Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients

Steven N. Hochwald, Lawrence E. Harrison, Martin J. Heslin, Michael E. Burt, Murray F. Brennan

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

BACKGROUND: Patients with upper gastrointestinal (GI) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enteral feeding in upper GI cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enteral feeding and compared it with standard postoperative care (ie, intravenous fluid). METHODS: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, μmol leu/kg/min) protein kinetics. RESULTS: Respiratory quotient and insulin (μU/mL) levels were significantly increased in patients receiving enteral feeding (0.85 ± 0.02, 19.8 ± 4.5 versus 0.78 ± 0.02, 9.3 ± 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 ± 0.04) as compared with IVF group (0.85 ± 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 ± 0.01 versus 0.10 ± 0.02) or synthesis (0.81 ± 0.09 versus 0.68 ± 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 ± 0.10 versus 0.37 ± 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (-0.10 ± 0.01 versus 0.30 ± 0.03, IVF versus FEED, P < 0.001). CONCLUSIONS: Early enteral feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper GI cancer patients.

Original languageEnglish (US)
Pages (from-to)325-330
Number of pages6
JournalAmerican Journal of Surgery
Volume174
Issue number3
DOIs
StatePublished - Sep 1 1997
Externally publishedYes

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Gastrointestinal Neoplasms
Enteral Nutrition
Proteins
Upper Gastrointestinal Tract
Jejunostomy
Morbidity
Mortality
Postoperative Care
Nonesterified Fatty Acids
Leucine
Malnutrition
Isotopes
Energy Metabolism
Neoplasms
Nitrogen
Fats
Insulin

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Hochwald, Steven N. ; Harrison, Lawrence E. ; Heslin, Martin J. ; Burt, Michael E. ; Brennan, Murray F. / Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients. In: American Journal of Surgery. 1997 ; Vol. 174, No. 3. pp. 325-330.
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abstract = "BACKGROUND: Patients with upper gastrointestinal (GI) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enteral feeding in upper GI cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enteral feeding and compared it with standard postoperative care (ie, intravenous fluid). METHODS: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, μmol leu/kg/min) protein kinetics. RESULTS: Respiratory quotient and insulin (μU/mL) levels were significantly increased in patients receiving enteral feeding (0.85 ± 0.02, 19.8 ± 4.5 versus 0.78 ± 0.02, 9.3 ± 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 ± 0.04) as compared with IVF group (0.85 ± 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 ± 0.01 versus 0.10 ± 0.02) or synthesis (0.81 ± 0.09 versus 0.68 ± 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 ± 0.10 versus 0.37 ± 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (-0.10 ± 0.01 versus 0.30 ± 0.03, IVF versus FEED, P < 0.001). CONCLUSIONS: Early enteral feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper GI cancer patients.",
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Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients. / Hochwald, Steven N.; Harrison, Lawrence E.; Heslin, Martin J.; Burt, Michael E.; Brennan, Murray F.

In: American Journal of Surgery, Vol. 174, No. 3, 01.09.1997, p. 325-330.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early postoperative enteral feeding improves whole body protein kinetics in upper gastrointestinal cancer patients

AU - Hochwald, Steven N.

AU - Harrison, Lawrence E.

AU - Heslin, Martin J.

AU - Burt, Michael E.

AU - Brennan, Murray F.

PY - 1997/9/1

Y1 - 1997/9/1

N2 - BACKGROUND: Patients with upper gastrointestinal (GI) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enteral feeding in upper GI cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enteral feeding and compared it with standard postoperative care (ie, intravenous fluid). METHODS: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, μmol leu/kg/min) protein kinetics. RESULTS: Respiratory quotient and insulin (μU/mL) levels were significantly increased in patients receiving enteral feeding (0.85 ± 0.02, 19.8 ± 4.5 versus 0.78 ± 0.02, 9.3 ± 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 ± 0.04) as compared with IVF group (0.85 ± 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 ± 0.01 versus 0.10 ± 0.02) or synthesis (0.81 ± 0.09 versus 0.68 ± 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 ± 0.10 versus 0.37 ± 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (-0.10 ± 0.01 versus 0.30 ± 0.03, IVF versus FEED, P < 0.001). CONCLUSIONS: Early enteral feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper GI cancer patients.

AB - BACKGROUND: Patients with upper gastrointestinal (GI) tract malignancies are at increased risk for malnutrition, as well as postoperative morbidity and mortality. As data clearly documenting the benefit of early postoperative enteral feeding in upper GI cancer patients as compared with no feeding are sparse, we examined the protein kinetic effects of early enteral feeding and compared it with standard postoperative care (ie, intravenous fluid). METHODS: Twenty-nine patients undergoing resection of an upper GI tract malignancy were prospectively randomized to either enteral feeding (FEED, n = 12) starting on postoperative day (POD) 1 via a jejunostomy tube or intravenous fluid (IVF, n = 17). On POD 5, all patients underwent resting energy expenditure determination and a protein metabolic study using the isotope 14C-leucine to determine whole body (WB, μmol leu/kg/min) protein kinetics. RESULTS: Respiratory quotient and insulin (μU/mL) levels were significantly increased in patients receiving enteral feeding (0.85 ± 0.02, 19.8 ± 4.5 versus 0.78 ± 0.02, 9.3 ± 0.8, FEED versus IVF, P < 0.05). Free fatty acids (meq/dL) were significantly lower in FEED group (0.36 ± 0.04) as compared with IVF group (0.85 ± 0.07, P < 0.0001). While there were no significant differences in WB protein oxidation (0.10 ± 0.01 versus 0.10 ± 0.02) or synthesis (0.81 ± 0.09 versus 0.68 ± 0.08, IVF versus FEED), WB protein catabolism was significantly less (0.91 ± 0.10 versus 0.37 ± 0.09, P = 0.002), and WB protein net balance was converted to positive in FEED group (-0.10 ± 0.01 versus 0.30 ± 0.03, IVF versus FEED, P < 0.001). CONCLUSIONS: Early enteral feeding decreases fat oxidation and whole body protein catabolism while improving net nitrogen balance. By significantly improving protein metabolism, enteral feeding may decrease postoperative morbidity and mortality in upper GI cancer patients.

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