Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial

Arthur R H Van Zanten,Marianne Klebach,Zandrie Hofman,Janneke De Wilde,Jan De Waele,Peter Van Horssen,Hans Kieft,Laurent Petit

doi:10.1186/s13054-018-2070-5

Abstract

BackgroundOptimal energy and protein provision through enteral nutrition is essential for critically ill patients. However, in clinical practice, the intake achieved is often far below the recommended targets. Because no polymeric formula with sufficient protein content is available, adequate protein intake can be achieved only by supplemental amino acids or semi-elemental formula administration. In the present study, we investigated whether protein intake can be increased with a new, very high intact-protein formula (VHPF) for enteral feeding.MethodsIn this randomized, controlled, double-blind, multicenter trial, 44 overweight (body mass index ≥ 25 kg/m2) intensive care unit patients received either a VHPF (8 g/100 kcal) or a commercially available standard high protein formula (SHPF) (5 g/100 kcal). Protein and energy intake, gastrointestinal tolerance (gastric residual volume, vomiting, diarrhea, and constipation), adverse events, and serious adverse events were recorded. Total serum amino acid levels were measured at baseline and day 5.ResultsThe primary outcome, protein intake at day 5, was 1.49 g/kg body weight (95% CI 1.21–1.78) and 0.76 g/kg body weight (95% CI 0.49–1.03, P < 0.001) for VHPF and SHPF, respectively. Daily protein intake was statistically significantly higher in the VHPF group compared with the SHPF group from day 2 to day 10. Protein intake in the VHPF group as a percentage of target (1.5 g/kg ideal body weight) was 74.7% (IQR 53.2–87.6%) and 111.6% (IQR 51.7–130.7%) during days 1–3 and days 4–10, respectively. Serum amino acid concentrations were higher at day 5 in the VHPF group than in the SHPF group (P = 0.031). No differences were found in energy intake, measures of gastrointestinal tolerance, and safety.ConclusionsEnteral feeding with VHPF (8 g/100 kcal) resulted in higher protein intake and plasma amino acid concentrations than an isocaloric SHPF (5 g/100 kcal), without an increase in energy intake. This VHPF facilitates feeding according to nutritional guidelines and is suitable as a first-line nutritional treatment for critically ill overweight patients.Trial registrationNetherlands Trial Register, NTR5643. Registered on 2 February 2016.

Highlights

Optimal energy and protein provision through enteral nutrition is essential for critically ill patients
Reasons for prescreen failures were body mass index (BMI) < 25 kg/m2 (46%), expected intensive care unit (ICU) stay < 5 days (36%), age < 18 years (1%), Sequential Organ Failure Assessment (SOFA) score > 12 (< 1%), and “other” (15%); only one patient had no information on the reason for screen failure
very high intact-protein formula (VHPF) (8 g/100 kcal) compared with an isocaloric standard high protein formula (SHPF) (5 g/100 kcal) results in markedly higher protein intake without an increase in energy intake, gastrointestinal intolerance, or adverse events. These results suggest that this VHPF is suitable as first-line nutritional treatment for critically ill patients because it offers a solution for adequate protein provision according to nutritional guidelines while avoiding the risk of overfeeding

Summary

Introduction

Optimal energy and protein provision through enteral nutrition is essential for critically ill patients. Extensive loss of total body protein mass is a universally observed phenomenon during critical illness. Loss of muscle protein occurs rapidly in critically ill patients and may result in a loss of up to 18% of muscle mass in the first 10 days of intensive care unit (ICU) stay, leading to a marked negative total body nitrogen balance. Several observational studies have demonstrated that a higher intake of enteral nutrition was associated with lower mortality rates [5,6,7]. Some recent reports suggest that lower caloric intake (i.e., 70–90% of energy expenditure) may be optimal in the initial phase of critical illness, whereas caloric overfeeding is associated with a worse outcome [9, 10]. On the basis of these studies, the current consensus is to provide adequate protein intake as a primary goal [11]

Objectives

Methods

Results

Discussion

Conclusion