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Nutrients
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Current State of the Art and Practical Aspects of Enteral...
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Current State of the Art and Practical Aspects of Enteral Nutrition

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 9858

Special Issue Editors

Prof. Dr. Stefan F. Mühlebach

E-Mail Website
Guest Editor
Division of Clinical Pharmacy and Epidemiology / Hospital Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
Interests: clinical nutrition; pharmacology; hospital pharmacy; nanomedicines; regulatory sciences
Dr. Katja Schönenberger

E-Mail Website
Co-Guest Editor
1. Division of Clinical Pharmacy and Epidemiology / Hospital Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
2. Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Interests: clinical nutrition; artificial nutrition; obesity; malnutrition; nutrition after bariatric surgery; nutritional epidemiology; food science

Special Issue Information

Dear Colleagues,

In malnourished patients and those at risk of malnutrition, enteral nutrition is used to compensate for their nutritional deficiencies. The composition of these commercial nutrients is balanced and chemically defined. Commercial products are modified in their energy, protein, and other macro- and micronutrient content to provide organ-, disease-, and age-specific nutrition in almost all patients with a functional gastrointestinal tract. Since their first use in astronauts’ diets in the 1960s for space missions, they have undergone successful clinical development for the treatment and prevention of malnutrition according to medical and patient-specific needs. They are used in the form of sip feedings or tube feedings with suitable products.

The present Special Issue of Nutrients aims to elaborate on the trends, state-of-the-art composition and use of enteral nutrition, including substrates with specific pharmacological actions (pharmaconutrients) or fibers with impacts on the microbiome. The good practice and handling of these products, as well as a correct combined medication regimen, are also addressed in this issue to update health care professionals on the topic to optimally assist in the treatment of patients in hospital and home settings.

Prof. Dr. Stefan F. Mühlebach
Dr. Katja Schönenberger
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
  • tube feeding
  • oral nutrition supplements
  • pharmaconutrients
  • malnutrition
  • protein
  • fibers and the microbiome
  • medication

Published Papers (4 papers)

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Research

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19 pages, 2255 KiB  
Article
Is Autologous Fecal Microbiota Transfer after Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients Rational and Feasible? Data from a Feasibility Test
by Hannes Hoelz, Jeannine Heetmeyer, Anastasia Tsakmaklis, Andreas Hiergeist, Kolja Siebert, Federica De Zen, Deborah Häcker, Amira Metwaly, Klaus Neuhaus, André Gessner, Maria J. G. T. Vehreschild, Dirk Haller and Tobias Schwerd
Nutrients 2023, 15(7), 1742; https://doi.org/10.3390/nu15071742 - 2 Apr 2023
Cited by 1 | Viewed by 2628
Abstract
Background: Exclusive enteral nutrition (EEN) is a highly effective therapy for remission induction in pediatric Crohn’s disease (CD), but relapse rates after return to a regular diet are high. Autologous fecal microbiota transfer (FMT) using stool collected during EEN-induced clinical remission might represent [...] Read more.
Background: Exclusive enteral nutrition (EEN) is a highly effective therapy for remission induction in pediatric Crohn’s disease (CD), but relapse rates after return to a regular diet are high. Autologous fecal microbiota transfer (FMT) using stool collected during EEN-induced clinical remission might represent a novel approach to maintaining the benefits of EEN. Methods: Pediatric CD patients provided fecal material at home, which was shipped at 4 °C to an FMT laboratory for FMT capsule generation and extensive pathogen safety screening. The microbial community composition of samples taken before and after shipment and after encapsulation was characterized using 16S rRNA amplicon sequencing. Results: Seven pediatric patients provided fecal material for nine test runs after at least three weeks of nutritional therapy. FMT capsules were successfully generated in 6/8 deliveries, but stool weight and consistency varied widely. Transport and processing of fecal material into FMT capsules did not fundamentally change microbial composition, but microbial richness was <30 genera in 3/9 samples. Stool safety screening was positive for potential pathogens or drug resistance genes in 8/9 test runs. Conclusions: A high pathogen burden, low-diversity microbiota, and practical deficiencies of EEN-conditioned fecal material might render autologous capsule-FMT an unsuitable approach as maintenance therapy for pediatric CD patients. Full article
(This article belongs to the Special Issue Current State of the Art and Practical Aspects of Enteral Nutrition)
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10 pages, 1619 KiB  
Article
Should Carbohydrate Intake Be More Liberal during Oral and Enteral Nutrition in Type 2 Diabetic Patients?
by Ondrej Sobotka, Marie Ticha, Marketa Kubickova, Petr Adamek, Lenka Polakova, Vojtech Mezera and Lubos Sobotka
Nutrients 2023, 15(2), 439; https://doi.org/10.3390/nu15020439 - 14 Jan 2023
Cited by 1 | Viewed by 2310
Abstract
Carbohydrate (CHO) intake in oral and enteral nutrition is regularly reduced in nutritional support of older patients due to the high prevalence of diabetes (usually type 2—T2DM) in this age group. However, CHO shortage can lead to the lack of building blocks necessary [...] Read more.
Carbohydrate (CHO) intake in oral and enteral nutrition is regularly reduced in nutritional support of older patients due to the high prevalence of diabetes (usually type 2—T2DM) in this age group. However, CHO shortage can lead to the lack of building blocks necessary for tissue regeneration and other anabolic processes. Moreover, low CHO intake decreases CHO oxidation and can increase insulin resistance. The aim of our current study was to determine the extent to which an increased intake of a rapidly digestible carbohydrate—maltodextrin—affects blood glucose levels monitored continuously for one week in patients with and without T2DM. Twenty-one patients (14 T2DM and seven without diabetes) were studied for two weeks. During the first week, patients with T2DM received standard diabetic nutrition (250 g CHO per day) and patients without diabetes received a standard diet (350 g of CHO per day). During the second week, the daily CHO intake was increased to 400 in T2DM and 500 g in nondiabetic patients by addition of 150 g maltodextrin divided into three equal doses of 50 g and given immediately after the main meal. Plasma glucose level was monitored continually with the help of a subcutaneous sensor during both weeks. The increased CHO intake led to transient postprandial increase of glucose levels in T2DM patients. This rise was more manifest during the first three days of CHO intake, and then the postprandial peak hyperglycemia was blunted. During the night’s fasting period, the glucose levels were not influenced by maltodextrin. Supplementation of additional CHO did not influence the percentual range of high glucose level and decreased a risk of hypoglycaemia. No change in T2DM treatment was indicated. The results confirm our assumption that increased CHO intake as an alternative to CHO restriction in type 2 diabetic patients during oral and enteral nutritional support is safe. Full article
(This article belongs to the Special Issue Current State of the Art and Practical Aspects of Enteral Nutrition)
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Review

