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Advances in Enteral Nutrition
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Advances in Enteral Nutrition

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

Deadline for manuscript submissions: closed (30 March 2018) | Viewed by 51359

Special Issue Editor

Prof. Dr. Leah Gramlich

E-Mail Website
Guest Editor
Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada；Royal Alexandra Hosipital, Alberta Health Services, Edmonton, AB T5H 3V9, Canada.
Interests: nutrition; gastroenterology; ERAS; implementation; cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Enteral Nutrition is used to provide nutrition to patients who are unable to take nutrients by mouth, and in whom the gastrointestinal tract is functional. In addition, the enteral route may be used to provide nutrients which may impact the course of disease, such as in the case of inflammatory bowel disease or antibiotic associated diarrhea in critical illness. The exact timing, route and composition of the nutrients provided enterally may also impact outcome for patients—this is described in the protocol development for the EFFORT trial in critical illness. In addition, there are large numbers of patients who receive long-term enteral nutrition in the home. Standards do not exist for Home Enteral Nutrition (HEN). The results of a North American survey of seven HEN programs will be presented and used to describe program components necessary for comprehensive care of the patient on home enteral nutrition, including a discussion of patient characteristics, enteral access devices, product use, outcomes and staffing considerations for home enteral nutrition programs.

Dr. Leah Gramlich
Guest Editor

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
  • Critical illness
  • Ethics
  • Home Enteral Nutrition
  • Probiotics

Published Papers (7 papers)

