Therapeutic Effect Of Enteral Nutrition Research Articles

Clinical Evaluation of Enteral Nutrition + Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective: To evaluate the therapeutic effect of enteral nutrition + probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury. Methods: From September 2018 to February 2023, 80 patients (20–82 years old) with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study. Their primary condition was severe craniocerebral injury, and all of them received conventional symptomatic treatment. Group A received enteral nutrition + probiotic therapy, whereas group B received enteral nutrition only. The differences in the following indicators were compared before and after treatment: nutritional and biochemical indicators, gastrointestinal function indicators, Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA), APACHE II score, serum procalcitonin (PCT), neutrophil (N) ratio, and C reactive protein (CRP). Result: The nutritional and biochemical indicators in group A were higher than those in group B, P < 0.05; the time to first passage of flatus, time to first passage of stool, and bowel sound recovery time in group A were shorter than those in group B, P < 0.05; the GCS of group A was higher than that of group B, P < 0.05; the SOFA and APACHE Ⅱ scores of group A were not different from those of group B, P > 0.05; and the PCT, N ratio, and CRP levels of group A were lower than those of group B, P < 0.05. Conclusion: In patients with gastrointestinal dysfunction after severe craniocerebral injury, enteral nutrition + probiotic therapy is highly effective and feasible, as it can optimize various nutritional indicators, shorten the gastrointestinal function recovery time, and reduce the body’s stress response.

Octanoic Acid-rich Enteral Nutrition Alleviated Acute Liver Injury Through PPARγ/STAT-1/MyD88 Pathway in Endotoxemic Rats.

Acute liver injury is the hallmark of organ failure in sepsis. Enteral nutrition (EN) is an important clinical therapeutic measure in septic patients. However, the therapeutic effect of EN alone is not obvious. Here, we investigated whether octanoic acid (OA)-rich EN alleviated acute liver injury through PPARγ/STAT-1/MyD88 pathway in endotoxemic rats. First, rats were randomly divided into four groups: Sham, Lipopolysaccharide (LPS), LPS+EN and LPS+EN+OA groups to investigate the effect of OA-rich EN on LPS-induced acute liver injury in endotoxemic rats. Then rats were randomly divided into five groups: Sham, LPS, LPS+EN+OA, LPS+EN+OA+SR202 (SR) and LPS+ pioglitazone (PI) groups to examine whether OA-rich EN alleviated acute liver injury through the PPARγ/STAT-1/MyD88 pathway. Rats received nutrition support via a gastric tube for 3 days. We evaluated the liver histology, apoptosis, liver enzymes and inflammatory cytokine levels in the liver and serum. PPARγ/STAT-1/MyD88 pathway was also measured. OA-rich EN inhibited the phosphorylation of STAT-1 and the activity of MyD88 by activating PPARγ and alleviating LPS-induced acute liver injury more effectively than EN alone in endotoxemic rats. The use of SR counteracted the effect of OA-rich EN on acute liver injury. Meanwhile, PI showed effects similar to OA-rich EN in endotoxemic rats. OA-rich EN alleviated acute liver injury through PPARγ/STAT-1/MyD88 pathway in endotoxemic rats.

Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children.

Chylothorax is caused by thoracic lymphatic system injury that leads to lymph extravasates in the thoracic cavity. Cardiac surgery was the most common cause. Reports comparing therapeutic effects between enteral nutrition (EN) with medium-chain triglycerides (MCT) and total parenteral nutrition (TPN) are few and inconsistent. Our study aimed to analyze the incidence of chylothorax in children in our hospital and optimum nutritional management modalities. We retrospectively reviewed the medical records of children admitted to our hospital with a diagnosis of chylothorax from 2014 to 2018. We analyzed the incidence of chylothorax, therapeutic effectiveness, and cost effectiveness of EN with MCT or TPN. 136 patients with chylothorax after surgery for congenital heart disease (CHD) were identified from 172 patients with chylothorax (79.07%); chylothorax occurred in 5.62% of all 2420 congenital heart disease surgeries that were performed during that period. Tetralogy of Fallot (TOF), ventricular septal defect (VSD), and double-outlet right ventricle (DORV) were the most common primary diagnoses. Fontan surgery, TOF repair, and VSD repair were the most common primary procedures. We enrolled 45 patients with cured chylothorax. Nutrition support costs in the EN with MCT group (n = 28) were significantly lower than in the TPN group (n = 17) (P = .000). Time to resolution and time to removal of the drainage tube were shorter in EN with MCT versus TPN (P = .003), and the length of hospital stay was shorter (P = .032). There were no significant differences between the 2 groups in time from admission to surgery, postoperative days before diagnosing chylothorax, or length of PICU stay (P > .05). The therapeutic effects of EN with MCT were significantly better than those of TPN, with lower costs. Therefore, we suggest that EN with MCT be chosen first to treat chylothorax caused by surgery with mild chest drainage volume when gastrointestinal tract function is allowed.

