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Enteral nutrition versus parenteral nutrition—the risks and benefits

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 260–265 (2007)Cite this article

Abstract

The role of nutrition in patient care became a part of mainstream medicine at about the end of the 1960s, with the publication of several papers that showed a benefit of nutritional support in the prevention of complications. At that time, the emphasis was on nutrition given by the parenteral route. Since then, a series of studies that compared parenteral nutrition with enteral nutrition have suggested that the enteral route of feeding causes fewer complications than the parenteral route. A careful review of the data shows that nutritional support can increase the risk of complications when given to well-nourished, obese and hyperglycemic patients. The avoidance of overfeeding and hyperglycemia is, therefore, of paramount importance. In this context, enteral nutrition, for which gastrointestinal tolerance limits overfeeding, can protect the patient.

Key Points

  • Parenteral nutrition is lifesaving for all patients who are unable to eat and/or absorb an oral diet

  • The demographics of the Western population have resulted in an increased incidence of obesity in the general population and in patients in intensive care units

  • Obese, hyperglycemic and diabetic patients are prone to develop infection as a result of hyperglycemia

  • Parenteral nutrition is more likely to cause hyperglycemia and increased sepsis than enteral nutrition

  • Strict glucose control has been shown to reduce the incidence of sepsis and mortality in patients in intensive care units

  • In avoidance of the complications associated with nutritional support, the most important consideration is not the route of administration but the avoidance of excessive energy intake and hyperglycemia

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Author notes

  1. 16 Cardinal Carter Wing, St Michael's Hospital, 30 Bond Street, Toronto, ON M4V 2V5, Canada khushjeejeebhoy@compuserve.com

Authors and Affiliations

  1. KN Jeejeebhoy is a Physician at St Michael's Hospital, Toronto, and Emeritus Professor of Medicine at the University of Toronto, ON, Canada.,

    Khursheed N Jeejeebhoy

Authors
  1. Khursheed N Jeejeebhoy
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The author declares no competing financial interests.

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Jeejeebhoy, K. Enteral nutrition versus parenteral nutrition—the risks and benefits. Nat Rev Gastroenterol Hepatol 4, 260–265 (2007). https://doi.org/10.1038/ncpgasthep0797

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