|VAN GOUDOEVER, JOHANNES|
|Burrin, Douglas - Doug|
Submitted to: Journal of Parenteral and Enteral Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/4/2006
Publication Date: 2/1/2006
Citation: Stoll, B., Price, P.T., Reeds, P.J., Chang, X., Henry, J.F., Van Goudoever, J.B., Holst, J.J., Burrin, D.G. 2006. Feeding an elemental diet vs a milk-based formula does not decrease intestinal mucosal growth in infant pigs. Journal of Parenteral and Enteral Nutrition. 30(1):32-39.
Interpretive Summary: The provision of oral nutrition is critical for normal gut development in infants and children. However, children are often unable to consume food by mouth due to intestinal problems and require special diets, referred to as element nutrition. Elemental diets are composed of nutrients in their basic chemical forms, such as sugars and amino acids, rather than as they exist in foods as complex carbohydrates and protein. Elemental diets are used to provide the gut a period of rest during intestinal disease, such as inflammatory bowel problems. Previous studies suggested that elemental diets do not provide the needed growth stimulus that occurs with normal foods. We tested this hypothesis in neonatal piglets, a well established model for human infants, fed either an elemental diet or a milk-based formula for a week. We found that the key measures of gut growth, such as weight and mucosal structure were not different between the elemental and formula diets, even though the element diet produced greater effects on some measures of cell growth, such as cell division and protein synthesis. This study suggests that elemental diets provide the needed stimulus for normal gut growth in infants and children.
Technical Abstract: BACKGROUND: We previously showed that the level of enteral nutrient intake determines the rate of intestinal growth in piglets. Our objective was to determine whether providing enteral nutrition in the form of elemental nutrients (glucose, amino acids, lipid [ED]) rather than cow's milk formula (lactose, protein, lipid [FORM]) reduces small intestinal growth and lactase activity. METHODS: Three-week-old piglets were fed either ED (n = 7) intragastrically or FORM (n = 6) orally for 6 days. RESULTS: Intestinal protein and DNA masses, villus height, and crypt depth were not different in ED and FORM pigs. Crypt cell proliferation, measured by in vivo bromodeoxyuridine labeling, was significantly (p < .05) higher (+37%) in ED than in FORM pigs. Rates of mucosal protein synthesis (%/d), measured by in vivo 2H-leucine incorporation, were higher (p < .05) in ED than FORM (147 vs 89) pigs. Circulating concentrations (pmol/L) of the intestinotrophic peptide, glucagon-like peptide-2 (GLP-2), were also higher (p < .05) in ED than in FORM (148 vs 87) pigs. The mean lactase-specific activity (micromol/min/g) in proximal and distal segments was higher (p < .05) in FORM than in ED (124 vs 58) pigs. CONCLUSIONS: We conclude that intestinal mucosal growth and villus morphology are similar in pigs fed ED and FORM, despite higher cell proliferation and protein synthesis rates and lower lactase activity with ED. This implies that elemental diets may be as trophic as polymeric formulas to simultaneously provide nutrition and a stimulus for intestinal growth during bowel rest.