Therapeutic Effect of Enteral Nutrition Supplemented with Probiotics in the Treatment of Severe Craniocerebral Injury: A Systematic Review and Meta-Analysis

Whether early enteral nutrition with probiotics can reduce the mortality and infection rate of patients with severe craniocerebral injury (SCI), improve their gastrointestinal function, and shorten the length of stay in the intensive care unit (ICU) has not been determined. PubMed, China National Knowledge Infrastructure, and Embase were electronically searched for the purpose of identifying randomized controlled trials investigated the potential of early enteral nutrition supplemented with probiotics on patients with SCI from the establishment of databases to August 26, 2019. STATA software version 12.0 was used to perform meta-analysis. A total of 39 trials enrolling 3387 patients were included. Early enteral nutrition supplemented with probiotics was associated with decreased risk of infection (pooled risk ratio [RR], 0.486; 95% confidence interval [CI], 0.394-0.599), decreased risk of 7-, 14-, and 28-day mortality (pooled RRs, 0.415, 0.497, and 0.385; 95% CIs, 0.196-0.878, 0.297-0.833, and 0.197-0.751, respectively), and decreased risk of gastrointestinal complications (pooled RR, 0.363; 95% CI, 0.274-0.481). It also shortened the time course recovery of enteral function and shortened the length of stay in hospital and length of ICU stay (standardized mean differences,-3.327 and-1.461; 95% CIs,-6.213 to-0.440 and-2.111 to-0.811, respectively). Enteral nutrition supplemented with probiotics effectively decreases the risk of mortality, gastrointestinal complications, and infection, and shortens the stays in ICU; therefore, it should be extensively adopted to manage these given patients.

The retrospective research of enteral nutrition with medium-chain triglyceride and total parenteral nutrition support of postoperative chylothorax in adults.

Background:Chylothorax is caused by thoracic lymphatic system injuries that leads to the lymph extravasating into the thoracic cavity. There are few reports comparing the therapeutic effects of enteral nutrition with medium-chain triglyceride and total parenteral nutrition, and the results are inconsistent. Our study aimed to research the optimum nutrition support method for chylothorax.Study design:We retrospectively reviewed 35 chylothorax patients after heart and chest surgery from 2014 to 2018, at West China Hospital of Sichuan University, among them there were 27 post-heart surgery patients. We analyzed the therapeutic effects and costs of enteral nutrition with medium-chain triglyceride (E group) and total parenteral nutrition (T group) for chylothorax.Results:The results were similar in patients with all surgeries and patients with only post heart surgery. The total cost during hospitalization in E group was higher than T group (P < 0.01), whereas the nutrition support cost was lower (P < 0.001). The length of hospital stay was longer in E group than T group (P > 0.05). Time from admission to surgery was shorter and from surgery to chylothorax diagnosis was longer in E group compared with T group. Time to resolution and removal of drainage was shorter in E group than T group but the differences were not significant.Conclusion:The therapeutic effects in enteral nutrition with medium-chain triglyceride and total parenteral nutrition had no obvious differences. Moreover, enteral nutrition with medium-chain triglyceride is safer and more economical. Therefore, we suggest that enteral nutrition with medium-chain triglyceride could be the first choice to treat postoperative chylothorax when the gastrointestinal tract function is allowed, and this result could be considered for postoperative chylous ascites.

