Enteral and parenteral nutrition: evidence-based approach

• Published in: Proceedings of the Nutrition Society Vol. 60; no. 3; pp. 399 - 402
• Main Author: Jeejeebhoy, Khursheed N.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.08.2001
• Subjects: Atrophy; Critical Illness - therapy; Crohns disease; Digestive System - microbiology; Digestive System Physiological Phenomena; Energy; Enteral nutrition; Enteral Nutrition - standards; Evidence-Based Medicine; Hospitalization; Humans; Hyperglycemia; Intensive care; Malnutrition; Morbidity; Mortality; Nutrition; Pancreatitis; Parenteral nutrition; Parenteral Nutrition, Total - adverse effects; Parenteral Nutrition, Total - methods; Parenteral Nutrition, Total - standards; Remission (Medicine); Sepsis; Symposium on ‘Evidence-based nutrition’; Translocation; Treatment Outcome; Enteral nutrition; Total parenteral nutrition
• ISSN: 0029-6651; 1475-2719
• DOI: 10.1079/PNS2001103

Nutrition support for patients in hospital has become an essential form of therapy. Total parenteral nutrition (TPN) was the preferred way of giving nutrition to hospital patients for many years but enteral nutrition (EN) is now the preferred route. EN is believed to promote gut function and prevent translocation of intestinal bacteria, thus reducing the incidence of sepsis in critically ill patients. In consequence, the use of TPN has been discouraged as a dangerous form of therapy. Critical review of the data suggests that in the human subject TPN does not cause mucosal atrophy or increase translocation of bacteria through the small intestine. However, overfeeding, which is easy with TPN, can explain the results of studies which have shown that TPN increases sepsis. Furthermore, the risks of TPN-induced complications have been exaggerated. When there is risk of malnutrition and EN is not tolerated, or there is gut failure, TPN is an equally effective and safe alternative.