Rationale: The amount of enteral nutrition (EN) delivered determines its efficacy. Nutritional
and inflammatory markers were prospectively assessed according to the level of coverage
of the nutritional needs after 5 days of EN.
Method: The administration of EN (1 kcal/ml and 0.4g protein/ml) was increased by 500ml/day
to cover nutritional needs: 1.1 x energy expenditure (Harris-Benedict). At baseline
(D0) and after 5d of EN (D5), serum samples of C-Reactive Protein (CRP), albumin,
transthyretin (TTR) and Insulin Growth Factor-1 (IGF-1) were obtained. At D5, patients
were divided according to the energy target achieved (<65% or >65%).
Results: 161 consecutive patients hospitalised in medical or surgical services were enrolled.
130 successfully completed the protocol (age: 64.7±15yr; BMI: 24±6kg/m2). Mean energy needs were 1614±508kcal/d and 5d mean intake was 914±320 kcal/d. At
D0, serum parameters were: CRP 110.8±83.7mg/L, albumin 30.6±6.6g/L, TTR 140±60 mg/L, IGF-1 78.2±42.3 ug/L.
Changes in serum parameters (D5-D0)
|
|
CRPmg/L
|
IGF-1ug/L
|
TTR mg/L
|
Albuming/L
|
|
All patients
|
–25.2±83.0*
|
20.8±48.1*
|
0.02±0.1 **
|
–1.2±4.8*
|
|
≤65% (n=67)
|
–14.7±73.9
|
16.8±47.0*
|
0.02±0.1
|
–0.7±4.7
|
|
>65% (n=63)
|
–36.3±90.9*
|
25.3±49.3*
|
0.03±0.1*
|
–1.7±4.9 *
|
|
X: mean±SD; paired t-test *p<0.01; ** p=0.01
|
Conclusion: The efficacy of EN is influenced by inflammatory status. Five days of EN improve
serum nutritional markers in patients receiving at least 65% of their metabolic needs.
The lack of change in the <65% group (except for IGF-1) might be explained by a more
persistent inflammation. IGF-1 and TTR are more sensitive parameters than albumin
to assess the efficacy of the nutritional support.
