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1 Medical College of Virginia and Virginia Commonwealth University and 2 McGuire Veterans Administration Hospital, Richmond, Virginia 23298; and 3 University of Rochester, Rochester, New York 14642
In the nutritional management of
digestive disorders, it is important to know the relative secretory and
metabolic responses to enteral and parenteral feeding. Twenty-seven
healthy volunteers were studied while receiving either oral drinks or
duodenal infusions of a complex formula diet, duodenal or intravenous
infusions of elemental (protein as free amino acids, low fat) formulae,
or saline. Pancreaticobiliary secretory responses were measured by nasoduodenal polyethylene glycol perfusion and aspiration, while monitoring blood hormone and nutrient levels. Diets were matched for
protein (1.5 g · kg
1 · d1)
and energy (40 kcal · kg1 · d1).
Compared with placebo, all oroenteral diets stimulated amylase, lipase,
trypsin, and bile acid secretion and increased plasma concentrations of
gastrin and cholecystokinin, whereas intravenous feeding did not. The
complex formula produced a similar response whether given as drinks or
duodenal infusions. Changing the duodenal formula to elemental reduced
enzyme secretion by 50%, independently of CCK. Higher increases in
plasma insulin, glucose, and amino acids were noted with intravenous
feeding. Delivering food directly to the intestine by a feeding tube
does not reduce pancreaticobiliary secretion. Enteral "elemental"
formulae diminish, but only intravenous feeding avoids pancreatic
stimulation. Intravenous administration impairs metabolic clearance.
pancreatic enzyme secretion; enteral and parenteral nutrition
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