Enteral Nutrition In Adults Research Articles

Preoperative Crohn's Disease Exclusion Diet and Exclusive Enteral Nutrition in Adults with Crohn's Disease: A Feasibility Randomised Controlled Trial.

Preoperative exclusive enteral nutrition (EEN) improves nutritional status, reduces intestinal inflammation, and likely improves surgical outcomes. Crohn's disease exclusion diet with partial enteral nutrition (CDED) also reduces intestinal inflammation but its safety preoperatively is unknown. This single-blinded, multicentre, randomised controlled trial of three preoperative nutritional therapies aimed to assess the feasibility of recruiting and retaining patients and collecting primary and secondary effectiveness outcomes. Adults undergoing elective Crohn's disease surgery with a body mass index (BMI) > 18.5 kg/m2 and without significant weight loss were eligible to participate. Patients were randomly assigned to six weeks of preoperative EEN, CDED, or standard care. Feasibility, nutritional, radiological, and surgical outcomes were recorded. Over 18 months, 48 patients were screened, 17 (35%) were randomised, and 13/17 (76%) patients were retained in the intervention phase. It was feasible to collect primary and secondary effectiveness data; at day 30, three patients had Clavien Dindo Grade 2 complications, and 10 had no complications. Nutritional therapy adherence of patients retained in the study was high. Recruitment and retention of patients who need elective Crohn's disease surgery for preoperative nutritional therapy is possible, although a shorter duration may improve EEN completion. The impact on surgical outcomes should be assessed in a larger study.

P1207 Microbiome composition determines sustained remission after the Crohn’s Disease Exclusion Diet (CDED) with or without Partial Enteral Nutrition in adults with mild-moderate Crohn’s disease; Results from the CDED-AD Pilot Randomized Controlled Trial

Abstract Background The Crohn's Disease (CD) Exclusion Diet (CDED) is an established dietary therapy for children with active mild-to-moderate CD. A recent randomized controlled trial showed efficacy in mild-to-moderate CD in adults. We have previously demonstrated the impact of CDED on the microbiome of children. The aim of this work was to assess if we can determine sustained clinical remission (SCR) from the baseline microbiome composition and examine the effect of CDED on microbiome composition in adult CD. Methods This was an open-label, prospective, randomized, controlled pilot trial involving patients with mild-to-moderate CD and evidence of active inflammation. Patients were randomly assigned to receive CDED with partial Enteral Nutrition (PEN) or CDED alone, both for 24 weeks. The V4V5 region of the 16S rRNA gene was amplified and sequenced, and reads were processed using QIIME2 and the SILVA database. Relationships between the microbiome, SCR, and Fecal Calprotectin (FC) were analyzed using logistic regression, Poisson Principal Component Analysis, paired T-Tests and subsampling ranking forward selection. Results Clinical remission (CR) at weeks 6, 12 and 24 was achieved in 62.5%, 52.5%, and 50% of patients, respectively. Week 0, 6, 12 and 24 stool samples were available for 35,32,30 and 26 patients, respectively. In patients with SCR, defined as remission at both weeks 12 and 24, the baseline microbiome revealed lower alpha diversity compared to those without SCR (p=0.018), and differing Microbiome principal components (PC) scores (p < 0.01). PC1 and PC3, characterized mainly by Alistipes, Faecalibacterium and UCG-002 predicted SCR (P<0.01). PC2 predicted elevated FC>250 µg/g at week 12 (p=0.004). Baseline abundance of Haemophilus was associated with decreased SCR probability (p<0.01). At week 6 in the entire cohort, there was a significant decrease in Actinobacteriota (p=0.035) and a significant increase in Bacteroidota (p=0.003). Additionally, there was a significant increase in several genera, including beneficial Alistipes and Oscillibacter (p<0.02) in those who achieved CR after 6, 12, or 24 weeks. Higher Firmicutes at week 6 were associated with FC<250 at week 12 (p=0.031). An uncultured genus from the Oscillospiraceae family was significantly associated with a decrease in the probability of SCR (p<0.01) and was significantly increased at week 6 in patients who did not attain CR (p<0.05). Conclusion The baseline microbiome composition was associated with SCR and FC<250 at week 12 in adult patients treated with CDED (with or without PEN) over 24 weeks. This suggests that the microbiome could be useful tool to identify patients who would benefit from long-term dietary intervention.

