Enteral compared with parenteral nutrition: a meta-analysis.

BACKGROUND The difference in outcomes in patients is unclear when 2 types of enteral nutrition, ie, tube feeding and conventional oral diets with intravenous dextrose (standard care), are compared with parenteral nutrition. OBJECTIVE We reviewed systematically and aggregated statistically the results of prospective randomized clinical trials (PRCTs) to examine the relations among the nutrition interventions, complications, and mortality rates. DESIGN We conducted a MEDLINE search for PRCTs comparing the effects of enteral and parenteral nutrition in adults. Two different people abstracted data for the method and outcomes separately. We used fixed-effects meta-analysis technique to combine the relative risks (RRs) of the outcomes of infection, nutrition support complications, other complications, and mortality. RESULTS Twenty-seven studies in 1828 patients met the study criteria. Aggregated results showed a significantly lower RR of infection with tube feeding (0.64; 95% CI: 0.54, 0.76) and standard care (0.77; 95% CI: 0.65, 0.91). A priori hypotheses showed a lower RR of infection with tube feeding than with parenteral nutrition, regardless of nutritional status, presence of cancer, year of study publication, or quality of the study method. In studies in which participants had high rates of protein-energy malnutrition, there was a significantly higher risk of mortality (3.0; 95% CI: 10.9, 8.56) and a trend toward a higher risk of infection with standard care than with parenteral nutrition (1.17; 95% CI: 0.88, 1.56). CONCLUSIONS Tube feeding and standard care are associated with a lower risk of infection than is parenteral nutrition; however, mortality is higher and the risk of infection tends to be higher with standard care than with parenteral nutrition in malnourished populations.