There is a kind of food, which takes ordinary food as raw material and is different from the form of ordinary food. It exists in the form of powder, liquid, etc. Similar to milk powder and protein powder, it can be orally or nasally fed and can be easily digested or absorbed without digestion. It is called “formula food for special medical purposes”, that is, we now use more enteral nutrition clinically.
1. What is enteral nutrition?
Enteral nutrition (EN) is a nutritional support mode that provides various nutrients for the body through the gastrointestinal tract to meet the physiological and pathological needs of the body. Its advantages are that nutrients are directly absorbed and utilized through the intestine, which is more physiological, convenient for administration, and low in cost. It is also helpful to maintain the integrity of intestinal mucosa structure and barrier function.
2. What conditions require enteral nutrition?
All patients with indications for nutritional support and functional and available gastrointestinal tract can receive enteral nutritional support, including dysphagia and mastication; Inability to eat due to disturbance of consciousness or coma; Stable period of digestive tract diseases, such as gastrointestinal fistula, short bowel syndrome, inflammatory bowel disease and pancreatitis; Hypercatabolic state, such as patients with severe infection, surgery, trauma and extensive burns. There are also chronic consumptive diseases, such as tuberculosis, tumor, etc; Preoperative and postoperative nutritional support; Adjuvant treatment of tumor chemotherapy and radiotherapy; Nutrition support for burn and trauma; Liver and kidney failure; Cardiovascular disease; Congenital defect of amino acid metabolism; The supplement or transition of parenteral nutrition.
3. What are the classifications of enteral nutrition?
At the first seminar on the basis of classification of enteral nutrition preparations, Beijing Branch of the Chinese Medical Association proposed a reasonable classification of enteral nutrition preparations, and proposed to divide enteral nutrition preparations into three types, namely amino acid type, whole protein type and component type. Amino acid matrix is a monomer, including amino acid or short peptide, glucose, fat, mineral and vitamin mixture. It is suitable for patients with impaired gastrointestinal digestion and absorption function, but it has poor taste and is suitable for nasal feeding. The whole protein type uses whole protein or free protein as the nitrogen source. It is suitable for patients with normal or near normal gastrointestinal function. It has a good taste, and can be taken orally or given nasally. Component type includes amino acid component, short peptide component, whole protein component, carbohydrate component, long chain triglyceride (LCT) component, medium long chain triglyceride (MCT) component, vitamin component, etc., which are mostly used as supplements or fortifiers for balanced enteral nutrition.
4. How do patients choose enteral nutrition?
Nephrotic patients have increased protein consumption and are prone to negative nitrogen balance, requiring low protein and amino acid rich preparations. The enteral nutrition preparation of kidney disease type is rich in essential amino acids, low in protein content, low in sodium and potassium, which can effectively reduce the burden on the kidney.
The metabolism of aromatic amino acids, tryptophan, methionine, etc. in patients with impaired liver function is blocked, the branched chain amino acids are reduced, and the aromatic amino acids are increased. However, the branched chain amino acids are metabolized by muscles, which do not increase the burden on the liver, and can compete with aromatic amino acids to enter the blood brain barrier, improving liver and brain diseases. Therefore, branched chain amino acids can account for more than 35%~40% of total amino acids in liver disease type nutriments.
After severe burns, the patient’s body temperature rises, hormones and inflammatory factors are released in large quantities, and the body is in a state of high metabolism. Except for the wound, the intestine is one of the main organs with endogenous high metabolism. Therefore, burn nutrition should contain high protein, high energy and easily digestible fat with less liquid.
Enteral nutrition preparations for patients with lung diseases should have high fat content, low carbohydrate content, and protein content only for maintaining lean tissue and anabolism, so as to improve respiratory function.
Due to the influence of chemotherapy, the nutritional status and immune function of patients with malignant tumors are poor, and the tumor tissue uses less fat. Therefore, nutritional preparations with high fat, high protein, high energy and low carbohydrate should be selected, in which glutamine, arginine, MTC and other immune nutrients are added.
Carbohydrates in nutritional preparations for diabetic patients should be oligosaccharides or polysaccharides, plus enough dietary fiber, which is conducive to slowing down the rate and extent of blood sugar rise.
Post time: Sep-14-2022