Enteral feeding and gut atrophy

Area of Science:

• Gastroenterology
• Nutrition Science
• Cellular Biology

Background:

• Enteral feeding is hypothesized to prevent intestinal mucosal atrophy and bacterial translocation during fasting or malnutrition.
• Parenteral nutrition alone can lead to significant intestinal mucosal mass reduction in animal models, but human relevance is unclear.

Purpose of the Study:

• To review recent findings (last 2 years) on the dilemma of enteral versus parenteral nutrition regarding intestinal mucosal atrophy.
• To evaluate the evidence for enteral feeding's role in preventing mucosal atrophy in humans.

Main Methods:

• Review of scientific literature published within the last two years.
• Analysis of studies conducted in animal models (rats, pigs) and human subjects.

Main Results:

• Animal studies in rats and pigs confirm mucosal atrophy with fasting, with some hormonal and glutamine effects corroborated but lacking proper controls.
• In humans, significant mucosal atrophy is not consistently observed, with only modest decreases reported in catabolic states; enteral feeding has not shown evidence of reversal.
• Emerging evidence in both animals and humans points to specific gene adaptations occurring during fasting and malnutrition, irrespective of mucosal atrophy.

Conclusions:

• The emphasis on mucosal atrophy may overshadow simultaneous adaptive processes.
• Investigating gene adaptation during fasting and malnutrition holds promise for developing future therapeutic interventions.