Hospitalized patients have great difficulties in maintaining an adequate nutritional condition. According to the Brazilian Society of Parenteral and Enteral Nutrition, about 30% of these patients become malnourished within the first 48 hours of hospitalization. Up to the seventh day of hospitalization, this percentage can reach 45%, especially those affected by severe infections, trauma, or newly operated patients.
One of the effects of malnutrition is the loss of lean mass, which increases the risk of infection, decreases scarring, and increases mortality risk. To avoid this condition, normalize protein synthesis, achieve nitrogen balance and, finally, recover the patient’s nutritional status, multidisciplinary teams resort to Nutritional Therapy (NT).
In nutritional therapy, special purpose diets are administered through the mouth, nasal tube, or stoma (stomach, intestines), which configures Enteral Nutrition (EN). However, when the passage of food through the digestive system cannot be performed, Parenteral Therapy (PT/PN) is an alternative, using the intravenous route to administer the food in the form of a particular parenteral solution.
“EN is composed of nutrients that need to go through the digestion and absorption processes used by the body. On the other hand, PN contains nutrients ready to be used by the body”, explains nutritionist Erica Serra from the Scientific Department of Prodiet Nutrição Clínica. “Both have the same objective, which is to nourish the patient to prevent or treat cases of malnutrition and its complications.”
Physicians and nutritionists prescribe nutritional therapy and type of administration according to criteria such as clinical status, age, risk of complications, and expected time for treatment. It is up to the health professional to evaluate the best option for each patient. Erica also explains the appropriate use of PN or EN becomes an essential instrument for the individual’s recovery.
Enteral nutrition (EN) is a particular type of food used to supplement conventional food or replace meals for an individual who:
– Presents a nutritional risk or some degree of malnutrition.
– Is unable to eat orally.
– Has a functioning digestive tract.
– Presents some problem in the process of digestion or absorption of nutrients.
– Has some particular needs due to pathology (such as diabetes, renal failure, and oncology, among others).
“The oral route is always preferred. If it is not possible to nourish the patient this way, the second option is by tube”, explains nutritionist Erica Serra.
Parenteral nutrition (PN) is the supply of nutrients intravenously (through the vein) in a patient who:
– Has nutritional risk or some degree of malnutrition.
– Has a non-functioning digestive tract.
– Presents severe trauma that makes oral or tube feeding impossible.
– Presents a stable hemodynamic state, that is, the blood circulation is normalized.
The choice between enteral or parenteral nutrition therapy is a multidisciplinary team decision that considers several factors, the main one being the clinical condition of each patient.