ACUTE RENUTRITION BY CYCLIC ENTERAL NUTRITION IN ELDERLY AND YOUNGER PATIENTS

Objective.-To evaluate the efficacy and tolerance of cyclic enteral nutrition (CyEN) in elderly compared with younger patients. Design.-Prospective case series. Setting.-University hospital nutritional support unit. Patients.-A total of 51 patients younger than 65 years (mean age, 45 years) and 45 patients 65 years of age and older (mean age, 77 years) referred for refeeding after having lost at least 20% of their body weight or at least 10% in 3 months. All patients were severely undernourished but were ambulatory. Intervention.-Cyclic enteral nutrition was administered via a nasogastric tube during the night; in the daytime patients were allowed to eat normally. Measurements.-Ten biological and anthropometric nutritional parameters and a global nutritional deficiency (GND) were measured at day 0, at day 15, and at the end of CyEN. Results.-Total energy intakes were 288% and 282% of resting energy expenditure in groups 1 and 2, respectively, and duration of CyEN was a mean of 27 days in both groups. Tolerance was generally good, although one patient in each group discontinued refeeding because of aspiration pneumonia. In both groups, seven nutritional parameters and the GND improved significantly; six parameters improved significantly more in younger than in elderly patients: body weight, serum albumin, serum prealbumin, serum transferrin, 24-hour urinary creatinine, and the GND (44.7% vs 35.4%; P=.006). After 1 year, the probability to be alive without relapse was 62% in the elderly and 76% in the younger patients (P=.18). Conclusions.-Cyclic enteral nutrition appears to be a well-tolerated and effective treatment of undernutrition in older malnourished ambulatory patients, although their response to CyEN was somewhat less than in younger patients.