Continuous vs Discontinuous Enteral Nutrition: Compared Effects on Serum Lipids and Lipoproteins in Humans

Abstract

The present study was designed to assess the cholesterol-lowering effect of enteral nutrition when administered either as discontinuous or as continuous infusion. Twelve neurologic patients were randomly assigned to receive exclusive continuous (n = 6) or discontinuous (n = 6) enteral feeding for 7 days. Serum lipids, apoproteins, and 24-hour urinary C-peptide concentrations were determined on days 0 and 7. The fall during continuous nutrition was significantly greater than that during discontinuous nutrition for serum cholesterol (14% vs 2.4%; p < .05), low-density lipoprotein cholesterol (17.4% vs 3.9%; p = .02), and apoprotein B (19% vs 0.2%; p < .05) concentrations. Mean 24-hour urinary C-peptide excretion increase was significantly greater (p < .05) during discontinuous (78%) than during continuous enteral nutrition (15.6%). These results suggest that the cholesterol-lowering effect of enteral nutrition was induced mainly by the continuous delivery of the nutrients and was related to changes in insulin secretion. (Journal of Parenteral and Enteral Nutrition 18:331–334, 1994)

Get full access to this article

View all access options for this article.

References

1. Rombeau JL , Caldwell MD , eds: Clinical Nutrition. IN Enteral and Tube Feeding, 2nd ed. WB Saunders Company, Philadelphia, 1990.

2. Silk DBA : Toward the optimization of enteral nutrition. Clin Nutr 6:61–74, 1987.

3. Mattson FH , Pearson J , Cortez S : Liquid formula diet for human metabolic studies. Am J Clin Nutr 36:1087–1088, 1982.

4. Grundy SM : Comparison of monounsaturated fatty acids and carbohydrates for lowering plasma cholesterol. N Engl J Med 314:745–748, 1986.

5. Matuchansky C , Fabre J , Guillard O, et al : A. Effects of cyclic (nocturnal) total parenteral nutrition and continuous enteral nutrition on circadian rhythms of blood lipids, lipoproteins and apolipoproteins in humans. Am J Clin Nutr 41:727–731, 1985.

6. Heymsfield SB , Hill JO , Evert M, et al : Energy expenditure during continuous intragastric infusion of fuel. Am J Clin Nutr 45:526–533, 1987.

7. Heymsfield SB , Casper K : Continuous nasoenteric feeding: Bioenergetic and metabolic response during recovery from semistarvation. Am J Clin Nutr 47:900–910, 1988.

8. Nacht CA , Schutz Y , Vernet O, et al : Continuous versus single bolus enteral nutrition: Comparison of energy metabolism in humans. Am J Physiol (Endocrinol Metab 14) 251:E524–E529, 1986.

9. Beau P , Tallineau C , Barbieux JP, et al : Cholesterol-lowering effect of continuous enteral nutrition in man. Clin Nutr 10:279–283, 1991.

10.

10. Goldberg AC , Schonfeld G : Effects of diet on lipoprotein metabolism. Ann Rev Nutr 5:195–212, 1985.

11.

11. Havel RJ : Lowering cholesterol, 1988. J Clin Invest 81: 1653–1660, 1988.

12.

12. Hopkins PN : Effects of dietary cholesterol on serum cholesterol: A meta-analysis and review. Am J Clin Nutr 55: 1060–1090, 1992.

13.

13. Jenkins DJA , Wolever TMS , Vuksan V et al : Nibbling versus gorging: Metabolic advantages of increased meal frequency. N Engl J Med 321:929–934, 1989.

14.

14. Beau P , Fabre J , Abitbol JL, et al : Nutrition entérale continue ambulatoire à l'hopital, chez Fadulte: Expérience prospective chez 98 malades. Gastroenterol Clin Biol 10:134–140, 1986.

15.

15. Burstein M , Legman P , ed: Lipoprotein precipitation. Monographs on Atherosclerosis (vol II). Kanger Bale, 1982.

16.

16. Friedewald WT , Levy RI , Fredrickson DS : Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 18:499–502, 1972.

17.

17. Fievet-Desreumaux C , Dedonder E , Dewailly P, et al : Immunochemical determination of human apolipoprotein Al by laser nephelometry. Clin Chem Acta 107:145–148, 1980.

18.

18. Fievet-Desreumaux C , Dedonder E , Fruchard JC, et al : Immunochemical determination of human apolipoprotein B by laser nephelometry. Clin Chem Acta 95:405–408, 1979.

19.

19. Dietschy JM , Brown MS : Effect of alterations of the specific activity of the intracellular acetyl CoA pool on apparent rates of hepatic cholesterologenesis. J Lipid Res 15:508–516, 1974.

20.

20. Mc Namara DJ , Kolb R , Parker TS, et al : Heterogeneity of cholesterol homeostasis in man. J Clin Invest 79: 1729–1739, 1987.

21.

21. Ciocon JO , Galindo-Ciocon DJ , Tiessen C, et al : Continuous compared with intermittent tube feeding in the elderly. JPEN 16:525–528, 1992.

22.

22. Pinchcofsky-Devin GD , Kaminski MV : Visceral protein increase associated with interrupted vs continuous enteral hyperalimentation. JPEN 9:474–476, 1985.

23.

23. Campbell IT , Morton RP , Cole JA, et al : A comparison of the effects of intermittent and continuous nasogastric feeding on the oxygen consumption and nitrogen balance of patients after major head and neck surgery. Am J Clin Nutr 38:870–878, 1983.

24.

24. Campbell IT , Morton RP , Macdonald IA, et al : Comparison of the metabolic effects of continuous postoperative enteral feeding and feeding at night only. Am J Clin Nutr 52: 1107–1112, 1990.

25.

25. Roongpisuthipong C , Heysmfield SB , Casper C, et al : Continuous nasoenteral feeding: Inverse relation between infusion rate and serum levels of bilirubin. JPEN 11:544–547, 1987.