Enteral nutrition support

Up to 33% of patients who are admitted to hospitals with hronic disease and trauma also present with moderate to evere malnutrition. This results in depletion of body cell mass, rolonged wound healing, and impaired function [1]. Malnurition is defined as unintentional weight loss of more than 10% f an individual’s body weight. It is classified as mild, modrate, or severe based on body mass index, arm muscle cirumference, skin fold thickness, and depletion of visceral proein stores (e.g., albumin, prealbumin, and retinol-binding rotein). The etiology of malnutrition can be subdivided into our continuous types: 1) decrease in nutrient intake (poor diet, ating difficulty) or excessive losses (long-term diarrhea, abormal bleeding, large draining wounds), 2) nutrient store epletion, 3) increased metabolic demand (i.e., hypercataboism), and 4) cell or tissue damage [1,2]. Prolonged starvation leads to deterioration of intestinal ntegrity. Within a few days of complete bowel rest, proressive atrophy and disruption of the intestinal mucosa ccur. With severe protein deficiency, microvilli of the ntestinal mucosa undergo shortening, resulting in generalzed disruption of the surface architecture [3]. Of particular mportance is the amino acid glutamine which is the prinipal metabolic fuel for intestinal epithelial cells [4]. Lack of luminal nutrient substrates followed by mucosal isruption is also associated with the process of bacterial ranslocation. In critically ill patients, prolonged bowel rest ay lead to loss of endothelial architecture and integrity, hereby allowing the enteric pathogens to migrate across the ffected bowel mucosa and into the systemic circulation [5]. he correction and prevention of malnutrition decreases orbidity, hospital stay, mortality rate, and recovery time rom illness [6,7]. Artificial nutritional support refers to the administration f nutrient solutions by enteral or intravenous (parenteral)