Predicting enteral nutrition-associated diarrhea with easily available clinical and biochemical parameters

Background: Artificial nutrition is now widely recognized as a medical treatment for patients unable to spontaneously meet their energy and protein requirements. Its efficacy may be limited, however, by the development of complications that may worsen the clinical status of the patients. During enteral nutrition, diarrhea frequently occurs, even if its pathogenic mechanisms are now better understood and enhanced delivery protocols have been implemented. Aim: We aimed at assessing whether the risk of developing enteral nutrition-associated diarrhea could be predicted by means of easily available and retrievable clinical and functional factors. Methods: The clinical records of 221 patients admitted to a rehabilitation center between 1999 and 2005 and receiving enteral nutrition or combined enteral+parenteral nutrition were retrospectively examined. Biographical (age, sex), clinical (comorbidity, quality of life, frailty) and nutritional parameters (anthropometry, biochemical markers, type of malnutrition) were collected if registered before the start of enteral nutrition/enteral+parenteral nutrition, and correlated with the development of diarrhea within the first 30 days of artificial nutrition. Results: Severe frailty and low circulating levels of cholinesterase at baseline were positively correlated with increased incidence of diarrhea during enteral nutrition/enteral+parenteral nutrition. Hypoalbuminemia did not correlate with the presence of diarrhea. Conclusions: Frailty class and circulating cholinesterase levels may represent useful markers to predict diarrhea when prescribing enteral nutrition or enteral+parenteral nutrition. Prospective clinical trials are needed to strengthen these results and translate them into clinical practice. © 2011 SINPE-GASAPE.