Early postoperative feeding with elemental diet.

Sagar, Sushma; Harland, P. S. E. G.; Shields, R.

doi:10.1136/bmj.1.6159.293

Cited by 184 publications

(61 citation statements)

References 12 publications

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“…However, EN is favored to preserve gut integrity 56,60,64 and immune markers 55,57,61,63 and to simplify glycemic management. 56,59 Similarly, the majority of studies comparing EN to SOD [65][66][67][68][69] indicate no benefit of EN over SOD with respect to morbidity 65,66,68,69 and mortality. 65,66,68,69 The evidence does not indicate improved outcomes with routine use of NST in all patients undergoing major cancer operations.…”

Section: Practice Guidelines and Rationalesmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

August

Huhmann

2009

J Parenter Enteral Nutr

441

279

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Section: Practice Guidelines and Rationalesmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

August

Huhmann

2009

J Parenter Enteral Nutr

441

279

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“…Although two of the studies did show that such feedings were associated with differences in duration of hospitalization, these differences were in opposite directions; shorter stays were seen in the treated group in one trial 52 and in the control group in the other. 55 No differences were found in the other ®ve trials reporting this outcome.…”

Section: ±60mentioning

confidence: 93%

Nutritional support

Ofman

Koretz

1997

Aliment Pharmacol Ther

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Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoper‐ative parenteral nutritional support may produce a small absolute reduction in post‐operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6‐mercaptopurine as the next modality in steroid failures. Branched‐chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease‐associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost‐constrained health care system.

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“…The liquid diets provided no particular advantage over routine bowel preparation. -In fact, in one of these studies the recipients of the elemental diets had more complications and a longer hospital stay.58 Two other trials evaluated the use of these residue free liquid diets as "medical colostomies" in patients undergoing anorectal surgery.59 61' Although there was a reduced analgesic requirement associated with the use of the liquid feeding,j the cost of the diet is greater than the cost of the one additional daily injection.…”

Section: Cancermentioning

confidence: 99%

Nutritional support: how much for how much?

Koretz¹

1986

Gut

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Early postoperative feeding with elemental diet.

Cited by 184 publications

References 12 publications

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

Nutritional support

Nutritional support: how much for how much?

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