Metabolic efficacy of enteral feeding in malnourished cancer and noncancer patients.

Total parenteral nutrition and enteral nutrition are the two available methods for supplementary nutritional support of malnourished patients. Although supplemental alimentation is beneficial in malnourished patients, it is unclear whether malnourished cancer bearing patients are successfully replenished with similar nutritional support. We studied the efficacy of 2 weeks of enteral nutrition on intermediary glucose and protein metabolism in malnourished tumor-bearing (TB) and non-tumor bearing (NTB) patients. Both TB and NTB patients showed equivalent suppression of endogenous glucose production (2.13 +/- 0.23 to 0.35 +/- 0.16 mg/kg/min and 2.35 +/- 0.18 to 0 mg/kg/min), suppression of alanine to glucose conversion (43.8 +/- 10.6% to 0.75 +/- 0.41% and 37.0 +/- 10.7% to 0.11 +/- 0.09%), attainment of positive nitrogen balance (-2.15 +/- 1.18 to 4.26 +/- 1.37 gN/d and -2.25 +/- 0.63 to 4.32 +/- 0.44 gN/d) and suppression of protein catabolism (2.39 +/- 0.13 to 1.10 +/- 0.27 gP/kg/d and 2.23 +/- 0.04 to 1.34 +/- 0.22 gP/kg/d). Following 2 weeks of enteral support, the TB patients differed from the NTB group with significantly elevated lactate levels (80 +/- 8 v 48 +/- 7 mg/L) and depressed plasma glycine levels (264 +/- 12 v 356 +/- 27 mumol/L plasma) and inability to replenish fat stores (triceps skin fold, 7.6 +/- 1.5 to 7.1 +/- 1.5 mm in TB v 5.9 +/- 0.7 to 8.0 +/- 1.2 mm in NTB). A significant reduction in whole body protein synthesis (2.08 +/- 0.19 to 1.84 +/- 0.18 gP/kg/d) in TB patients was obtained while NTB showed no significant change (1.86 +/- 1.3 to 1.91 +/- 0.26 gP/kg/d).(ABSTRACT TRUNCATED AT 250 WORDS)