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Diet and Nutrition 2023

Enteral diet: what it is for, types and how to feed

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Enteral diet: what it is for, types and how to feed
Enteral diet: what it is for, types and how to feed
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Enteral diet, also known as enteral nutrition, is a type of feeding that allows you to administer all nutrients, or part of them, through the digestive system when the person cannot consume a normal diet, either because it is necessary to ingest more calories, because it is not possible to eat orally, or because it is necessary to let the digestive system rest.

This type of nutrition is given through a tube, known as a feeding tube, which is usually placed from the nose or mouth to the stomach or intestine. Its length and place where it is inserted varies according to the underlying disease, the general state of he alth of the person, the estimated duration and the objective to be achieved.

Another less common way of administering the enteral diet is through a gastrostomy, in which the tube is placed directly from the skin to the stomach, being indicated when this type of feeding needs to be done for more than 4 weeks, as in cases of people with advanced Alzheimer's. Understand better what gastrostomy is and when it is indicated.

What is it for

The enteral diet is used when it is necessary to administer more calories and these cannot be supplied by the usual diet, or when some disease does not allow the consumption of calories orally. However, the intestine must be working properly.

Some situations where enteral nutrition can be administered are:

  • Premature infants less than 24 weeks;
  • Respiratory distress syndrome;
  • Malformations of the gastrointestinal tract;
  • Trauma to the head;
  • Short bowel syndrome;
  • Acute pancreatitis in recovery phase;
  • Chronic diarrhea and inflammatory bowel disease;
  • Burns or caustic esophagitis;
  • Malabsorption Syndrome;
  • Severe malnutrition;
  • Eating disorders such as anorexia nervosa.

In addition, this type of nutrition can also be used as a transition between parenteral nutrition, which is placed directly into the vein, and oral feeding, in order to gradually adapt the gastric system. See what parenteral nutrition is and when it is indicated.

Types of enteral diet

There are several ways to administer the enteral diet through the tube:

Probe types What is Advantages Disadvantages
Nasogastric This is a tube inserted through the nose into the stomach. It is the most used route because it is the easiest to place. May cause nasal, esophageal or tracheal irritation; may move around when coughing or vomiting and may cause nausea.
Orogastric and oroenteric It is placed from the mouth to the stomach or intestine. Does not obstruct the nose, being the most used in newborns. May lead to increased saliva production.
Nasoenteric It is a tube placed from the nose to the intestine, which can be placed into the duodenum or jejunum. It is easier to move; is better tolerated; decreases the possibility of the tube becoming obstructed and causes less gastric distention. Decreases the action of gastric juices; presents risk of intestinal perforation; limits the selection of formulas and feeding schemes.
Gastrostomia It is a tube that is placed directly on the skin up to the stomach. Does not obstruct the airway; allows the use of larger diameter probes and is easier to manipulate. Needs to be placed by surgery; can cause increased reflux; can cause skin infection and irritation; presents risk of abdominal perforation.
Duodenostomy and jejunostomy The probe is placed directly from the skin to the duodenum or jejunum. Reduces the risk of aspiration of gastric juices into the lung; allows for food after gastric surgery. More difficult to place, requiring surgery; presents a risk of tube obstruction or rupture; can cause diarrhea; needs an infusion pump.

This type of feeding can be administered with a syringe, known as a bolus, or through the force of gravity or an infusion pump.

The ideal is that enteral feeding is administered at least every 3 - 4 hours, but there are cases where feeding can be done continuously, with the help of an infusion pump. These types of pumps mimic bowel movements, making food better tolerated, especially when the tube is inserted into the intestine.

How to feed a person on an enteral diet

The food and the amount to be administered will depend on some factors, such as age, nutritional status, needs, disease and the functional capacity of the digestive system. However, it is normal to start feeding with a low volume of 20 mL per hour, which gradually increases.

Nutrients can be given through a crushed diet or through enteral formula:

1. Crushed diet

Consists in the administration of crushed and strained food, through the probe. In this case, the nutritionist must calculate in detail the diet, as well as the volume of food and the time at which it should be administered. In this diet it is common to include vegetables, tubers, lean meats and fruits.

The nutritionist may also consider supplementing the diet with an enteral formula, to ensure a sufficient supply of all nutrients, preventing possible malnutrition.

Although it is closer to the classic diet, this type of nutrition has a greater risk of contamination by bacteria, which can end up limiting the absorption of some nutrients. In addition, as it consists of crushed foods, this diet also presents a greater risk of tube obstruction.

2. Enteral formulas

There are several ready-made formulas that can be used to suppress the needs of people undergoing enteral nutrition, which include:

  • Polymeric: are formulas that have all nutrients, including proteins, carbohydrates, fats, vitamins and minerals.
  • Semi elemental, oligomeric or semi-hydrolyzed: these are formulas whose nutrients are pre-digested, being easier to absorb at the intestinal level;
  • Elementary or hydrolysed: they have all the simple nutrients in their composition, being very easy to absorb at the intestinal level.
  • Modular: are formulas that contain only one macronutrient such as protein, carbohydrates or fat. These formulas are especially used to increase the amount of a specific macronutrient.

Besides these, there are also other special formulas whose composition is adapted to some chronic diseases such as diabetes, liver problems or kidney disorders.

Possible complications

During the enteral diet, some complications may arise, from mechanical problems, such as tube obstruction, to infections, such as aspiration pneumonia, or even gastric rupture, for example.

Metabolic complications or dehydration, vitamin and mineral deficit, high blood sugar or electrolyte imbalance can also arise. In addition, cases of diarrhea, constipation, abdominal distension, reflux, nausea or vomiting may also occur.

However, all these complications can be avoided if there is supervision and guidance from a doctor, as well as proper handling of the tube and feeding formulas.

When not to use

Enteral diet is contraindicated for patients at high risk of bronchoaspiration, i.e., tube fluid may enter the lungs, which is more common in people who have difficulty swallowing or who suffer from severe reflux.

In addition, enteral nutrition should also be avoided in people who are decompensated or unstable, who have chronic diarrhea, intestinal obstruction, frequent vomiting, gastric hemorrhage, necrotizing enterocolitis, acute pancreatitis or in cases where there is an intestinal atresia. In all these cases, the best option is usually the use of parenteral nutrition. See what this type of nutrition consists of.

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