Comparison of Tolerance and Nutritional Outcome Between a Peptide and a Standard Enteral Formula in Critically Ill, Hypoalbuminemic Patients

Abstract

Dipeptides have been reported to be more efficiently absorbed from the gastrointestinal tract than free amino acids. The objective of this study was to compare prospectively a peptide enteral formula (PEF) with a standard enteral formula (SEF) for tolerance and nutritional outcome in acutely injured, hypoalbuminemic (less than 3.0 g/dL) patients who require enteral nutrition support. The prevalence of diarrhea and elevated gastric residuals was assessed daily. Prealbumin, transferrin, colloid oncotic pressure, Prognostic Nutritional Index, and nitrogen balance were measured on days 0, 5, and 10 of enteral nutrition support. Forty-one patients received 345 days of enteral nutrition support. Prevalences of diarrhea and elevated gastric residuals were similar between groups. Prealbumin increased and the Prognostic Nutritional Index decreased significantly from baseline at day 10 in both groups. Transferrin increased in both groups, but not significantly. Colloid oncotic pressure increased significantly from baseline at days 5 and 10 in the SEF group and day 10 in the PEF group. Nitrogen balance increased significantly from baseline at days 5 and 10 in each group. The only significant difference between groups was for nitrogen balance at day 10, which was higher in the SEF group. We conclude based upon our selected measurements of tolerance and nutritional outcome PEF seems to offer no advantage over SEF in acutely injured, hypoalbuminemic patients.

Peptide-based enteral formula improves tolerance and clinical outcomes in abdominal surgery patients relative to a whole protein enteral formula

“…Some investigators have reported that peptide-based enteral diets are associated with better protein responses and less diarrhea compared to intact-protein diets[2,3]. On the other hand, others have reported that peptide-based formulas seem to offer no benefits over intact-protein diets in acutely injured, hypoalbuminemic patients[4]. However, while previous studies have described the small peptide formulas, no particular dipeptide- or tripeptide-based formulas have been investigated.…”

Commercial Enteral Formulas and Nutritional Support Team

“…In severely ill patients, the exocrine pancreatic function, which partially affects the digestion and absorption of certain nutrients, may be compromised (Mowatt-Larssen et al 1992). Under this condition, an oligomeric formula could prove advantageous over a complete protein formula.…”

Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula

“…Patients with burns and traumatic injuries may experience GI motility problems [63,64]. In sepsis, exocrine pancreatic function is reduced, which can impair protein digestion [65]. Treatments for cancer and other conditions - for example, opiates, radiotherapy, or chemotherapy - have side effects of anorexia and impaired GI function [66].…”