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Update of Enteral Nutrition

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 August 2019) | Viewed by 45241

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Special Issue Editors

Prof. Dr. Carmina Wanden Berghe

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Guest Editor

University General Hospital of Alicante - Institute of Biomedical and Healthcare Research of Alicante ISABIAL-FISABIO, Miguel Hernandez University, Alicante, Spain
Interests: nutrition; nutritional support; home enteral nutrition; home parenteral nutrition; malnutrition
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Javier Sanz Valero

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Guest Editor

Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Alicante, Spain
Interests: scientific documentation in nutrition sciences; information and communication technologies in nutrition; methodology

Prof. Dr. M Dolores Ruiz-López

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Guest Editor

1. Department of Nutrition and Food Science, University of Granada, Granada, Spain
2. Institute of Nutrition and Food Technology, Biomedical Research Center, University of Granada, Granada, Spain
Interests: nutrition; sarcopenia; aging

Special Issue Information

Dear Colleagues,

Enteral nutrition aims to feed, through a functioning digestive tract, people with swallowing difficulties or total oral disability. In this way, it is possible to maintain or improve the nutritional status of patients in a situation of malnutrition, both in hospital and in their homes.

It is the most frequent form of artificial nutrition and mainly affects patients with neurological and oncological diseases who need it for long periods of time, even for their lifetime. Even if, apparently, this nutritional treatment has remained unchanged for the last years, in fact, it has been undergoing changes regarding the enteral feeding devices, ingredients used, innovative practices, safe administration, and reimbursement policies.

We invite you to submit articles on enteral nutrition that meet the goals of this Special Issue.

The aim of this Special Issue titled "Update of Enteral Nutrition" is to publish selected articles that deepen our knowledge of specific and innovative aspects of enteral nutrition. In particular, it will include articles (revisions and clinical or experimental studies) on the role of specific nutrients and non-nutritional substances used in enteral nutrition, features of enteral nutrition that can be studied only after its administration to patients, administration methods, trends in the composition of enteral nutrition, effects or complications of enteral nutrition, and other aspects that directly or indirectly advance our understanding of enteral nutrition.

Prof. Dr. Carmina Wanden Berghe
Prof. Dr. Javier Sanz Valero
Prof. Dr. M Dolores Ruiz López
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Enteral nutrition
Enteral formulas
Home nutrition support
Fibers
Fatty acids
Nutraceuticals

Published Papers (9 papers)

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Research

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6 pages, 471 KiB

Open AccessArticle

Patients Discharged with Home Enteral Nutrition from a Third-Level Hospital in 2018

by Cristina Campos-Martín, María Dolores García-Torres, Cristina Castillo-Martín, Rocío Domínguez-Rabadán and Juana María Rabat-Restrepo

Nutrients 2019, 11(11), 2570; https://doi.org/10.3390/nu11112570 - 24 Oct 2019

Cited by 5 | Viewed by 3137

Abstract

Patients who, during admission, begin to use enteral nutrition (EN) and do not recover adequate oral intake need proper planning prior to discharge. The present study is a descriptive analysis of patients discharged with EN from our hospital in 2018. In all, the study included 141 patients (50.3% male) with an average age of 76.18 ± 14 years with the most frequent reasons for enteral support being neurological disease (71.3%) and ear, nose, and throat (ENT) and maxillofacial surgery (17.02%) (others accounted for 11.68%). In these two groups, differences were observed in both the average age (77 vs. 70.5 years) and sex of patients—mostly women (58%) in the first group and men (70%) in the second. Overall, the access routes used were nasogastric tube (76.4%), and percutaneous endoscopic gastrostomy (18.4%); 67.1% of the episodes ended by 30 June, 60.6% of patients died (47% of neurological patients), and 39.3% patients recovered function of the oral passage (85% of surgical/head and neck tumor). The duration of support was as follows: 1–3 months, 32%; 6–12 months, 26.9%; more than 12 months, 18.5%. This indicated some frequent and clearly differentiated profiles in the patients studied, which may contribute to better care and support in order to maintain long-term treatment. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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12 pages, 269 KiB

Open AccessFeature PaperArticle

Complications Associated with Enteral Nutrition: CAFANE Study

by Carmina Wanden-Berghe, Maria-Carmen Patino-Alonso, Purificación Galindo-Villardón and Javier Sanz-Valero