Lessons from an audit of exclusive enteral nutrition in adult inpatients and outpatients with active Crohn’s disease: a single-centre experience

ObjectiveTo evaluate clinical outcomes, patterns of use, tolerance and nutritional outcomes of exclusive enteral nutrition (EEN) in adults with Crohn’s disease and to compare initiation in the inpatient compared with...

Modified Delphi in adapting a tool to assess the level of knowledge and practice on adult enteral nutrition therapy among nurses

Background: Enteral nutrition (EN) is the preferred method of nutritional administration for critically ill patients according to the world’s standards. Nurses have a key role in delivering EN and assessing nurses’ knowledge and practice on this, are crucial for maintaining quality nursing care. Aims and Objectives: This study was to utilize modified Delphi in adapting a tool to assess the level of knowledge and practice on adult EN therapy among nurses in Sri Lanka. Materials and Methods: A three-round modified Delphi technique (DT) was employed in adapting a research tool to assess nurses’ knowledge and practice according to the nursing and EN guidelines in Sri Lanka. The questionnaire included 34 knowledge assessment items and 41 observational items to assess practice. Eight subject experts were purposively selected to rate each item on a 5-point Likert scale under three subheadings. Consensus defined at 80% agreement and mean ≥3. Mean value <3 was considered for suggested modifications. Experts participated in a final meeting in round 3 to finalize the tool. Results: Response rate was 100% throughout the process. During round 1, 13/34 knowledge items were modified, two were removed, and one item was added. In round 2, four items were modified, and one was removed. From the observational items, 40/41 achieved consensus, one was modified, and a new one was added in round one. One was modified in round 2. All achieved consensus by round three. The final tool contained 32 knowledge items and 42 observational items with test-retest reliability correlations ranging from 0.99 to 0.95. Conclusion: Modified DT was appropriate in achieving judgmental validity through experts’ consensus in adapting a research tool to assess nurses’ knowledge and practices on EN therapy for adult critically ill patients in Sri Lanka.

Home enteral nutrition in adults ‒ results from the north estonia medical centre, 2019‒2020

Rationale: Estonian Health Insurance Fund started reimbursement for home enteral nutrition (HEN) in 2019 and this is the first study of HEN patients in Estonia. The study describes adult HEN patients and HEN service in the North Estonia Medical Centre (NEMC) in 2019‒2020. The aims were: 1) to create HEN electronic database; 2) to describe adult HEN patients´ demographic, health- and service-related factors; 3) to analyze the associations between survival and age, sex, diagnose, body mass index (BMI), type of treatment; 4) to analyze direct costs of HEN service to the healthcare system.

Enteral Nutrition in Adults with Chronic Kidney Disease: Things to Consider

Enteral Nutrition in Adults with Chronic Kidney Disease: Things to Consider

Preoperative enteral nutrition in adults with complicated Crohn's disease: Effect on disease outcomes and gut microbiota

