Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children.

Background: There is no consensus regarding the optimal enteral formula in patients with neonatal short bowel syndrome. The common practice in many centers is to give a semielemental diet.

Methods: To test the hypothesis that hydrolyzed protein is not superior to standard formula in promoting growth and development of children with short bowel syndrome, 10 children aged 4.08 +/- 2.45 months (mean +/- SD) underwent a prospective, randomized, crossover, double-blind study lasting 60 days (with crossover on day 31). Two enteral formulas, which differed only with respect to the nitrogen form-hydrolyzed and nonhydrolyzed whey protein-were used. The endpoints of the study were nitrogen balance and intestinal permeability measured by the sugar absorption test (lactulose/mannitol excretion ratio).

Results: Energy intake from enteral formula in patients fed hydrolyzed and nonhydrolyzed formula was the same and amounted to about 31% of total intake. The ratio of total energy intake (enteral and parenteral) to resting energy expenditure was 1.7 +/- 0.5 and 1.5 +/- 0.3 in patients fed hydrolyzed and non hydrolyzed formula respectively. Nitrogen balance was 0.28 +/- 0.05 g/kg/d and 0.29 +/- 0.05 g/kg/day, respectively. Lactulose/mannitol ratio before the study was 0.85 +/- 0.85 and after hydrolyzed and nonhydrolyzed formula was 0.59% +/- 0.51% and 0.69% +/- 0.72%, respectively.

Conclusion: Intestinal permeability, energy, and nitrogen balance in short bowel syndrome were not influenced in the short term by hydrolysis of the enteral nitrogen source.