Nutrients 2019, 11(9), 2041; https://doi.org/10.3390/nu11092041 - 01 Sep 2019

Cited by 25 | Viewed by 7006

Abstract

Objectives: To determine the association between home enteral nutrition (HEN) administration modality and its complications in patients. Methods: This is a prospective multicenter longitudinal study including 15 Spanish hospitals, from April 2015 to March 2017. A 4-month follow-up period was conducted for each patient by home visit. The study subjects were adult patients who began their nutrient intake by tube feeding, known as HEN, during the recruitment period. The variables studied included the type and modality of HEN administration and its related complications, such as vomiting, regurgitation, constipation, diarrhea, and abdominal distention. Mechanical complications and bronchoaspiration were also evaluated. Descriptive variables were used for fitting. Results: The study consisted of 306 patients; 4 were lost due to death. Specific HEN modalities protected against constipation (odds ratio (OR) = 0.4) and regurgitation (OR = 0.4). The use of a nasogastric tube (NGT) resulted in a lower risk of diarrhea compared to percutaneous endoscopic gastrostomy (PEG) (OR = 0.4) but resulted in a higher risk of tube obstruction (OR = 7.4). The use of intermittent gravity versus bolus feeding was a protection factor against vomiting (OR = 0.4), regurgitation (OR = 0.3), constipation (OR = 0.3), diarrhea (OR = 0.4) and abdominal distension (OR = 0.4). The increase in the number of doses was a risk factor for the incidence of regurgitation (OR = 1.3). Conclusions: Gastrointestinal complications were the most frequent problems, but an adequate choice of the formula, route, feeding modality, number of doses, administration time, and dose volume can reduce the risk of these complications. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

12 pages, 1103 KiB

Open AccessArticle

Influence of Hyperglycemia Associated with Enteral Nutrition on Mortality in Patients with Stroke

by Juan José López-Gómez, Esther Delgado-García, Cristina Coto-García, Beatriz Torres-Torres, Emilia Gómez-Hoyos, Cristina Serrano-Valles, Ángeles Castro-Lozano, Juan F. Arenillas-Lara and Daniel A. de Luis-Román

Nutrients 2019, 11(5), 996; https://doi.org/10.3390/nu11050996 - 30 Apr 2019

Cited by 7 | Viewed by 4637

Abstract

Objectives: To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia. Methods: A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients); NoHyper: those who did not have hyperglycemia before or after (47.8% patients); and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients). Results: The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20–14.79), p = 0.02); and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76–26.47), p < 0.01). Conclusions: In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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12 pages, 1029 KiB

Open AccessArticle

Nutritional Outcome in Home Gastrostomy-Fed Children with Chronic Diseases

by Cecilia Martínez-Costa, Caterina Calderón, Lilianne Gómez-López, Soraya Borraz, Elena Crehuá-Gaudiza and Consuelo Pedrón-Giner

Nutrients 2019, 11(5), 956; https://doi.org/10.3390/nu11050956 - 26 Apr 2019

Cited by 10 | Viewed by 3158

Abstract

The aim of the study was to assess the anthropometric outcomes after gastrostomy tube (GT) placement in children with chronic diseases and the influence of primary diagnosis, age, and nutritional support. A longitudinal, multicenter, and prospective study was performed evaluating 65 children with GT feeding and chronic diseases (61.5% with neurological disease). Each child was evaluated three times (at baseline and at 6 and 12 months after GT placement) and the following data was collected: primary diagnosis, age at GT placement, anthropometry, and feeding regime. Repeated measures ANOVA were used to analyze the main effects (intra and intergroup) and the interactions effects on weight gain and linear growth at 6 and 12 months after GT placement. All patients significantly improved their body mass index (BMI)-for-age z-score (p < 0.001) and height-for-age z-score (p < 0.05) after 6 and 12-month of follow-up. BMI gain increased significantly the first 6 months, followed by a plateau, while height followed a linear trend. Children with GT placement before 18 months old experienced an accelerated growth rate during the first 6 months post-GT. This technique showed the effectiveness of GT placement improving nutritional status and growth catch up regardless of their primary diagnosis and the type of nutritional support. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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Review