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Research

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11 pages, 217 KiB  
Article
Home Enteral Nutrition: Towards a Standard of Care
by Leah Gramlich, Ryan T. Hurt, Jennifer Jin and Manpreet S. Mundi
Nutrients 2018, 10(8), 1020; https://doi.org/10.3390/nu10081020 - 04 Aug 2018
Cited by 50 | Viewed by 8237
Abstract
The purpose of this overview is to make the case for the establishment and publication of standards for home enteral nutrition (HEN) therapy in adult patients who require a long-term alternative to oral feeding. Overviews can provide a broad and often comprehensive summation [...] Read more.
The purpose of this overview is to make the case for the establishment and publication of standards for home enteral nutrition (HEN) therapy in adult patients who require a long-term alternative to oral feeding. Overviews can provide a broad and often comprehensive summation of a topic area and, as such, have value for those coming to a subject for the first time. It will provide a broad summation, background and rationale, review specific considerations unique to HEN (tubes, products and supplies) and we describe a recent audit of seven HEN programs which highlights tube and process related challenges. Based on the overview of the literature and our experience with the audit we propose a way forward for best home enteral nutrition care. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)
13 pages, 273 KiB  
Article
Feasibility of a Lactobacillus casei Drink in the Intensive Care Unit for Prevention of Antibiotic Associated Diarrhea and Clostridium difficile
by Cathy Alberda, Sam Marcushamer, Tayne Hewer, Nicole Journault and Demetrios Kutsogiannis
Nutrients 2018, 10(5), 539; https://doi.org/10.3390/nu10050539 - 26 Apr 2018
Cited by 33 | Viewed by 9132
Abstract
Background: Over 70% of patients are prescribed antibiotics during their intensive care (ICU) admission. The gut microbiome is dramatically altered early in an ICU stay, increasing the risk for antibiotic associated diarrhea (AAD) and Clostridium difficile infections (CDI). Evidence suggests that some probiotics [...] Read more.
Background: Over 70% of patients are prescribed antibiotics during their intensive care (ICU) admission. The gut microbiome is dramatically altered early in an ICU stay, increasing the risk for antibiotic associated diarrhea (AAD) and Clostridium difficile infections (CDI). Evidence suggests that some probiotics are effective in the primary prevention of AAD and CDI. Aim: To demonstrate safety and feasibility of a probiotic drink in ICU patients. Methods: ICU patients initiated on antibiotics were recruited, and matched with contemporary controls. Study patients received two bottles daily of a drink containing 10 billion Lactobacillus casei which was bolused via feeding tube. Tolerance to probiotics and enteral nutrition, development of adverse events, and incidence of AAD was recorded. CDI rates were followed for 30 days post antibiotic treatment. Results: Thirty-two patients participated in the trial. There were no serious adverse events in the probiotic group, compared to three in the control group. AAD was documented in 12.5% of the probiotic group and 31.3% in the control group. One patient in the probiotic group developed CDI compared to three in the control group. Discussion: A probiotic containing drink can safely be delivered via feeding tube and should be considered as a preventative measure for AAD and CDI in ICU. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)
10 pages, 1194 KiB  
Article
Bioelectrical Impedance Phase Angle as an Indicator of Malnutrition in Hospitalized Children with Diagnosed Inflammatory Bowel Diseases—A Case Control Study
by Paweł Więch, Mariusz Dąbrowski, Dariusz Bazaliński, Izabela Sałacińska, Bartosz Korczowski and Monika Binkowska-Bury
Nutrients 2018, 10(4), 499; https://doi.org/10.3390/nu10040499 - 17 Apr 2018
Cited by 22 | Viewed by 5926
Abstract
The phase angle (PhA) seems to be a reliable screening tool for the identification of malnutrition risk in hospitalized children with inflammatory bowel disease (IBD). The aim of the present study was to assess the body composition and nutritional status of hospitalized children [...] Read more.
The phase angle (PhA) seems to be a reliable screening tool for the identification of malnutrition risk in hospitalized children with inflammatory bowel disease (IBD). The aim of the present study was to assess the body composition and nutritional status of hospitalized children and adolescents with IBD by using bioelectrical impedance analysis (BIA) with phase angle (PhA) calculation, which has not been evaluated in hospitalized children with IBD yet. A total of 59 children and adolescents aged 4–18 years, with IBD: 34 ulcerative colitis (UC) and 25 Crohn’s disease (CD) were included in the study. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. In both groups, BIA was performed and PhA was calculated. IBD patients had significantly lower PhA (UC: 5.34 ± 1.34 vs. 5.96 ± 0.76, p = 0.040; CD: 5.16 ± 1.18 vs. 5.90 ± 0.62, p = 0.009) compared to the control subjects. Significant changes in selected body composition parameters were observed particularly in CD, especially in fat free mass components. Lower phase angle score together with lower body composition parameters and selected nutrition indicators in children and adolescents with IBD demonstrate their worse nutritional and functional status compared to healthy subjects. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)
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13 pages, 225 KiB  
Article
A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region
by Alvin Wong, Merrilyn D. Banks and Judith D. Bauer
Nutrients 2018, 10(2), 214; https://doi.org/10.3390/nu10020214 - 14 Feb 2018
Cited by 14 | Viewed by 5570
Abstract
Literature regarding the use of home enteral nutrition (HEN) and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the [...] Read more.
Literature regarding the use of home enteral nutrition (HEN) and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs), and clinical nutrition education in this region. An electronic questionnaire was sent to 20 clinical nutrition societies and leaders in the Asia Pacific region in August 2017, where thirteen countries responded. Comparison of HEN reimbursement and practice between countries of different income groups based on the World Bank’s data was investigated. Financial support for HEN is only available in 40% of the countries. An association was found between availability of financial support for HEN and health expenditure (r = 0.63, p = 0.021). High and middle-upper income countries use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diet. The presence of NSTs is limited, and only present mainly in acute settings. Sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrates the varied clinical and economic situation in the Asia Pacific region. There is a lack of reimbursement, clinical support, and inadequate educational opportunities, especially for the lower-middle income countries. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)
672 KiB  
Article
Normal Diet within Two Postoperative Days—Realistic or Too Ambitious?
by Fabian Grass, Markus Schäfer, Nicolas Demartines and Martin Hübner
Nutrients 2017, 9(12), 1336; https://doi.org/10.3390/nu9121336 - 08 Dec 2017
Cited by 9 | Viewed by 5002
Abstract
Enhanced Recovery After Surgery (ERAS) protocols advocate early postoperative resumption of normal diet to decrease surgical stress and prevent excessive catabolism. The aim of the present study was to identify reasons for delayed tolerance of normal postoperative diet. This was a retrospective analysis [...] Read more.
Enhanced Recovery After Surgery (ERAS) protocols advocate early postoperative resumption of normal diet to decrease surgical stress and prevent excessive catabolism. The aim of the present study was to identify reasons for delayed tolerance of normal postoperative diet. This was a retrospective analysis including all consecutive colorectal surgical procedures since May 2011 until May 2017. Data was prospectively recorded by an institutional data manager in a dedicated database. Uni- and multivariate risk factors associated with delayed diet (beyond POD 2) were identified by multiple logistic regression among demographic, surgery- and modifiable pre- and intraoperative ERAS-related items. In a second step, univariate analysis was performed to compare surgical outcomes for patients with early vs. delayed oral intake. The study cohort consisted of 1301 consecutive colorectal ERAS patients. Herein, 691 patients (53%) were able to resume normal diet within two days of surgery according to ERAS protocol, while in 610 patients (47%), a delay in tolerance of normal diet was observed. Male gender was independently correlated to early tolerance (Odds Ratio (OR) 0.66; 95% Confidence Interval (CI) 0.46–0.84, p = 0.002), while ASA score ≥ 3 (OR 1.60; 95% CI 1.12–2.28, p = 0.010), abdominal drains (OR 1.80; 95% CI 1.10–2.49, p = 0.020), right colectomy (OR 1.64; 95% CI 1.08–2.49, p = 0.020) and Hartmann reversal (OR 2.61; 95% CI 1.32–5.18, p = 0.006) constituted risk factors for delayed tolerance of normal diet. Patients with delayed resumption of normal diet experienced more overall (Clavien grade I–V) (47% vs. 21%, p < 0.001) and major (Clavien grade IIIb–V) (11% vs. 4%, p < 0.001) complications and had a longer length of stay (9 ± 5 vs. 5 ± 4 days, p < 0.001). Over half of patients could not tolerate early enteral realimentation and were at higher risk for postoperative complications. Prophylactic drain placement was the only independent modifiable risk factor for delayed oral intake. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)
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Review

