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American Journal of Clinical Nutrition, Vol. 71, No. 6, 1603-1610, June 2000
© 2000 American Society for Clinical Nutrition

Original Research Communications

Minimal enteral nutrient requirements for intestinal growth in neonatal piglets: how much is enough?1,2,3,4

Douglas G Burrin, Barbara Stoll, Ruhong Jiang, Xiaoyan Chang, Bolette Hartmann, Jens Juul Holst, George H Greeley, Jr and Peter J Reeds

1 From the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston; the Department of Medical Physiology, the Panum Institute, University of Copenhagen; the Department of Surgery, the University of Texas Medical Branch, Galveston; and Texas Children's Hospital, Houston.

Background: Parenterally nourished preterm infants commonly receive minimal enteral feedings, the aim being to enhance intestinal function. Whether this regimen increases intestinal growth has not been established.

Objective: Our objective was to determine the minimal enteral nutrient intakes necessary to stimulate and to normalize neonatal intestinal growth.

Methods: Intestinal growth and cell proliferation were quantified in neonatal pigs given equal amounts of an elemental nutrient solution for 7 d. Different groups (n = 5–7 per group) received 0%, 10%, 20%, 40%, 60%, 80%, or 100% of total nutrient intake enterally, with the remainder given parenterally.

Results: In the jejunum, wet weight, protein mass, and villus height were significantly greater at enteral intakes >40%. Stimulation of ileal protein mass required a higher enteral intake (60%). In both segments, abrupt increases in DNA mass, crypt depth, ornithine decarboxylase activity, and crypt cells in S-phase occurred between enteral intakes of 40% and 60%. Circulating concentrations of glucagon-like peptide-2 and peptide YY, but not gastrin, increased significantly between enteral intakes of 40% and 60% and closely paralleled indexes of cell proliferation.

Conclusions: The minimal enteral nutrient intake necessary to increase mucosal mass was 40% of total nutrient intake, whereas 60% enteral nutrition was necessary to sustain normal mucosal proliferation and growth. Our results imply that providing <40% of the total nutrient intake enterally does not have significant intestinal trophic effects.

Key Words: Cell proliferation • glucagon-like peptide-2 • GLP-2 • PYY • peptide YY • total parenteral nutrition • enteral nutrition • minimal enteral feeding • preterm infants • premature infants • low-birth-weight infants • neonatal nutrition • neonatology




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