SHORT-TERM RESTORATIVE NUTRITION IN MALNOURISHED PATIENTS - PROS AND CONS OF INTRAVENOUS AND ENTERAL ALIMENTATION USING COMPOSITIONALLY MATCHED NUTRIENTS

In a prospective controlled clinical study 30 patients with moderate d egree of malnutrition, normal liver and kidneys, and a functioning gas trointestinal tract were randomized to receive a free amino acid and s mall peptide enteral diet (15 patients) or an isonitrogenous isocalori c parenteral support for at least 10 days (total energy: 2900 kcal, ni trogen: 14.5 g, carbohydrates: 380 g, fat: 112 g, N/non protein calori es: 1/175). The parenteral and enteral diets had the same protein/lipi d/carbohydrate composition, The data indicated that both routes led to positive nitrogen balance, Nitrogen equilibrium was achieved by day 3 in the TPN group and by day 5 in the enteral group, There were no sig nificant changes in serum albumin within either group, Serum level of transferrin reached a significant increase in both groups (p=0.003). T hyroxine-binding prealbumin rose significantly in both groups as well (p=0.019 and 0.004 respectively), Statistically significant rises in l ymphocyte counts (p=0.003 and 0.001 respectively), in levels of C-3 (p =0.009 and 0.001 respectively), IgA (p=0.002), IgG (p=0.004 and 0.003 respectively) and IgM. (p=0.004) occurred in either treatment group, T here was a high incidence of negative skin tests at the start of the s tudy in the enteral group (73.3%) and the TPN group (60%), By the end of the study the incidence of negative results for this test was 40.0% and 26.6% respectively, Despite maintenance of similar glucose levels in both groups, TPN led to significantly (p=0.000) higher serum insul in levels, The serum insulin increased almost linearly over the study period, and eventually prevented fat mobilization and lipolysis, so th at free fatty acid levels had fallen significantly (p=0.000). A signif icant elevation of the liver enzymes over the study period occurred in the TPN group, but not in the enterally fed patients, The present fin dings provide no evidence that semi-elemental diets are in any way inf erior to isonitrogenous isocaloric regimes parenterally given for a sh ort period of time.