PD333 - CLINICAL EFFECTS OF ENTERAL VERSUS PARENTERAL NUTRITION ON GUT HEALTH: A LITERATURE REVIEW

PD333

CLINICAL EFFECTS OF ENTERAL VERSUS PARENTERAL NUTRITION ON GUT HEALTH: A LITERATURE REVIEW

V. Mourits¹, H. Kumar¹, I. Renes¹, Z. Hofman^1,*

¹Danone Research & Innovation, Utrecht, Netherlands

Rationale: Enteral nutrition (EN) uses the gut and supports its function, while parenteral nutrition (PN) bypasses that route. Despite broad recognition of the importance of maintaining gut function, PN is still widely used in clinical practice. This review evaluates the clinical effects of EN versus PN on gut health. 

Methods: A literature search in Embase and Medline databases identified 15 human studies (2015-2025) directly comparing EN vs PN on gut motility, barrier function, microbiome composition, and immune outcomes. 

Results: Compared to PN, EN improved postoperative gut motility by reducing time to first flatus in 4 out of 4 studies tested (4/4, all p<0.05) and bowel movement (3/3 all p≤0.01). EN supports barrier integrity, as shown by improved villus morphology and tight junction protein expression (1/1, p<0.05), increased citrulline (1/2, p=0.01), decreased D-lactic acid (1/1, p<0.05), and reduced lactulose/mannitol ratio (1/1, p<0.0001). One study reported EN to increase I-FABP (p≤0.03), while also reporting increased citrulline. EN reduced inflammation, as shown by reduced pro-inflammatory cytokines (3/3, all p<0.05) and endotoxin levels (2/2, all p<0.05), and increased short-chain fatty acids (SCFAs) (2/3 studies). Microbial alpha-diversity differed between EN and PN (3/6, all 3 p≤0.01). EN tended to promote a more favorable microbial profile, including increased SCFAs (2/3 studies), while PN was associated with increased pathobionts, with 5 out of 6 studies showing higher abundance of Escherichia-Shigella and Klebsiella sp.

Conclusion: In patients, EN shows advantages over PN in supporting gut motility, barrier integrity, immune function, and microbiome composition. These findings may guide the choice of nutritional therapy and highlight the need for further investigation.

Disclosure of Interest: V. Mourits Other: Employee of Danone Research & Innovation, H. Kumar Other: Employee of Danone Research & Innovation, I. Renes Other: Employee of Danone Research & Innovation, Z. Hofman Other: Employee of Danone Research & Innovation