The Effect of Enteral Nutrition on Intra-Abdominal Pressure in Severe Acute Pancreatitis Patients

Abstract BACKGROUND: To investigate the effect of enteral nutrition (EN) on intra-abdominal pressure (IAP) in severe acute pancreatitis (SAP) patients and the relationship between the decreasion of IAP and the the therapeutic effect of EN. METHODS: Eighty SAP patients were randomly divided into study group and control group (40 patients in each group). Patients in the study group received EN and Patients in the control group received total parenteral nutrition (TPN) for 7 days. Intra-cystic pressure (ICP) of the two groups was measured during treatment period. The outcomes of treatment were observed, APACHE Ⅱ scores, NB data were applied in analysis. RESULTS: The ICP data was lower in the study group than in the control group on days 4 and 5 of treatment (P < 0.05). On days 3-5 of treatment, the APACHE Ⅱ scores of the study group were lower than which of the control group (P < 0.05). Nitrogen balance (NB) date increased significantly in study group than in the control group (P < 0.05). abdominalgia relief...

Therapeutic effect of nasogastric tube and nasointestinal tube enteral nutrition for severe traumatic brain injury

Objective To investigate the therapeutic effect of enteral nutrition in patients with severe traumatic brain injury (sTBI) by nasogastric tube and nasointestinal tube. Methods A retrospective case control study was made on 64 patients with sTBI hospitalized from October 2013 to December 2015. The patients were assigned to nasogastric tube group (n=32) and nasointestinal tube group (n=32) according to the random number table, and the same nutrient solution was given to all patients. Eighteen male and 14 female patients aged (37.8±8.7)years were identified in nasogastric tube group, and the Glasgow coma score (GCS) was (4.7±1.3)points. Twenty males and 14 females aged (39.7±6.5)years were identified in nasointestinal tube group, and the GCS was (4.1±1.2)points. Triceps skinfold thickness, body mass index, hemoglobin, level of serum albumin and level of prealbumin were measured and compared between groups before and after operation. Incidence of complications was recorded as well. Results All the above-mentioned indexes of the two groups did not differ significantly before the therapy (P>0.05), but showed significant differences 7 and 15 days after therapy (P<0.05). Incidence of complications in nasointestinal tube group (17 lung infection, nine gastrointestinal bleeding, 11 electrolyte imbalance) was lower than that in nasogastric tube group (seven lung infection, two gastrointestinal bleeding, one reflux esophagitis, four electrolyte imbalance) (P<0.05). Conclusion Nasointestinal tube enteral nutrition is better than nasogastric tube enteral nutrition in improving nutritional status and reducing complications in patients with sTBI. Key words: Craniocerebral trauma; Enteral nutrition; Nursing care

Review article: evidence‐based dietary advice for patients with inflammatory bowel disease

The therapeutic effect of enteral nutrition in Crohn's disease (CD) and the epidemiological associations between diet and inflammatory bowel disease (IBD) implicate diet in IBD causation. There is little evidence, however, to support specific dietary changes and patients often receive contradictory advice. To review the literature on the impacts of diet on IBD causation and activity to produce guidance based on 'best available evidence'. Review of Medline, Embase and Cochrane databases from 1975 to 2012 using MeSH headings 'crohn's disease' 'ulcerative colitis' 'enteral' 'diet' 'nutrition' 'fatty acid' and 'food additives'. Enteral nutrition with a formula-defined feed is effective treatment for CD, but approximately 50% of patients relapse within 6 months of return to normal diet. There is no direct evidence of benefit from any other specific dietary modification in CD, but indirect evidence supports recommendation of a low intake of animal fat, insoluble fibre and processed fatty foods containing emulsifiers. Foods tolerated in sustained remission may not be tolerated following relapse. Some evidence supports vitamin D supplementation. In ulcerative colitis (UC), evidence is weaker, but high intakes of meat and margarine correlate with increased UC incidence and high meat intake also correlates with increased likelihood of relapse. There is little evidence from interventional studies to support specific dietary recommendations. Nevertheless, people with IBD deserve advice based on 'best available evidence' rather than no advice at all, although dietary intake should not be inappropriately restrictive. Further interventional studies of dietary manipulation are urgently required.

