Research report Energy compensation in enterally fed children Laura Kane a , Charlotte Wright a, *, Wan Fathin Fariza a , Marion Hetherington b a Paediatric Epidemiology and Community Health (PEACH), Faculty of Medicine, University of Glasgow, QMH Tower, Yorkhill Hospitals, Glasgow G3 8SJ, UK b Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK Introduction Enteral feeding, via gastrostomy or nasogastic tube provides vital nutritional support for neonates and infants with major medical or surgical problems who are unable to meet their dietary requirements through normal oral intake alone. However, when the acute medical issues preventing feeding have resolved, some infants seem unable to make the transition to oral feeding and in extreme circumstances may remain dependent on enteral feeding for years, despite being apparently capable of eating (Mason, Harris, & Blissett, 2005). Children in these circumstances often appear to have no interest in food and may lose weight rapidly when their feeds are reduced (Wright, Smith, & Morrison, 2010). This leads to the suggestion that such children may have disordered appetite and energy regulation, either as a result of their underlying condition or because of the disruptive effect of long-term tube feeding. All individuals need to be intrinsically capable of regulating their nutrient intake to maintain energy balance. Healthy children have been shown to demonstrate energy self-regulation both in the short term, adjusting energy intake in response to food or drink consumed before a meal (Birch & Deysher, 1985, 1986; Birch, McPhee, Bryant, & Johnson, 1993; Birch, McPhee, & Sullivan, 1989; Hetherington, Wood, & Lyburn, 2000; Shea, Stein, Basch, Contento, & Zybert, 1992) and the longer term, over 24 h (Birch, Johnson, Andresen, Peters, & Schulte, 1991). Satiety is a complex process governed by negative feedback resulting from gastric and duodenal distension, release of peripheral appetite suppressing (anorexigenic) signals, such as leptin, and stimulation of the central suppressive leptin–melano- cortin pathway, which communicates with the paraventricular nucleus or ‘‘satiety centre’’ (Druce & Bloom, 2006). Satiety is also dependent upon inhibition of positive feedback from the appetite- stimulating (orexigenic) pathway, including orosensory stimula- tion (Druce & Bloom, 2006). Meal termination ensues when opposing positive and negative afferent feedback signals are of equal force (Norton, Anderson, & Hetherington, 2006). However, psychological food motivation and environmental stimuli may override physiological regulation of food intake (Bellisle & Dalix, 2001; Blass et al., 2006; De Castro, 1994; Hetherington, Anderson, Norton, & Newson, 2006; Lumeng & Hillman, 2007; Mrdjenovic & Levitsky, 2005; Norton et al., 2006; Shide & Rolls, 1991). Artificial feeding could affect both physiological appetite regulation and eating behaviour in many ways. Tube-feeding bypasses part of the upper gastrointestinal tract, so that long-term enterally fed children may lack innate somatic satiety cues. The child may also have missed a critical period of associative learning (Birch, 1998; Hetherington, 2002; Rolls, Engell, & Birch, 2000) and have disordered daily eating patterns (Poustie et al., 2006). Other studies have suggested that both the age at which tube feeding started (Mason et al., 2005) and when reduction in feeds began (Wright et al., 2010) may critically affect the ease of transition. Appetite 56 (2011) 205–209 ARTICLE INFO Article history: Received 9 June 2010 Received in revised form 1 November 2010 Accepted 3 November 2010 Available online 12 November 2010 Keywords: Energy compensation Energy intake Enteral feeding Preload Satiety ABSTRACT Limited exposure to solid food in early childhood may affect the development of appetite regulation. We used formal satiation studies to assess energy compensation in children who have been artificially fed. Subjects were 11 children, median age 4.5 years (range 1–10) who were formerly (n = 4) or currently (n = 5) mainly tube fed or supplement fed (n = 2), with a range of surgical or neurodevelopmental problems. On 2 separate days a high-energy preload (HEP) and low-energy preload (LEP) drink were given followed by a multi-item test lunch. A compensation index (COMPX) score was derived as follows: COMPX (%) = [(Meal lep  Meal hep )/(Preload hep  Preload lep )]  100. The median (range) COMPX of the participants was 70% (73% to 178%). The 8 boys tended to compensate more (median 99%) than the 3 girls (30%; P Mann–Whitney = 0.1), but there was no clear association of compensation with age. Although a small preliminary study, this suggests that children who have been artificially fed demonstrate energy compensation comparable to that of normally fed children. ß 2010 Elsevier Ltd. All rights reserved. * Corresponding author. E-mail address: cmw7a@clinmed.gla.ac.uk (C. Wright). Contents lists available at ScienceDirect Appetite journal homepage: www.elsevier.com/locate/appet 0195-6663/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.appet.2010.11.002