Feeding strategies to care for patients who transition from enteral nutrient deprivation while on total parenteral nutrition (TPN) to enteral feedings, generally proceed to full enteral nutrition once the gastrointestinal tract recovers; however, an increasing body of literature suggest that a sub-group of patients may actually develop an increased incidence of adverse events, including septicemia and death. To examine this further, we studied the effects of acute refeeding in a mouse model of TPN. Interestingly, refeeding led to some beneficial effects, including prevention in the decline in intestinal epithelial cell (IEC) proliferation. However, refeeding led to a significant increase in mucosal expression of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), as well as an up-regulation in Toll-like receptor 4 (TLR-4). Refeeding also failed to prevent TPN-associated increases in IEC apoptosis, and loss of epithelial barrier function, and failure of Lgr5+ stem cells expression. Transitioning from TPN to enteral feedings led to a partial restoration of the small bowel microbial population. In conclusion, while acute refeeding led to some restoration of normal GI physiology, acute enteral refeeding led to a significant increase in mucosal inflammatory markers, and may suggest future strategies to enteral refeeding should be explored.
- parenteral nutrition
- enteral nutrition
- intestinal epithelial cell proliferation
- tumor necrosis factor-alpha (TNF-α)
- Copyright © 2015, American Journal of Physiology- Gastrointestinal and Liver Physiology