Impact of environmental and dietary factors on the course of inflammatory bowel disease

Besides their possible effects on the development of inflammatory bowel disease (IBD), some environmental factors can modulate the clinical course of both ulcerative colitis (UC) and Crohn's disease (CD). This review is mainly devoted to describing the current knowledge of the impact of some of these factors on the outcome of IBD, with special emphasis on smoking and diet. Although the impact of smoking on the susceptibility to develop CD and UC is firmly established, its influence on the clinical course of both diseases is still debatable. In CD, active smoking is a risk factor for postoperative recurrence. Beyond this clinical setting, smoking cessation seems to be advantageous in those CD patients who were smokers at disease diagnosis, while smoking resumption may be of benefit in ex-smokers with resistant UC. The role of dietary habits on the development of IBD is far from being well established. Also, food intolerances are very frequent, but usually inconsistent among IBD patients, and therefore no general dietary recommendations can be made in these patients. In general, IBD patients should eat a diet as varied as possible. Regarding the possible therapeutic role of some dietary components in IBD, lessons should be drawn from the investigation of the primary therapeutic effect of enteral nutrition in CD. Low-fat diets seem to be particularly useful. Also, some lipid sources, such as olive oil, medium-chain triglycerides, and perhaps omega-3 fatty acids, might have a therapeutic effect. Fermentable fiber may have a role in preventing relapses in inactive UC.

Early therapeutic benefit of enteral nutrition in active Crohn disease

Abstract This study was designed to test the hypothesis that enteral nutrition (EN) provides an early therapeutic benefit in Crohn disease (CD) by improving intestinal barrier functions and decreasing inflammation. Twenty-one adult patients with active CD were enrolled for treatment with total EN therapy for 6 weeks. Serum levels of C-reactive protein, tumor necrosis factor α , interleukin (IL)-1 β , IL-6, diamine oxidase, endotoxin, albumin, prealbumin, fibronectin, and transferrin were measured at baseline as well as on days 3, 7, 14, 21, 28, and 42 after treatment. At each visit, body composition analysis was performed, and Crohn disease activity index was calculated. Significant improvements in inflammatory parameters (C-reactive protein, tumor necrosis factor α , IL-1 β , and IL-6) after 1 week and in intestinal barrier function (diamine oxidase and endotoxin) after 2 weeks were observed. These changes proceeded any significant changes in nutritional parameters (body composition analysis and biological parameters) that occurred after 3 to 4 weeks. This study showed that an early therapeutic effect of EN on active adult CD is attributable to down-regulating systemic and intestinal inflammation rather than nutritional restitution.

Medium- and Long-Chain Fatty Acids Differentially Modulate Interleukin-8 Secretion in Human Fetal Intestinal Epithelial Cells

The primary therapeutic effects of enteral nutrition in patients with Crohn's disease have been reported previously. Although the quantity and type of fat in enteral nutrition are considered to be important, it is unclear how fat modulates mucosal inflammatory responses in the intestine. In the present study, we evaluated the effects of medium-chain and long-chain fatty acids (MCFA and LCFA) on interleukin (IL)-8 secretion in a fetal intestinal epithelial cell line, intestine-407 cells. IL-8 expression was evaluated at the protein and mRNA levels. The activation of nuclear factor-kappaB was assessed with an electrophoretic gel mobility shift assay. The addition of oleic acid (LCFA) micelles, but not octanoic acid (MCFA) micelles, weakly but significantly enhanced basal IL-8 secretion in the intestine-407 cells. The addition of MCFA (5 mmol/L) induced a 40% increase in IL-1beta-induced IL-8 secretion and a 35% increase in tumor necrosis factor (TNF)-alpha-induced IL-8 secretion, respectively. The addition of LCFA (5 mmol/L) induced a 140% increase in IL-1beta-induced IL-8 secretion and a 110% increase in TNF-alpha-induced IL-8 secretion, respectively. These responses were also observed at the mRNA levels. The electrophoretic gel mobility shift assay indicated that both MCFA and LCFA enhanced IL-1beta- and TNF-alpha-induced nuclear factor-kappaB activation. We demonstrated the proinflammatory activities of MCFA and especially LCFA. It is likely that medium-chain triglycerides may be more suitable than long-chain triglycerides as an energy source in enteral diets in the treatment of patients with Crohn's disease.

Fat composition is the differential factor to explain the primary therapeutic effect of enteral nutrition in Crohn's disease. Results of a double-blind, randomized, multicenter european trial

Fat composition is the differential factor to explain the primary therapeutic effect of enteral nutrition in Crohn's disease. Results of a double-blind, randomized, multicenter european trial