Types of nutrition support
Enteral nutrition refers to providing nutrition via the gastrointestinal tract (gut). It can be provided by means of oral nutritional supplements (ONS) and/or enteral tube feeding (ETF). It offers the possibility of increasing or ensuring adequate or extra nutrient intake in cases where normal food and/or fluid intake is inadequate.
Oral nutritional supplements are used when patients are unable to meet their nutritional requirements with normal foods alone, despite receiving dietary advice. Oral nutritional supplements are the simplest and least invasive method of increasing the nutrient intake of cancer patients.
Your healthcare professional will advise you how to take your nutritional supplements. It is important to know how many you should take and for how long, following this advice will mean that you get the best out of them. How many you need will depend on your weight, age, sex, what else you are eating and how your nutritional needs are affected by the cancer or treatment.. Therefore, it's important that patients who are recommended nutritional supplements are given a wide choice of flavours and styles. Supplements are versatile, hints and tips for how to incorporate them into your diet can be found here.
The composition of nutritional supplements is also important, nutritional supplements support the intake of macronutrients (proteins, fats, carbohydrates) - and micronutrients (vitamins and minerals and trace elements).
Tube feeding (The following information is taken from the NICE Nutrition Support for Adults Understanding NICE guidance – information for people who need nutrition support, their families and carers, and the public booklet. To view the whole booklet following this link to the NICE website)
Tube feeding into your gut
If you can’t eat and drink normally or you are not able to take in enough nutrients you may be offered a liquid diet through a tube into your gut. This is called enteral feeding. Usually a tube is inserted into your nose and is passed down into your stomach. This tube is called a nasogastric tube. It is connected to a container of liquid feed. This feed can be given continuously or in fixed doses depending on your needs. This liquid feed should contain all of the nutrients needed by your body. If your stomach isn’t working properly the tube should be passed down into your small intestine instead.
If you need enteral feeding for more than 4 weeks you may be offered a different feeding tube; this is called a gastrostomy or a PEG (percutaneous endoscopic gastrostomy) tube or a jejunostomy tube. A PEG tube is inserted through your abdomen into your stomach and can make enteral feeding easier and more comfortable. A jejunostomy tube is inserted directly into the jejunum (which is part of your small intestine). This means the feed doesn’t go into the stomach and is given directly into the small intestine. Your enteral feeding should be stopped when you are able to take in your nutrition support orally.
Tube feeding into your blood
If you can’t be fed by a tube into your stomach or intestine you may be offered a sterile liquid feed through a tube into your blood. This is called parenteral feeding. A narrow tube known as a catheter is placed in a vein. This is connected to a container of sterile liquid feed. This sterile liquid feed should contain all of the nutrients needed by your body. The standard mixture of nutrients should be adjusted to suit your needs. For example, you may need additional vitamins to be added. The feed should be introduced gradually. It can be given continuously or in cycles depending on your needs.
Your healthcare professional should check improvements in your nutrition regularly. Once you are able to absorb nutrients and be fed by a tube into your gut, or eat normally, parenteral feeding should be gradually stopped. Your healthcare professional should check your progress daily.
Good nutrition right from diagnosis may help well-being and may help you to cope with your treatment.
Source: Nutrition in cancer Editorial Board, The National Institute for Health and Clinical Excellence (NICE)
