This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Lipman, T. O. Search for Related Content PubMed PubMed Citation Articles by Lipman, T. O. Social Bookmarking                         What's this?

Grains or Veins: Is Enteral Nutrition Really Better Than Parenteral Nutrition? A Look at the Evidence

Gastroenterology-Hepatology-Nutrition Section, Department of Veterans Affairs Medical Center, Washington, DC, Georgetown University School of Medicine, Washington, DC

Background: Enteral nutrition is said to be better than parenteral nutrition for providing nutrition support to humans. Purpose: To assess the literature documenting the assertions that enteral nutrition is superior to parenteral nutrition with respect to cost, safety, physiology, intestinal structure and function, bacterial translocation, and outcome. Data identification: Sources included MEDLINE search, personal files, and references from human comparative studies of enteral vs parenteral nutrition. Study selection: The goal was to include all human studies directly addressing questions of comparative efficacy of enteral and parenteral nutrition. Emphasis was given to prospective randomized controlled studies where available. Retrospective comparisons were not included. Data extraction: An attempt was made to briefly summarize methodology and findings of relevant studies. No general attempt was made to assess quality of individual studies. Results of data synthesis: Enteral nutrition appears to be less expensive than parenteral nutrition, but new economic analyses are needed given the newer aggressive access techniques for enteral nutrition. Enteral nutrition is associated with meaningful morbidity and mortality. The little comparative data existent suggest no differences in safety. Comparative studies of physiology and metabolism as well as comparative and noncomparative studies of intestinal function and structure do not support putative advantages of enteral nutrition. There is no evidence that enteral nutrition prevents bacterial translocation in humans. Enteral nutrition probably reduces septic morbidity compared with parenteral nutrition in abdominal trauma. Otherwise, there is no evidence that enteral nutrition consistently improves patient outcome compared with parenteral nutrition. Conclusions: With the exception of decreased cost and probable reduced septic morbidity in acute abdominal trauma, the available literature does not support the thesis that enteral nutrition is better than parenteral nutrition in humans. (Journal of Parenteral and Enteral Nutrition 22:167-182, 1998)

Journal of Parenteral and Enteral Nutrition, Vol. 22, No. 3, 167-182 (1998)
DOI: 10.1177/0148607198022003167


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Thomson The Enteral vs Parenteral Nutrition Debate Revisited JPEN J Parenter Enteral Nutr, July 1, 2008; 32(4): 474 - 481. [Abstract] [Full Text] [PDF]

				S.-S. Chen, C. J Torres-Sanchez, N. Hosein, Y. Zhang, D. B. Lacy, C. Chang, and O. P. McGuinness Route-dependent effect of nutritional support on liver glucose uptake Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2005; 289(5): R1319 - R1327. [Abstract] [Full Text] [PDF]

				M. A. Hamilton, M. V. Chapman, M. Mutch, E. Bennett-Guerrero, and M. G. Mythen The Relationship Between a Pentagastrin-Stimulated Gastric Luminal Acid Production Test (Gastrotest) and Enteral Feeding-Related Gastrointestinal Complications in Critically Ill Patients Anesth. Analg., May 1, 2005; 100(5): 1447 - 1452. [Abstract] [Full Text] [PDF]

				J. MacFie Current status of bacterial translocation as a cause of surgical sepsis Br. Med. Bull., December 13, 2004; 71(1): 1 - 11. [Full Text] [PDF]

				P. E Marik and G. P Zaloga Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis BMJ, June 12, 2004; 328(7453): 1407. [Abstract] [Full Text] [PDF]

				S. R. Roberts, D. A. Kennerly, D. Keane, and C. George Nutrition Support in the Intensive Care: Unit Adequacy, Timeliness, and Outcomes Crit. Care Nurse, December 1, 2003; 23(6): 49 - 57. [Full Text] [PDF]

				A. L Buchman Reply to LA Cynober Am. J. Clinical Nutrition, July 1, 2002; 76(1): 256 - 257. [Full Text] [PDF]

				American Society for Parenteral and Enteral Nutrit Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients JPEN J Parenter Enteral Nutr, January 1, 2002; 26(1_suppl): 1SA - 138SA. [PDF]

				C. L Braunschweig, P. Levy, P. M Sheean, and X. Wang Enteral compared with parenteral nutrition: a meta-analysis Am. J. Clinical Nutrition, October 1, 2001; 74(4): 534 - 542. [Abstract] [Full Text] [PDF]

				B. R. Bistrian Update on total parenteral nutrition Am. J. Clinical Nutrition, August 1, 2001; 74(2): 153 - 154. [Full Text] [PDF]

				K. N Jeejeebhoy Total parenteral nutrition: potion or poison? Am. J. Clinical Nutrition, August 1, 2001; 74(2): 160 - 163. [Abstract] [Full Text] [PDF]

				B. Taylor and L. Schallom Bedside Small Bowel Feeding Tube Placement in Critically III Patients Utilizing a Dietitian/Nurse Team Approach Nutr Clin Pract, August 1, 2001; 16(4): 258 - 262. [Abstract] [PDF]

				F. Pacelli, M. Bossola, V. Papa, M. Malerba, C. Modesti, A. Sgadari, R. Bellantone, G. B. Doglietto, C. Modesti, and for the EN-TPN Study Group Enteral vs Parenteral Nutrition After Major Abdominal Surgery: An Even Match Arch Surg, August 1, 2001; 136(8): 933 - 936. [Abstract] [Full Text] [PDF]

				B. R. Bistrian Hyperglycemia and Infection: Which is the Chicken and Which is the Egg? JPEN J Parenter Enteral Nutr, July 1, 2001; 25(4): 180 - 181. [PDF]

				S. Song Chen, C. Donmoyer, Y. Zhang, S. A. Hande, D. B. Lacy, and O. P. McGuinness Impact of Enteral and Parenteral Nutrition on Hepatic and Muscle Glucose Metabolism JPEN J Parenter Enteral Nutr, September 1, 2000; 24(5): 255 - 260. [Abstract] [PDF]

				L. Khaodhiar, B. R. Bistrian, D. Weyandt, W. Karzai, R. Roubenoff, C. Lennon, J. Mason, I. H. Rosenberg, E. Saltzman, D. K. Heyland, et al. Total Parenteral Nutrition for Critically Ill Patients JAMA, October 20, 1999; 282(15): 1423 - 1425. [Full Text] [PDF]

				Y.-M. Yu, R. G. Tompkins, C. M. Ryan, and V. R. Young The Metabolic Basis of the Increase in Energy Expenditure in Severely Burned Patients JPEN J Parenter Enteral Nutr, May 1, 1999; 23(3): 160 - 168. [Abstract] [PDF]

				C. H. Lang, R. A. Frost, J. Ejiofor, D. B. Lacy, and O. P. McGuinness Hepatic production and intestinal uptake of IGF-I: response to infection Am J Physiol Gastrointest Liver Physiol, December 1, 1998; 275(6): G1291 - G1298. [Abstract] [Full Text] [PDF]