Article Text

Download PDFPDF
Impact of nutrient density of nocturnal enteral feeds on appetite: a prospective, randomised crossover study
  1. S Evans1,
  2. A Daly1,
  3. A MacDonald1,
  4. P Davies2,
  5. I W Booth2
  1. 1Birmingham Children’s Hospital, Birmingham, UK
  2. 2Institute of Child Health, University of Birmingham, Birmingham, UK
  1. Correspondence to:
    Sharon Evans
    Dietetic Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; evanss21{at}


Objective: To determine whether the energy density of isocaloric nocturnal enteral feeds (NEF) influences daily nutrient intake in children.

Method: In a 6 week, randomised, crossover trial, the impact on spontaneous nutrient intake of manipulating the energy density of two isocaloric overnight feeds (1.0 kcal/ml and 1.5 kcal/ml) was compared in a group of 32 children aged 1–10 years (or 8–25 kg body weight) on long term, overnight enteral feeding at home. Total daily oral energy, protein, fat and carbohydrate intake were assessed using 3 day food diaries. Anthropometric data were also recorded during the study.

Results: Spontaneous intakes of energy, protein, fat and carbohydrate from food were 20–30% greater when receiving the lower nutrient density feed (1 kcal/ml). This was due to a gender effect; males consumed twice as much protein from food than females and had slightly higher (but not significant) energy and fat intakes when on the larger volume feed. All children increased in weight, height and mid-upper arm circumference in the 6 week period.

Conclusions: Children appear to tolerate and grow equally well, irrespective of the nutrient density and volume of NEF taken. However, it appears that children will consume a more energy and nutrient dense oral diet when given their NEF as a higher volume/lower nutrient density feed. This is particularly so for boys, while for girls the volume of NEF or feed concentration appeared to have no impact on quantity of oral diet taken. However, further blinded studies with larger subject numbers would be useful to support these findings.

  • BMI, body mass index
  • EAR, estimated average requirement
  • NEF, nocturnal enteral feed
  • RNI, reference nutrient intake
  • appetite
  • children
  • energy density
  • enteral nutrition
  • tube feeding

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published Online First 21 February 2007

  • Nestlé Clinical Nutrition provided financial sponsorship for this study.

  • Competing interests: None.

Linked Articles

  • Précis
    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
  • Atoms
    Howard Bauchner