Rational use of elemental and nonelemental diets in hospitalized patients.

Study A included 30 patients who received immediate postoperative enteral feeding with a nonelemental diet. The nonelemental diet was well tolerated. Study patients rapidly achieved nitrogen equilibrium and had a cumulative nitrogen balance of -11.1 g verus -46.7 g for the control group. In part B, 16 patients with varying degrees of bowel dysfunction received elemental and nonelemental diets in a crossover design. Patients with moderate small bowel impairment tolerated nonelemental better than the elemental diets. In those patients with more severe bowel impairment, the elemental diet was better tolerated. Nitrogen balance for both types of diet was similar in both groups of patients. It is concluded that nonelemental diets are better tolerated in most patients with moderate degrees of small bowel abnormality. In patients with severe bowel abnormality, elemental diets may be better tolerated, but nonelemental diets should still be the initial formula.