Metabolic response to malnutrition: its relevance to enteral feeding.

Abstract

The intestinal tract shares in the response to malnutrition, and the consequent changes in mucosal function determine the ability of the intestine to handle enteral feeds. Such a route for nutritional support is important in protecting intestinal function not only in absorption but also in hormone production. Enteral feeding is increasingly having an important role in the interactions between acute diarrhoeal disease and malnutrition.

Delayed enteral feeding impairs intestinal carbohydrate absorption in critically ill patients*

“…These changes result in an appreciable decrease in absorption of nutrients as part of the end stage of digestion and transport. As a result of decreased energy available for normal enterocytes turnover, migration, and maturation, the intestine can no longer operate optimally as either a digestive organ or an organ of protection (23,26). Although the turnover rate of gastrointestinal tract in rodents is much more rapid than that of the humans (27), a similar relationship between nutritional deprivation and loss of intestinal mass and function has also been observed in humans (11,12).…”

“…This luminal source of energy for enterocytes may be critical for their survival and function, particularly when splanchnic blood flow is often reduced during critical illness (16,29). In rats, intestinal mucosal change correlates best with deprivation of luminal nutrition rather than overall nutritional state (23,26). The reasons for the prolonged mechanical ventilation and ICU stay in patients with delayed feeding are unclear, and our study was not powered adequately to address this.…”

Important Aspects of Nutrition in Children with Cancer

“…Changes of hormonal factors During adaptation to uncomplicated malnutrition, there is an increase in catecholamines, glucagon, cortisol, and growth hormone levels, and a decreased insulin secretion (46). Endocrine disturbances in cancer patients present in contrast to uncomplicated malnourished humans in the form of insulin resistance and as elevated secretion of growth hormone (47,48).…”

Intestinal IMINO transporter SIT1 is not expressed in human newborns

“…The amniotic fluid contains amino acids, carbohydrates, and growth factors and provides about an eighth of the fetus' nutritional need (9). The importance of luminal stimuli for the maturation of the intestine has been shown by several studies where the proximal intestine was obstructed experimentally (16,31), as well as in patients receiving total parenteral nutrition (25). For instance, experimental esophageal ligation has been shown to decrease somatic growth, small intestinal villus height, and small intestinal nutrient transport (6,9).…”