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21 pages, 1012 KiB  
Review
The Role of Dietary Fibre in Enteral Nutrition in Sepsis Prevention and Therapy: A Narrative Review
by Valentina V. Huwiler, Melanie Scalise, Katja A. Schönenberger, Stefan Mühlebach, Zeno Stanga and Maria L. Balmer
Nutrients 2023, 15(11), 2489; https://doi.org/10.3390/nu15112489 - 26 May 2023
Viewed by 2194
Abstract
Objective: This narrative review summarises the current evidence on the role of dietary fibre in enteral nutrition in the prevention and therapy of sepsis, with a focus on critically ill patients. The aim is to discuss the implications for clinical practice and identify [...] Read more.
Objective: This narrative review summarises the current evidence on the role of dietary fibre in enteral nutrition in the prevention and therapy of sepsis, with a focus on critically ill patients. The aim is to discuss the implications for clinical practice and identify future directions for policy and research. Resources: We searched MEDLINE and Google Scholar for records on sepsis, critically ill, enteral nutrition, and dietary fibre. We included all types of articles such as meta-analyses, reviews, clinical trials, preclinical studies, and in vitro studies. Data were evaluated for significance and clinical relevance. Synopsis of Review: Despite the ongoing debate, enteral nutrition containing dietary fibres showed great potential in attenuating sepsis-related outcomes and preventing the incidence of sepsis in critically ill patients on enteral nutrition. Dietary fibres target different underlying mechanisms such as microbiota, mucosal barrier integrity, local cellular immune response, and systemic inflammation. We discuss the clinical potential and concerns that currently exist with the standard implementation of dietary fibre in enterally fed intensive care patients. Additionally, we identified research gaps that should be addressed to determine effectiveness and the role of dietary fibres in sepsis itself and its associated outcomes. Full article
(This article belongs to the Special Issue Current State of the Art and Practical Aspects of Enteral Nutrition)
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Other

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6 pages, 237 KiB  
Brief Report
Early Tube Feeding after Percutaneous Endoscopic Gastrostomy (PEG): An Observational Study
by Rachel Strahm, Manuel Weber, Reiner Wiest and Kai-Uwe Schmitt
Nutrients 2023, 15(5), 1157; https://doi.org/10.3390/nu15051157 - 25 Feb 2023
Viewed by 2080
Abstract
This study investigated whether enteral nutrition by early tube feeding led to changes in clinical parameters compared to tube feeding after 24 h. Starting on 1 January 2021, and following the latest update of the ESPEN guidelines on enteral nutrition, patients with percutaneous [...] Read more.
This study investigated whether enteral nutrition by early tube feeding led to changes in clinical parameters compared to tube feeding after 24 h. Starting on 1 January 2021, and following the latest update of the ESPEN guidelines on enteral nutrition, patients with percutaneous endoscopic gastrostomy (PEG) received tube feeding 4 h after tube insertion. An observational study was conducted to analyze whether the new scheme affected patient complaints, complications, or hospitalization duration compared to the previous procedure of tube feeding starting after 24 h. Clinical patient records from one year before and one year after the introduction of the new scheme were examined. A total of 98 patients were included, and of those 47 received tube feeding 24 h after tube insertion, and 51 received tube feeding 4 h after tube insertion. The new scheme did not influence the frequency or severity of patient complaints or complications related to tube feeding (all p-values > 0.05). However, the study showed that the length of stay in hospital was significantly shorter when following the new scheme (p = 0.030). In this observational cohort study an earlier start of tube feeding did not produce any negative consequences but did reduce the duration of hospitalization. Therefore, an early start, as suggested in the recent ESPEN guidelines, is supported and recommended. Full article
(This article belongs to the Special Issue Current State of the Art and Practical Aspects of Enteral Nutrition)
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