ObjectivesThe use of exclusive enteral nutrition (EEN) in patients with Crohn's disease (CD) before surgical resection can reduce disease activity and improve nutritional status. The mechanism of EEN action is unclear, but it might involve modulation of the intestinal microbiota. The aim of this study was to evaluate the effects (namely changes in gut microbiota) of preoperative EEN in adults with complicated CD referred to surgery. MethodsThis was a prospective study of adult patients with CD referred to surgery. Patients with body mass index <18.5 kg/m2, weight loss >10 %, serum albumin <3 g/dL, or a combination of some or all three, received EEN for ≥2 wk. The effects of EEN on clinical (Harvey–Bradshaw Index [HBI]) and laboratory markers (C-reactive protein [CRP], serum albumin, and fecal calprotectin) and fecal microbiota were analyzed after EEN (before surgery) and 6 mo later. We used 16 S rRNA gene sequencing to determine changes in the fecal microbiota. ResultsFifteen patients were included, of whom 60% were men with a mean age of 45.4 ± 19.1 y. Of those, 10 received EEN. The median duration of preoperative EEN was 41.5 d (15–70 d). During EEN, there was a significant reduction in mean HBI (8.7 ± 1.9 versus 4.1 ± 2.4; P = 0.001) and CRP (11.7 ± 10.3 versus 0.8 ± 0.8 mg/dL; P = 0.008) and an increase in serum albumin (3.1 ± 0.6 versus 4 ± 0.6 g/dL; P = 0.022). Two patients did not require surgery after EEN. The overall microbial composition changed after EEN (Permutational analysis of variance test, P = 0.046) and there was a significant reduction in α diversity (8 ± 2.3 versus 5.2 ± 1.5; P = 0.023). EEN significantly changed the relative abundance of 11 taxonomic operational units (OTUs). At the family level, we found this was mainly due to the decrease in the Enterobacteriaceae family (7 OTUs). Six months after surgery, α diversity was not different from that before or after EEN; at this time point 6 OTUs were significantly different, mainly due to the decrease of Clostridiales order (3 OTUs). The incidence of postoperative complications and hospital length of stay were similar in EEN and immediate surgery groups, as well as clinical and endoscopic recurrence rates 6 mo after surgery. ConclusionsPreoperative EEN improved disease activity and nutritional status in patients with CD referred to surgery. Despite being malnourished, patients given EEN did not have increased postoperative complications compared with well-nourished patients. During EEN, overall microbiota composition changed and α diversity decreased. EEN did not influence postoperative recurrence and gut microbiota 6 mo after surgery.

Compliance with pathway for confirmation of the position of nasogastric tubes for enteral nutrition in adults

Category: Other.

Benefits of Exclusive Enteral Nutrition in Adults With Complex Active Crohn’s Disease: A Case Series of 13 Consecutive Patients

Abstract Background and Aims Immunosuppressive therapy is routine for adults with complex active Crohn’s disease (CD), however carries risks, particularly in the setting of sepsis. Exclusive enteral nutrition (EEN) is widely used in paediatric CD, yet efficacy data in adults are sparse. This study evaluated outcomes of EEN in adults with complex active CD. Methods Between December 2016 and June 2018, 13 patients with complex active CD (range 20–74 years) managed at a single hospital received 2 or more weeks of EEN. Patients were offered EEN based on either malnutrition, contraindication to immunosuppression, or CD refractory to multiple therapies. Subjective and objective outcomes were recorded at 2 and 6 weeks and compared with baseline data. Results Nine of 13 patients experienced subjective improvement in wellbeing. Objective improvements included nine CRP decrements (median = 87.7 mg/L, IQR = 70.6 mg/L), nine serum albumin increments (median = 7 g/L, IQR = 4 g/L), and six gained weight (median = 3.6 kg, IQR = 3.0 kg). All five patients with complex abscess resolved without surgery. One ileocolic fistula and one enterocutaneous fistula achieved resolution without surgery. One of two perianal fistulae cases resolved without surgery. Seven of 10 patients initially thought to need surgery avoided it due to disease resolution. Only one of the three patients who proceeded to surgery sustained a post-operative complication. There were no EEN-associated complications. Conclusions In complex active CD, our real-world data show that EEN improves wellbeing, decreases inflammatory markers, leads to healthy weight gain, reduces need for surgical intervention, and reduces postoperative complications.

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease.

Background and AimExclusive enteral nutrition (EEN) is progressively being used as a therapeutic option for adults with Crohn's Disease (CD); however, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care that can be used as a benchmark practice and will provide direction for future research.MethodsA working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified.ResultsAn optimal care pathway for using EEN in adults with CD was developed with six key consensus statements on how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment, enteral prescription and duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed.ConclusionEEN is recommended as a treatment option to induce remission in adults with active CD. The consensus statements developed are practical and are based on best available evidence and expert opinion to assist in developing a standardized approach to delivering EEN therapy.

