IC95% 1.1-2.1) and to the multivariable analysis, for patients with pancreatic cancer 4.8 months HR 3.13 (IC95% 1.9-5.2), stage IV 9.8 months and HR 4.8 (IC95% 1.7-13.2). Tumor location, cancer stage and the presence of nutritional impact symptoms influenced weight loss and survival of oncologic patients.

Analysis of Macro Nutritional Substances, Branched-Chain Amino Acids, Viscosity Enteral Formula for Hepatic Cirrhosis Patients

Patients with hepatic impairment are particularly at risk of malnutrition because of impaired absorption, hypermetabolism, and poor oral intake. Enteral diet therapy based on pumpkin and soybean flour is one of the local foods functional as an alternative enteral formula for patients with liver cirrhosis because it contains high Branched-Chain Amino Acids (BCAA) and Medium-Chain Triglyceride (MCT). The purpose of this study was to analyze the nutritional value (proximate test), BCAA test (Leucine, Isoleucine, Valine) and Viscosity Test (thickness) and organoleptic test of enteral formulas of patients with liver cirrhosis from pumpkin and soybean flour. This descriptive qualitative research method uses three levels of treatment, comparison of pumpkin with soybean powder. The characteristics analyzed are macronutrients (energy, protein, fat, carbohydrates), BCAA (leucine, isoleucine, valine), viscosity. Statistical analysis with One Way Anova and organoleptic test with a hedonic method. The macronutrient content analysis following the diet's requirements and principles was enteral formula two at a relative concentration (80:20). The statistical test results showed a p-value of 0.000 (&lt;0.05), which means a significant difference in the content of leucine, isoleucine, and valine in the three enteral formulas. Increasing the ratio of pumpkin tends to increase the viscosity of the enteral cirrhosis formula. The enteral formula has characteristics per 1000 ml as follows: 38 grams of protein, 161.1 grams of carbohydrates, 25.2 grams of fat, 1023 kcal of energy, 5743.43 mg of BCAAs, and the results of the organoleptic test selected for the enteral formula 2.

Sindrome de Silver-Russell: relato de caso

Objective: Silver-Russell syndrome (SRS) is a rare but well-recognized condition associated with classic phenotypic characteristics. This article aims to describe a patient with SRS, in order to help professionals in the diagnosis and adequate therapeutic management, since the early approach results in a better prognosis. METHODS: This is a case report of a male child, 1 year and 4 months old, admitted to an infirmary, who was diagnosed with SRS. Patient information was collected with the family during hospitalization. Analysis of medical records and literature review was also performed. RESULTS: A patient with chronic malnutrition, who had macrocranial physical examination, elongated facies, large ears with low implantation, occipital capillary rarefaction, micrognathia, hypospadias, 5th finger clinodactyly and delayed developmental milestones, received a diagnosis of SRS during hospitalization. Complementary exams ruled out pathologies of the gastrointestinal tract and in the speech-language evaluation, swallowing disorders were not detected. An enteral diet for nutritional recovery was initiated, but the patient maintained insufficient weight gain and an important food aversion, being the patient submitted to gastrostomy. On an outpatient return after hospital discharge, the patient remained low weight gain despite the use of hypercaloric formula and appropriate volume for his age. CONCLUSION: SRS leads to a wide spectrum of abnormal physical characteristics and functional abnormalities. Multidisciplinary monitoring and early, specific intervention are necessary for better management of this group of patients.

A preliminary study of environmental risks: application of an enteral diet manipulation center

A preliminary study of environmental risks: application of an enteral diet manipulation center

Quality of Life of Cancer Patients Receiving Enteral Nutrition: A Systematic Review of Randomized Controlled Trials.

Most studies confirm the beneficial effects of enteral nutrition on the quality of life, but some studies indicate an inverse association and its detrimental impacts. However, there are insufficient data on the effects of enteral nutrition on the quality of life of cancer patients. This systematic review aimed to describe the influence of applied enteral nutrition on the quality of life of cancer patients, based on the results of randomized controlled trials. It was registered in the PROSPERO database (CRD42021261226) and conducted based on the PRISMA guidelines. The searching procedure was conducted using the PubMed and Web of Science databases, as well as Cochrane Library, and it included studies published until June 2021. It was conducted to select randomized controlled trials assessing the influence of enteral nutrition (compared with the other model of nutrition) on the quality of life of cancer patients. A general number of 761 records were screened and a final number of 16 studies were included in the systematic review. The studies were included and assessed by two independent researchers, while the risk of bias was analyzed using the Newcastle–Ottawa Scale (NOS). Studies compared patients treated with and without enteral nutrition, patients treated with various methods of enteral nutrition or with enteral diets of various content, as well as patients treated with enteral and parenteral nutrition. Within the included studies, the majority were conducted in patients with cancers located in various parts of the body, or diverse areas within the gastrointestinal system, while some studies were conducted in specific populations of patients with a defined cancer location—esophagus, stomach, or ovary. The duration of applied enteral nutrition within the included studies was diversified—from two weeks or less to half a year or even more. The vast majority of studies used well-known and validated tools to assess the quality of life, either developed for a specific group of head/neck, esophagus/stomach, and ovary cancer patients or developed for more general patient populations. Most studies concerning patients treated with and without enteral nutrition supported applying enteral nutrition, which was concluded in seven studies out of ten (including four studies with a low risk of bias). The other important observations to be emphasized—formulated based on the studies with a low risk of bias—presented the role of oral supportive nutrition guided by a dietitian, as well as the beneficial role of enteral and parenteral nutrition, combined. In spite of a relatively low number of randomized controlled trials assessing the influence of enteral nutrition on the quality of life of cancer patients, which should be considered as a limitation, the results were promising. Most studies supported the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.

Effect of enteral nutrition with eicosapentaenoic acids for prevention of bedsores in cerebrovascular disease patients

Rationale: In cases with severely impaired consciousness due to cerebrovascular diseases, patients must go through therapy under hospitalization for several days, and are at risk of bedsores due to long-term bed rest during thrapeutical period. If bedsores could be prevented by feeding an enteral diet enriched with EPA, it can be supposed that this diet therapy might make a contribution to improvement of aspects of clinical care and reduction of clinical costs.

Macronutrients and fatty acids of enteral diets: A comparison between labels and analytical findings

The present study evaluated the parameters of the nutritional quality of fatty acids and macronutrients in ten industrial enteral formulas. The results obtained were compared with those reported on the food labels. Two samples presented lower total protein contents compared to the values reported by the manufacturers. Four samples presented relatively higher carbohydrate contents – between 128 and 177 %, compared to the values reported on the labels. Four other samples exhibited relatively lower total lipid contents – between 65 and 68 %, as opposed to the values reported on the label. The caloric density values obtained were within the established tolerance limits. The contents of saturated fatty acids (SFA) in six formulas exceeded the values indicated on the labels; furthermore, the contents of monounsaturated fatty acids (MUFA) found in four formulas were lower than the values reported on the labels, while seven samples recorded lower contents of polyunsaturated fatty acids (PUFA) compared to the labels reported values. Only 30 % of the formulas presented all the parameters of macronutrients as reported on the labels. The discrepancy between the values obtained in the experiments and the values reported on the labels points to the need for stringent supervision of the actual composition of enteral formulas administered to individuals with specific nutritional needs who may have their clinical outcomes compromised by the intake of inadequate contents of fatty acids and macronutrients that differ from the contents prescribed in the Intensive Care Unit (ICU), in the outpatient clinic, or at home.