Nutritional Response of Patients in an Intensive Care Unit to an Elemental Formula vs A Standard enteral Formula

Abstract

Elemental diets are traditionally used for nutrition support in patients with diseases that affect absorption and digestion. An elemental diet has been recommended for initial enteral feeding during parenteral nutrition (1). Clinical trials have shown that hydrolyzed protein formulas are as effective as amino acid formulas in inducing remission of Crohn's disease (2,3). In clinical practice, however, personal bias continues to exist when enteral formulas are chosen. An elemental diet potentially benefits patients with hypoalbuminemia, which may compromise absorption and result in diarrhea. A previous study comparing an elemental formula with a standard enteral formula in critically ill patients with hypoalbuminemia indicated no difference in diarrhea and nutritional markers between groups (4). However, patients were allowed an oral diet ad libitum, the elemental formula was peptide based, and both study formulas contained moderate amounts of fat. A similar study of postoperative jejunostomy feedings in which a low-fat, amino-acid-based elemental formula was used confirmed these observations (some patients in the study consumed an oral diet) (5). The results of these trials could have been affected by the allowance of oral feedings.