RESUMEN
The net absorption and retention of energy, fat, nitrogen, and six elements (potassium, phosphorus, calcium, magnesium, sodium, and chloride) from two intrajejunally infused enteral formulas were compared to solid food. Undernourished patients (group 1) underwent two consecutive 7-day balance studies on a predigested protein-low fat (elemental) formula and an intact protein-standard fat (polymeric) formula, the initial diet selected randomly. Periods were isocaloric and isonitrogenous, but differed in the amounts of remaining elements. The undernourished patients in group 2 ate a solid food standard hospital diet for the 7-day balance study in an amount equal in energy and protein to group 1. There were no major differences in the nutrient absorption between the three diets. Nitrogen balance was similar for the two formulas (mean +/- SD) (elemental 6.1 +/- 3.5 g/day; polymeric 4.8 +/- 3.2 g/day) and solid food (5.2 +/- 3.5 g/day), and the balance for the six remaining elements was approximately proportional to the amount supplied. Subjective tolerance of both formulas was good, with a tendency for superior tolerance of the polymeric formula. We conclude that for the nutrients investigated, 1) intrajejunally administered enteral formulas are capable of renourishing hospitalized patients with an efficacy similar to that of solid food, and 2) predigestion of the formula does not improve absorption.
Asunto(s)
Elementos Químicos/metabolismo , Metabolismo Energético , Alimentos Formulados , Alimentos , Metabolismo de los Lípidos , Nitrógeno/metabolismo , Disponibilidad Biológica , Peso Corporal , Nutrición Enteral , Femenino , Humanos , Absorción Intestinal , MasculinoRESUMEN
Two patients with malabsorption syndrome and weight loss refractory to conventional pharmacologic and dietary therapy were evaluated on a metabolic ward. Baseline studies indicated moderate to severe protein-energy malnutrition, and severe energy, fat, and nitrogen malabsorption. Metabolic balance studies on low-fat elemental formulas infused nasoenterally over 18-hour periods indicated improved retention of nitrogen, phosphorus, calcium, magnesium, and energy when compared with a solid food diet. Because this dietary modification appeared to correct their malabsorption, both patients learned to insert the nasoenteral tube themselves, and a low-calorie solid-food diet combined with nocturnal tube feedings was continued at home. During the next 9 to 12 months, both patients had increases in body weight, and in the mass of fat-free tissue, skeletal muscle, and fat. This therapeutic approach may correct life-threatening semistarvation in selected patients.