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9 pages, 241 KiB  
Review
Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease
by Tawnya Hansen and Donald R. Duerksen
Nutrients 2018, 10(5), 537; https://doi.org/10.3390/nu10050537 - 26 Apr 2018
Cited by 46 | Viewed by 9837
Abstract
Genetic and environmental factors are thought to profoundly influence the pathophysiology of Crohn’s disease (CD). Changes in dietary and hygiene patterns affect the interactions between the immune system and environment. The gut microbiome is responsible for mediating host immune response with significant dysbiosis [...] Read more.
Genetic and environmental factors are thought to profoundly influence the pathophysiology of Crohn’s disease (CD). Changes in dietary and hygiene patterns affect the interactions between the immune system and environment. The gut microbiome is responsible for mediating host immune response with significant dysbiosis observed in individuals with CD. Diet therapy using exclusive enteral nutrition (EEN) has been studied as primary therapy for the management of CD. EEN may cultivate the presence of beneficial microbiota, improve bile acid metabolism, and decrease the number of dietary microparticles possibly influencing disease and immune activity. In this review, we will address the current evidence on EEN in the management of adult and pediatric CD. In adults, EEN appears to be moderately beneficial for the induction of remission of CD; however, its use is understudied and underutilized. Stronger evidence is in place to support the use of EEN in pediatric CD with the added benefit of nutrition support and steroid-sparing therapy during the growth phase. Overall, EEN is an established therapy in inducing CD remission in the pediatric population while its role as primary therapy of adult Crohn’s disease remains to be defined. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)

Other

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8 pages, 1578 KiB  
Commentary
Should We Prescribe More Protein to Critically Ill Patients?
by Daren K. Heyland, Renee Stapleton and Charlene Compher
Nutrients 2018, 10(4), 462; https://doi.org/10.3390/nu10040462 - 07 Apr 2018
Cited by 28 | Viewed by 7138
Abstract
In the context of critical illness, evidence suggests that exogenous protein/amino acid supplementation has the potential to favorably impact whole-body protein balance. Whether this translates into retention of muscle, greater muscle strength, and improved survival and physical recovery of critically ill patients remains [...] Read more.
In the context of critical illness, evidence suggests that exogenous protein/amino acid supplementation has the potential to favorably impact whole-body protein balance. Whether this translates into retention of muscle, greater muscle strength, and improved survival and physical recovery of critically ill patients remains uncertain. The purpose of this brief commentary is to provide an overview of the clinical evidence for and against increasing protein doses and to introduce two new trials that will add considerably to our evolving understanding of protein requirements in the critically ill adult patient. Full article
(This article belongs to the Special Issue Advances in Enteral Nutrition)
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