Enteral nutrition; uncomplicated? Can we achieve the target?

Objective: Enteral nutrition (EN) is safe, well tolerated and efficient nutritional support for patients with functional gastrointestinal (GI) tract. The major problems of EN are intolerance of the nutrition products and problems of achieving the targeted dose. This is a prospective observational study investigating the nutrition related problems, solutions to those problems, and the time for achieving the targeted dose in patients who received EN in our inpatient clinic and intensive care unit. Methods: This prospective study was made between 11/01/2015-11/01/2016. This study evaluated patients demographic findings, nutrition status, daily calculated calories (25 kcal/kg/day), daily calculated protein dose (1.5 gr/kg/day), daily delivered calories, daily delivered protein dose, whether or not additional parenteral nutrition applied, biochemical parameters (blood sugar, Na, K, Ca, Mg, cholesterol, liver function tests, urea, CRP, albumin, prealbumin), intolerance issues, complications and EN termination reasons. Results: Considering 2258 patients hospitalized during this period, a total of 70 patients (3.1%) were applied EN (Female/Male: 30/40, The mean age of the patients was 60±16.5 years). The average application time is 11.5 (2-42) days. Among these patients, 26 had an NRS-2002 score ≥3, and only 6 had a BMI<18.8. The rate of calorie and protein application was lower than the calculated, respectively, 37.14% and 52.8% of the cases. It was observed that 40.54% of total malignant patients were subjected to immunonutrition. There were GI tract related problems in 20 patients. Diarrhea was the most important problem during enteral support. Oral supplementation intolerance problem was observed in 20% of the population. Hyperglycemia was detected in 35.7% of the patients, and more than half of them were between 200-300 mg/dL levels. Almost 53% of the patients had malignancy, however, only 5 of them had prescription for oral supplementation during discharge. Conclusion: EN was performed less than required with inaccurate calories and protein intake, and immunonutrition protocols in malignant patients are not properly complied and oral supplement prescription for those patients is rarely given after hospital discharge. Additionally, product intolerance is seriously frequent, and product and dosage changes should be done more actively.