The enteral diet, also known as enteral nutrition, is a type of food that allows all or part of the nutrients to be administered through the digestive system when the person cannot consume a normal diet, either because it is necessary to ingest more calories, or because they cannot It is possible to feed orally, or because it is necessary to let the digestive system rest.
This type of nutrition is administered through a tube, known as a feeding tube, which is usually placed from the nose, or mouth, to the stomach, or intestine. Its length and place where it is inserted varies according to the underlying disease, the person’s general health status, the estimated duration and the objective to be achieved.
Another less common way of administering the enteral diet is through a gastrostomy, in which the tube is placed directly from the skin to the stomach, being indicated when this type of feeding needs to be done for more than 4 weeks, as happens in cases of people with advanced Alzheimer’s. Understand better what gastrostomy is and when it is indicated.
What is it for
The enteral diet is used when it is necessary to administer more calories and these cannot be supplied by the usual diet, or when a disease does not allow the consumption of calories orally. However, the intestine needs to be working properly.
Some situations where enteral nutrition can be administered are:
- Preterm babies under 24 weeks;
- Respiratory distress syndrome;
- Malformations of the gastrointestinal tract;
- Head trauma;
- Short bowel syndrome;
- Acute pancreatitis in the recovery phase;
- Chronic diarrhea and inflammatory bowel disease;
- Burns or caustic esophagitis;
- Malabsorption syndrome;
- Severe malnutrition;
- Eating disorders, such as anorexia nervosa.
Furthermore, this type of nutrition can also be used as a transition between parenteral nutrition, which is placed directly into the vein, and oral nutrition, in order to gradually adapt the gastric system. See what parenteral nutrition is and when it is indicated.
Types of enteral diet
There are several ways to administer the enteral diet through the tube:
This type of food can be administered with a syringe, known as a bolus, or through the force of gravity or an infusion pump.
Ideally, enteral feeding should be administered at least every 3 – 4 hours, but there are cases in which feeding can be done continuously, with the help of an infusion pump. This type of pump imitates bowel movements, making food better tolerated, especially when the tube is inserted into the intestine.
How to feed someone with an enteral diet
The food and quantity to be administered will depend on some factors, such as age, nutritional status, needs, illness and the functional capacity of the digestive system. However, it is normal to start feeding with a low volume of 20 mL per hour, which is gradually increased.
Nutrients can be given through a crushed diet or through enteral formulas:
1. Crushed diet
It consists of administering crushed and strained food through the probe. In this case, the nutritionist must calculate the diet in detail, as well as the volume of food and the time at which it should be administered. In this diet it is common to include vegetables, tubers, lean meats and fruits.
The nutritionist may also consider supplementing the diet with an enteral formula, to ensure a sufficient supply of all nutrients, preventing possible malnutrition.
Although it is closer to classic food, this type of nutrition has a greater risk of contamination by bacteria, which can end up limiting the absorption of some nutrients. Furthermore, as it consists of crushed foods, this diet also presents a greater risk of tube obstruction.
2. Whole formulas
There are several ready-made formulas that can be used to meet the needs of people undergoing enteral nutrition, which include:
- Polymeric: These are formulas that contain all nutrients, including proteins, carbohydrates, fats, vitamins and minerals.
- Semi-elementaryoligomeric or semi-hydrolyzed: these are formulas whose nutrients are pre-digested, making them easier to absorb at the intestinal level;
- Elementary or hydrolyzed: they have all the simple nutrients in their composition, being very easy to absorb in the intestine.
- Modular: are formulas that contain only one macronutrient such as proteins, carbohydrates or fats. These formulas are used especially to increase the amount of a specific macronutrient.
In addition to these, there are other special formulas whose composition is adapted to some chronic diseases such as diabetes, liver problems or kidney problems.
Possible complications
During enteral feeding, some complications may arise, from mechanical problems, such as tube obstruction, to infections, such as aspiration pneumonia, or even gastric rupture, for example.
Metabolic complications or dehydration, vitamin and mineral deficits, increased blood sugar or electrolyte imbalance may also arise. In addition, cases of diarrhea, constipation, abdominal distension, reflux, nausea or vomiting may also occur.
However, all these complications can be avoided if there is supervision and guidance from a doctor, as well as proper handling of the tube and feeding formulas.
When it should not be used
The enteral diet is contraindicated for patients at high risk of bronchoaspiration, that is, the liquid from the tube can enter the lungs, which is more common in people who have difficulty swallowing or who suffer from severe reflux.
Furthermore, enteral nutrition should also be avoided in people who are decompensated or unstable, who have chronic diarrhea, intestinal obstruction, frequent vomiting, gastric hemorrhage, necrotizing enterocolitis, acute pancreatitis or in cases where there is intestinal atresia. In all these cases, the best option is generally the use of parenteral nutrition. See what this type of nutrition consists of.