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21 pages, 1673 KiB

Open AccessReview

Enteral Nutrition in Patients with Inflammatory Bowel Disease. Systematic Review, Meta-Analysis, and Meta-Regression

by Jose M. Comeche, Pablo Caballero, Ana Gutierrez-Hervas, Sofia García-Sanjuan, Iris Comino, Cesare Altavilla and Jose Tuells

Nutrients 2019, 11(11), 2657; https://doi.org/10.3390/nu11112657 - 04 Nov 2019

Cited by 18 | Viewed by 5771

Abstract

Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and is characterized by inflammation of the gastrointestinal tract. One of the possible treatments for this pathology is a change in the type of diet, of which enteral nutrition (EN) is one. This study is to understand how the use of EN can affect the adult population diagnosed with IBD. We conducted a systematic review, meta-analysis, and a meta-regression. On the different databases (MEDLINE, Scopus, Cochrane, LILACS, CINAHL, WOS), we found 363 registers with an accuracy of 12% (44 registers). After a full-text review, only 30 research studies were selected for qualitative synthesis and 11 for meta-analysis and meta-regression. The variables used were Crohn’s disease activity index (CDAI), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). EN has been shown to have efficacy for the treatment of Crohn’s disease and is compatible with other medicines. As for the CDAI or rates of remission, there were no differences between enteral and parenteral nutrition. Polymeric formulas have shown better results with respect to the CRP. The long-term treatment could dilute the good CDAI results that are obtained at the start of the EN treatment. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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24 pages, 549 KiB

Open AccessReview

Compliance and Adherence to Enteral Nutrition Treatment in Adults: A Systematic Review

by Alicia Gea Cabrera, María Sanz-Lorente, Javier Sanz-Valero and Elsa López-Pintor

Nutrients 2019, 11(11), 2627; https://doi.org/10.3390/nu11112627 - 02 Nov 2019

Cited by 18 | Viewed by 4154

Abstract

Objective: To review the scientific literature that has verified and/or assessed compliance and adherence to enteral nutrition (EN) in adult patients. Method: This study involved a critical analysis of articles retrieved from MEDLINE (PubMed), The Cochrane Library, Embase, Scopus and Web of Science using the terms “Treatment Adherence and Compliance” and “Enteral Nutrition”, applying the filters “Comparative Study” or “Clinical Trial”, “Humans” and “Adults”. Date of the search: 25 October 2018. Results: A total of 512 references were retrieved, of which 23 documents were selected after applying the inclusion and exclusion criteria. The techniques measuring adherence to EN were determined by dietary intake, self-reporting, counts of leftover containers or presence of complications; however, in no case were validated questionnaires used. The time and periodicity of the assessment presented very heterogeneous results, with measurement predominantly being done at the beginning and at the end of the study. The best adherence rates were obtained in hospitalized patients (approximately 80%). Conclusions: Frequent and regular monitoring of the adherence of patients under prolonged treatment with EN is necessary, and the use of measurement techniques that allow obtaining information on the causes of non-adherence facilitates early interventions to optimize treatment outcomes. Patient and/or caregiver education in the management of EN and the intervention of the community pharmacy in monitoring patients can be key to improving the adherence to EN. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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18 pages, 423 KiB

Open AccessReview

Search and Selection of Probiotics That Improve Mucositis Symptoms in Oncologic Patients. A Systematic Review