P521 Pre-operative enteral nutrition in adults with Crohn’s disease: effect on gut microbiota and disease outcomes

P521 Pre-operative enteral nutrition in adults with Crohn’s disease: effect on gut microbiota and disease outcomes

Enteral nutritional therapy for induction of remission in Crohn's disease.

Enteral nutritional therapy for induction of remission in Crohn's disease.

Iodine Content of Enteral and Parenteral Nutrition Solutions

Iodine is essential for thyroid hormone synthesis, and iodine deficiency may result in thyroid disorders including goiter and hypothyroidism. Patients on long-term enteral nutrition (EN) or parenteral nutrition (PN) may be at risk for micronutrient deficiencies. The recommended daily allowance for iodine intake is 150 μg for nonpregnant adults. However, there is no current consensus among scientific societies regarding the quantity of iodine to be added in adult EN and PN formulations. The objective of this study was to determine the iodine content of U.S. adult enteral and parenteral nutrition solutions. This study also aimed to determine whether adult patients in the United States who are receiving long-term artificial nutrition may be at risk for iodine deficiency. Ten enteral nutrition solutions and 4 parenteral nutrition solutions were evaluated. The iodine contents of these solutions were measured spectrophotometrically and compared to the labeled contents. Measured and labeled EN iodine contents were similar (range 131-176 μg/L and 106-160 μg/L, respectively). In contrast, PN formulas were found to contain small, unlabeled amounts of iodine, averaging 27 μg/L. Typical fluid requirements are 30 to 40 mL/kg/day for adults receiving either total EN (TEN) or total PN (TPN). Adults on long-term TEN likely consume enough servings to meet their daily iodine requirements. However, patients on long-term TPN would require on average 5.6 L PN/day to meet the recommended daily allowance of iodine. This volume of PN is far in excess of typical consumption. Thus, U.S. patients requiring long-term TPN may be at risk for iodine deficiency. EN = enteral nutrition; PN = parenteral nutrition; TEN = total enteral nutrition; TPN = total parenteral nutrition; UIC = urinary iodine concentration.

Sa1937 - Exclusive Enteral Nutrition in Adults with Active Crohn's Disease is Associated with Decreased Disease Activity

Sa1937 - Exclusive Enteral Nutrition in Adults with Active Crohn's Disease is Associated with Decreased Disease Activity

P612 Exclusive enteral nutrition in adults with active Crohn's disease is associated with decreased disease activity

P612 Exclusive enteral nutrition in adults with active Crohn's disease is associated with decreased disease activity

Feasibility and results of pull-percutaneous endoscopic gastrostomy for enteral nutrition in adults with severe cerebral palsy

Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP. We performed a retrospective study of 26 consecutive severe adult (age: 28 [19-48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6-64] months) at the same tertiary hospital centre. The procedure was a technical success for 19 patients (BMI: 13.8 [10.7-21.4]) with (n=11) or without (n=8) previous respiratory disorder. Indications were mainly swallowing disorders (n=14) and inadequate oral intake (n=8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1-8.8]kg (P<0.01). Quality-of-life assessed by relatives and the healthcare team was improved in 13/16 and 13/15 cases respectively. AEs and outcomes did not differ significantly with previous respiratory disorder or nutritional status. PEG tube placement is feasible in adult CP, although the risk of failure is increased by anatomical specificities. Previous respiratory disorders and undernourishment did not increase AE rates or modify outcomes. There were positive changes over time for nutritional status and perceived quality-of-life, but no neurological improvement.

