Small Amount of Low-Residue Diet with Parenteral Nutrition Can Prevent Decreases in Intestinal Mucosal Integrity

Abstract

ObjectiveTo investigate the suitable combination ratio of low-residue diet (LRD) and parenteral nutrition (PN) for nutritional support of surgical patients. Summary Background DataBacterial translocation (BT) is a severe complication of total parenteral nutrition (TPN). However, it is sometimes impossible to supply sufficient amounts of nutrients to surgical patients by the enteral route. The authors reported previously that concomitant use of LRD with PN provided preferable nutritional support for patients undergoing surgery for colorectal cancer. MethodsNinety male Donryu rats were used for three experiments. In experiment 1, rats were divided into two groups to receive TPN or total enteral nutrition with LRD. In experiment 2, rats were divided into six groups, receiving variable amounts of LRD. In experiment 3, rats were divided into five groups to receive isocaloric nutritional support with variable proportions of PN and LRD. Intestinal permeability was assessed by monitoring urinary excretion of phenolsulfonphthalein. BT was assessed in tissue cultures of mesenteric lymph nodes and spleen. ResultsIn experiment 1, increases in intestinal permeability and BT were observed in rats maintained on 7-day TPN, but not in those maintained on total enteral nutrition for up to 14 days. In experiment 2, the changes in body weight of rats were correlated with the dose of LRD. However, the intestinal permeability was increased only in rats receiving LRD at 15 kcal/kg per day. In experiment 3, additive LRD corresponding to 15% of total caloric intake prevented increases in intestinal permeability and BT. ConclusionCombined nutritional therapy consisting of PN and small amounts of LRD can provide better nutritional support than TPN for surgical patients.

Effects of Combined Nutritional Therapy on Acute Necrotizing Pancreatitis in Rats in the Early Phase of the Disease

“…Previous studies with rats of the same strain, approximate age, and weight had shown that the average ad libitum intake was 240-300 kcal/kg/day [8,15]. In our study we used 240 kcal/kg/day, and 80% of the total caloric need (192 kg/day) was given through the parenteral route, and the remainder, 20% of the total need (48 kcal/kg/day), by the enteral route [11].…”

“…Although the parenteral route for nutritional support improves the nutritional status of the patients, it can be complicated by bacterial translocation leading to systemic inflammatory response syndrome [10]. On the other hand, enteral nutrition improves the nutritional status and decreases septic complications by improving intestinal mucosal integrity, but the establishment and maintenance of an enteral path in patients with severe pancreatitis may be problematic and it may be difficult to achieve the appropriate nutrient delivery in the early period because of impaired upper gastrointestinal motility [7,[10][11][12]. A combination of enteral and parenteral nutrition is therefore a reasonable way to meet the metabolic demands of these patients.…”

“…The amount of the nutrients delivered parenterally can be progressively reduced as the patients become able to tolerate appropriate amounts of food enterally. Recently combined nutritional therapy (CNT), consisting of parenteral nutrition and small amounts of enteral diet, has been reported to be an appropriate form of nutritional support which improves the integrity of the intestinal mucosa in surgical patients [11,12].…”

Oral nutrition for left‐sided malignant colonic obstruction after decompression with a transanal drainage tube: A case series of 6 patients

“…Combined nutritional therapy consisting of PPN and a small amount of an LRD can prevent decreases in intestinal mucosal integrity and provide better nutritional support than TPN for surgical patients 19. In our cases, nutritional evaluation showed an increase in the PNI after correction of dehydration in 5 of the 6 patients.…”

Bowel Necrosis Associated With Early Jejunal Tube Feeding

“…22,29 The supplementation of fibers to the enteral feedings may prevent overgrowth of pathogenic bacteria and septic complications; however, its role on the gastrointestinal motility and susceptibility to bowel ischemia is still unknown in the clinical setting. [30][31][32] The clinical presentation of feeding-related bowel ischemia is very nonspecific: early signs and symptoms include bloating, crampy pain, and loss of bowel sounds. Late in the course, massive abdominal distention, paralytic ileus, pneumatosis intestinalis, and transmural bowel necrosis may develop; the progression of the clinical course mimics septic shock with possible progression to multisystem organ failure.…”