by José Antonio Picó-Monllor and José Manuel Mingot-Ascencao

Nutrients 2019, 11(10), 2322; https://doi.org/10.3390/nu11102322 - 01 Oct 2019

Cited by 28 | Viewed by 4479

Abstract

Mucositis is a common and severe adverse effect of radiotherapy and/or chemotherapy treatments applied to oncologic patients. The development of effective therapies and adjuvant treatments to increase their efficacy and reduce adverse effect is a priority in cancer therapy. Probiotics are non-pathogenic live microorganisms that when ingested in adequate amounts can colonize the intestinal tract promoting the restoration of a healthy gut microbiota and contributing to all its functions including the maintenance of the integrity of the mucosa and the modulation of the immune system. In order to check the possible efficacy and safety of these microorganisms to prevent or ameliorate mucositis′ symptoms, we have systematically searched the bibliographic databases MEDLINE (via Pubmed), EMBASE, The Cochrane library, Scopus, Web of science, and Latin American and Caribbean Literature in Health of Sciences (LILACS) using the descriptors “Mucositis”, “Probiotics”, “Neoplasms”, “Humans”, and “Clinical Trials”. After applying our inclusion and exclusion criteria, 15 studies were accepted for review and critical analysis. Our analysis suggests that a combination of Bifidobacterium longum, Lactobacillus acidophilus, Bifidobacterium breve, Bifidobacterium infantis, and Saccharomyces boulardii could be a good combination of probiotics to reduce incident rates of mucositis or ameliorate its symptoms in chemo or radiotherapy treated patients. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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31 pages, 467 KiB

Open AccessReview

Enteral Nutrition in Adult Crohn’s Disease: Toward a Paradigm Shift

by Simona Di Caro, Konstantinos C. Fragkos, Katie Keetarut, Hui Fen Koo, Gregory Sebepos-Rogers, Hajeena Saravanapavan, John Barragry, Jennifer Rogers, Shameer J. Mehta and Farooq Rahman

Nutrients 2019, 11(9), 2222; https://doi.org/10.3390/nu11092222 - 14 Sep 2019

Cited by 31 | Viewed by 6714

Abstract

Medical and surgical treatments for Crohn’s disease are associated with toxic effects. Medical therapy aims for mucosal healing and is achievable with biologics, immunosuppressive therapy, and specialised enteral nutrition, but not with corticosteroids. Sustained remission remains a therapeutic challenge. Enteral nutrition, containing macro- and micro-nutrients, is nutritionally complete, and is provided in powder or liquid form. Enteral nutrition is a low-risk and minimally invasive therapy. It is well-established and recommended as first line induction therapy in paediatric Crohn’s disease with remission rates of up to 80%. Other than in Japan, enteral nutrition is not routinely used in the adult population among Western countries, mainly due to unpalatable formulations which lead to poor compliance. This study aims to offer a comprehensive review of available enteral nutrition formulations and the literature supporting the use and mechanisms of action of enteral nutrition in adult Crohn’s disease patients, in order to support clinicians in real world decision-making when offering/accepting treatment. The mechanisms of actions of enteral feed, including their impact on the gut microbiome, were explored. Barriers to the use of enteral nutrition, such as compliance and the route of administration, were considered. All available enteral preparations have been comprehensively described as a practical guide for clinical use. Likewise, guidelines are reported and discussed. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

20 pages, 1285 KiB

Open AccessReview

Oligomeric Enteral Nutrition in Undernutrition, due to Oncology Treatment-Related Diarrhea. Systematic Review and Proposal of An Algorithm of Action

by Alejandro Sanz-Paris, María Martinez-García, Javier Martinez-Trufero, Julio Lambea-Sorrosal, Fernando Calvo-Gracia and María Elena López-Alaminos

Nutrients 2019, 11(8), 1888; https://doi.org/10.3390/nu11081888 - 13 Aug 2019

Cited by 16 | Viewed by 5537

Abstract

Oncology treatment-related diarrhea and malnutrition appear together in oncological patients because of the disease itself, or the treatments that are administered for it. Therefore it is essential to carry out a nutritional treatment. Enteral nutrition formulas, containing peptides and medium chain triglycerides, can facilitate absorption in cases of malabsorption. There are few references to the use of enteral nutrition in the clinical society guidelines of patient management with oncology treatment-related diarrhea (OTRD). A bibliographic review of the studies with oligomeric enteral nutrition in OTRD found only nine studies with chemotherapy (all with the same oligomeric formula in which oral mucositis improves, while the rest of the outcomes show different results), and eight studies with radiotherapy (with different products and very heterogeneous results). We hereby present our action algorithm to supplement the diet of OTRD patients with an oligomeric enteral nutrition formula. The first step is the nutritional assessment, followed by the assessment of the functional capacity of the patient’s intestine. With these two aspects evaluated, the therapeutic possibilities available vary in degrees of complexity: These will range from the usual dietary recommendations, to supplementation with oral oligomeric enteral nutrition, along with complete enteral nutrition with oligomeric formula, and up to potentially total parenteral nutrition. Full article

(This article belongs to the Special Issue Update of Enteral Nutrition)

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