Comparisons between short-peptide formula and intact-protein formula for early enteral nutrition initiation in patients with acute gastrointestinal injury: a single-center retrospective cohort study

Abstract

Background: Early enteral nutrition (EN) in critically ill patients is important and most of them have suffered acute gastrointestinal injury (AGI). In this study, we investigated the influence of short-peptide EN formula and intact-protein EN formula on the prognosis of patients with AGI grades I-II to provide some guidance.Methods: A retrospective cohort study was performed. The primary outcomes were the percentage of EN calories (25 kcal/kg/d) and protein (1.2 g/kg/d) on the 3rd and 7th days of intensive care unit (ICU) admission, EN percent elevation in calories and protein on days 3-7, and the incidence of gastric retention and diarrhea after EN administration. Secondary outcomes included ICU and 28-day mortality, length of ICU stay, total hospitalization cost, and ventilator-free days. Univariate and multivariate Cox regression analysis was used to identify factors associated with gastric retention and diarrhea. And we used Kaplan-Meier survival curves to compare 28-day mortality rates between the two groups.Results: There were no statistically significant differences in ICU and 28-day mortality, ICU length of stay, total hospitalization cost, or ventilator-free days in the short-peptide formula group compared with the intact-protein formula group. Kaplan-Meier survival curves of 28-day mortality also showed no statistically significant difference. The EN percent elevation in calories and protein on days 3-7 in the short-peptide formula group was significantly higher than the intact-protein formula group (48% vs. 38%, P=0.03 and 37% vs. 38%, P=0.04, respectively). For gastrointestinal (GI) adverse events, the incidence of gastric retention (15.5% vs. 29.8%, P=0.03) and diarrhea (8.5% vs. 19.8%, P=0.04) were lower in the short-peptide group.In the multivariate-adjusted model, the use of short-peptide formula was the only independent variable of reduction in gastric retention and diarrhea [HR =0.469 (95% CI: 0.239-0.922), P=0.028; and HR =0.394 (95% CI: 0.161-0.965), P=0.041, respectively].Conclusions: Short-peptide formula is more easily tolerated by patients in the acute phase of AGI and can quickly achieve nutritional goals by EN provision, making it the preferred formula for the initiation of EN in the acute phase of AGI.

Peptide‐based formula: Clinical applications and benefits

“…In a recently published study, Wang et at noted that the use of PBF in patients who were critically ill with acute GI injuries was an independent predictor of better EN tolerance and higher achievement of nutrition goals on a multivariate model compared with intact-protein formula. 57 The study aimed to compare percentage of calories and proteins delivered by EN out of target amounts between short-peptide and intact-protein enteral formulas. Additionally, incidence of diarrhea and gastric retention were examined.…”

“…The role of PBF as initial or alternative EN formula has been evaluated at different levels (Table 1). One important cohort is in‐patient and patients who are critically ill and requiring aggressive nutrition interventions 14,36,37,53,55‐57 . Additionally, a few retrospective reports have investigated the use of PBF in home settings as well 29,35,38,51 .…”

“…One important cohort is in-patient and patients who are critically ill and requiring aggressive nutrition interventions. 14,36,37,53,[55][56][57] Additionally, a few retrospective reports have investigated the use of PBF in home settings as well. 29,35,38,51 Interestingly, the healthcare utilization and/or cost analysis and modeling of cost related to the use of PBFs suggest that transition to PBF in presence of EFI may principally be a cost-effective intervention.…”

Dietitian's approach to managing enteral nutrition intolerance when a formula change is indicated: A clinical practice survey

“…Furthermore, a small case series of 10 patients in a complex continuing care facility reported an improvement in excessive gas, distention, and elevated GRVs with a switch from whole protein to peptide‐based formulas; however, vomiting was unchanged or worsened 19 . Finally, in both enterally fed ICU patients experiencing acute GI injury and those post–abdominal surgery fed with EN, the use of peptide‐based EN formulas was associated with significantly lower gastric retention, compared with intact protein 30,31 …”

“…19 Finally, in both enterally fed ICU patients experiencing acute GI injury and those post-abdominal surgery fed with EN, the use of peptide-based EN formulas was associated with significantly lower gastric retention, compared with intact protein. 30,31 Source of fiber was ranked in the top three formula features of interest to manage upper-GI symptoms. In our study, dietitians most recommended an absence of fiber in a formula to help manage these symptoms.…”