Current practice in relation to nutritional assessment and dietary management of enteral nutrition in adults with Crohn's disease

Nutritional assessment and dietary intervention, particularly enteral nutrition, are important in the management of Crohn's disease (CD). National audits have reported that dietetic resourcing in gastroenterology is inadequate. The present study aimed to identify current practice in the nutritional assessment and dietary management of enteral nutrition in CD, as well as investigate the factors that influenced it. A nationwide questionnaire survey adopting complete population sampling of all 296 U.K. acute hospitals was undertaken aiming to determine dietetic resourcing for gastroenterology. In addition, the case-note review method was used to investigate approaches to nutritional assessment and dietary management of enteral nutrition as treatment for active CD. Data were returned from 149 (56%) hospitals, providing assessment and management information on 190 patients. The median number of dietetic sessions dedicated to gastroenterology was 2 per week (interquartile range 4). Hospitals with five or more sessions per week dedicated to gastroenterology used a greater number of components in their nutritional assessment [mean (SD) 21.5 ( 5.0)] than those with fewer sessions [mean (SD) 19.6 (SD) 6.1, P = 0.05]. Enteral nutrition was perceived to be effective in 100 (55%) of 182 patients. The major reasons for limited success were poor compliance and inadequate volumes consumed, as well as insufficient treatment duration. The components included in a nutritional assessment of CD patients are significantly lower in hospitals with fewer dietetic gastroenterology sessions. Focus on improving compliance and duration of enteral nutrition is urgently required to maximise the success of enteral nutrition in the treatment of CD.

Use of exclusive enteral nutrition in adults with Crohn’s disease: A review

Exclusive enteral nutrition (EEN) is well-established as a first line therapy instead of corticosteroid (CS) therapy to treat active Crohn's disease (CD) in children. It also has been shown to have benefits over and above induction of disease remission in paediatric populations. However, other than in Japanese populations, this intervention is not routinely utilised in adults. To investigate potential reasons for variation in response between adult studies of EEN and CS therapy. The Ovid database was searched over a 6-mo period. Articles directly comparing EEN and CS therapy in adults were included. Eleven articles were identified. EEN therapy remission rates varied considerably. Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies. Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease. There was limited evidence to determine if disease location, duration of disease or age of diagnosis affected EEN therapy outcomes. There is some evidence to support the use of EEN as a treatment option for a select group of adults, namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD. In addition, the use of more palatable formulas could improve treatment compliance.

Topic 8 成人における経口摂取と経腸栄養

Topic 8 成人における経口摂取と経腸栄養

Home enteral nutrition in adults: A five-year (2001–2005) epidemiological analysis

In the last twenty years Home Enteral Nutrition (HEN) has undergone considerable development and has determined economic and organisational changes. The aim of this study is to evaluate the epidemiological data of 655 patients treated in the five-year period (2001-2005) in an area in the North-East of Italy. The following data were analysed at the initiation of HEN: age, sex, pathology, Karnofsky index, type of enteral access device, presence of pressure ulcers, weight, body mass index, haematochemical tests, daily enteral intake. Length of therapy and patient survival were then considered. The outcome was based on patient mortality and the patient's ability to resume oral nutrition. HEN was prescribed for the following pathologies: 26.7% neurovascular, 40.9% neurodegenerative, 11.5% head-neck cancer, 9.8% abdominal cancer, 1.5% head injury, 2.6% congenital anomaly, 7.0% other pathologies. Before commencement of enteral feeding an average of 22.9% weight loss from past weight was observed across all indications for HEN. Mean incidence (cases/10(6) inhabitants/year) and prevalence (cases/10(6) inhabitants) were respectively 308.7 (range 80.7-355.6) and 379.8 (range 138.7-534.6). The median length of HEN was 196 days; only 7.9% of patients resumed oral nutrition. The median survival rate was 9.1 months and resulted influenced by age (Odds ratio: 1.80; 95% Confidence Interval: 1.19-2.72), sex (0.22; 0.08-0.59), and Karnofsky index (0.65; 0.43-0.97). Resumption of oral nutrition was influenced by age (0.50; 0.36-0.68), sex (2.50; 1.23-5.06), Karnofsky index (1.55; 1.15-2.10) and type of enteral access device (0.44; 0.26-0.76). Efficient organisation means being able to look after a greater number of patients undergoing HEN, raising awareness regarding the nutritional treatment.