When is enteral nutrition indicated?

Bechtold, Matthew L.; Brown, Patricia M.; Escuro, Arlene A.; Grenda, Brandee; Johnston, Theresa; Kozeniecki, Michelle; Limketkai, Berkeley N.; Nelson, Krystie K; Powers, Jan; Ronan, Andrea; Schober, Nathan; Strang, Brian J; Swartz, Cristina; Turner, Justine; Tweel, Lauren; Walker, Renee; Epp, Lisa; Malone, Ainsley

doi:10.1002/jpen.2364

Cited by 36 publications

(53 citation statements)

References 232 publications

(394 reference statements)

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“…However, it is important to recognize the need to follow standardized regimens and consensus recommendations for specific clinical situations or conditions in order to avoid or minimize risks. In a recently published consensus statement by the American Society for Parenteral and Enteral Nutrition's (ASPEN's) EN committee, 19 a number of recommendations were made specifying various clinical indications of EN. Recommendations are based on clinically proven benefits of EN.…”

Section: Introductionmentioning

confidence: 99%

Peptide‐based formula: Clinical applications and benefits

et al. 2023

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The use of enteral nutrition (EN) continues to increase given benefits. However, with this increase in use, it is also becoming evident that enteral feeding intolerance (EFI) is also quite prevalent, leading to the inability to meet nutrition needs in many patients. Given the wide variability in the EN population as well as the number of formulas available, there is not a clear consensus regarding the best approach to EFI management. One approach that is emerging to improve EN tolerance is the use of peptide-based formulas (PBFs). PBFs refer to enteral formulas containing proteins that have been enzymatically hydrolyzed to dipeptides and tripeptides. These hydrolyzed proteins are often combined with higher medium-chain triglyceride content to generate an enteral formula that is essentially easier to absorb and utilize. Emerging data demonstrate that the use of PBF in patients with EFI may improve clinical outcomes along with a corresponding reduction in healthcare utilization and potentially the cost of care. This review aims to navigate through key clinical applications and benefits of PBF and to discuss relevant data shared in the literature.

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Section: Introductionmentioning

confidence: 99%

Peptide‐based formula: Clinical applications and benefits

et al. 2023

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“…With current recommendation no formula type indicated; no difference in formula type (elemental, semielemental, polymeric) or fat content impacted remission rates 72 …”

Section: Discussionmentioning

confidence: 98%

“…Exclusive EN may be an alternative to corticosteroid therapy for inducing but not maintaining remission of CD in adults 72 With current recommendation no formula type indicated; no difference in formula type (elemental, semielemental, polymeric) or fat content impacted remission rates 72 …”

Section: Discussionmentioning

confidence: 99%

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Enteral nutrition product formulations: A review of available products and indications for use

Church

Zoeller

2023

Nut in Clin Prac

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When oral nutrition is not feasible, enteral nutrition (EN) therapy is often considered the preferred route of nutrition support to meet the nutrient needs of individuals with a functional gastrointestinal tract across multiple levels of care (critical care, acute care, and home care). Enteral formulations have progressively evolved over the last 50 years from the simple blending of hospital food thin enough to run through a feeding tube, to the development of commercial standard formulas, followed by specialized formulas with immune-modulating and disease-specific qualities, to the most recent shift to food-based or blenderized EN composed of natural, whole foods with perceived health benefits. With the vast number of enteral formulations on the market, clinicians may be overwhelmed trying to determine proven vs theoretical benefits. This review is intended to explore differences in enteral formulations, identify implications for clinical practice, and review evidencedbased clinical guidelines to assist clinicians in enteral formula selection.

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“…The importance of nutritional management after stroke is well recognized by most relevant guidelines, which generally recommend early screening for dysphagia and malnutrition and the consideration of oral nutritional supplements for patients who are malnourished or at risk of malnourishment ( 50 – 55 ). These recommendations are supported by a recent meta-analysis concluding that impaired nutritional status on admission is associated with poor functional recovery and increased mortality ( 56 ).…”

Section: Discussionmentioning

confidence: 99%

Evident lower blood levels of multiple nutritional compounds and highly prevalent malnutrition in sub-acute stroke patients with or without dysphagia

Wijk

Studer²,

Berg³

et al. 2023

Front. Neurol.

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IntroductionMalnutrition is prevalent after stroke, particularly if post-stroke oropharyngeal dysphagia (OD) reduces nutritional intake. To further understand stroke-related malnutrition, a thorough nutritional assessment was performed in ischemic stroke patients with or without OD during sub-acute inpatient rehabilitation.MethodsIn this exploratory, observational, cross-sectional, multi-center study in Germany (NTR6802), ischemic stroke patients with (N = 36) or without (N = 49) OD were age- and sex-matched to healthy reference subjects. Presence of (risk of) malnutrition (MNA-SF), blood concentration of stroke-relevant nutritional compounds and metabolites, nutritional intake, quality of life (EQ-5D-5L), and activities of daily living (Barthel index) were assessed.ResultsMore than half of the stroke patients displayed (risk of) malnutrition, with higher prevalence in patient with OD vs. without OD. Fasted blood concentrations of vitamins B1, B2, B6, A, D, and E, selenium, choline, coenzyme Q10, albumin, pre-albumin, transferrin, docosahexaenoic acid, and eicosapentaenoic acid were all lower in stroke patients compared to their matched healthy reference subjects, irrespective of OD status. Reported energy, macronutrient, and water intake were lower in stroke patients vs. healthy reference subjects. As expected, quality of life and activities of daily living scores were lower in stroke vs. healthy reference subjects, with OD scoring worse than non-OD patients.DiscussionThis study shows that malnutrition is highly prevalent in sub-acute stroke patients during rehabilitation. Even though patients with OD were more likely to be malnourished, blood levels of specific nutritional compounds were similarly lower in stroke patients with or without OD compared to healthy reference subjects. Furthermore, subgroup analysis showed similarly lower blood levels of specific nutritional compounds in patients that are normal nourished vs. patients with (risk of) malnutrition. This might imply disease-specific changes in blood levels on top of overall protein-energy malnutrition. The results of the current study underline that it is important to screen for nutritional impairments in every stroke patient, either with or without OD.

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When is enteral nutrition indicated?

Cited by 36 publications

References 232 publications

Peptide‐based formula: Clinical applications and benefits

Peptide‐based formula: Clinical applications and benefits

Enteral nutrition product formulations: A review of available products and indications for use

Evident lower blood levels of multiple nutritional compounds and highly prevalent malnutrition in sub-acute stroke patients with or without dysphagia

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