Fat-Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter, Single-Blind, Randomized Controlled Trial

JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):785-795. doi: 10.1177/0148607115601858. Epub 2015 Sep 8.

Abstract

Background: Improvement of fat digestion and absorption was supposed to relieve feeding intolerance. This trial aimed to evaluate the effect of a fat-modified enteral formula on feeding tolerance in critically ill patients.

Materials and methods: This trial was conducted in 7 hospitals in China. In total, 144 intensive care unit (ICU) patients with estimated need of enteral nutrition (EN) for at least 5 days were randomly given fat-modified enteral formula containing medium-chain triglycerides (MCT), carnitine, and taurine (interventional feed group, n = 71) or standard enteral formula (control feed group, n = 73). EN intake, feeding intolerance (diarrhea, vomiting, gastric retention, and abdominal distension) and outcomes (mechanical ventilator-free days of 28 days, length of ICU stay, length of hospital stay, and in-hospital mortality) were collected.

Results: Daily calories and protein intake were increased in the interventional feed group compared with the control feed group ( P < .01). Total incidence of feeding intolerance was 42.3% in the interventional feed group and 65.7% in the control feed group ( P < .001). Daily incidence of feeding intolerance was 11.3%, 18.3%, 14.1%, 25.4%, and 26.1% in the interventional feed group and 31.5%, 32.9%, 34.2%, 34.2%, and 30.4% in the control feed group from study days 1-5 ( P = .0083). Incidence of feeding intolerance without abdominal distention was 32.9% in the interventional feed group and 49.3% in the control feed group ( P = .047), while the incidence of abdominal distension was 26.8% in the interventional feed group and 43.8% in the control feed group ( P = .03). No significant differences existed in outcomes between the 2 groups.

Conclusions: The fat-modified enteral formula containing MCT, carnitine, and taurine may improve feeding tolerance in critically ill patients.

Keywords: critically ill patients; enteral nutrition; fat-modified enteral formula; feeding intolerance.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alanine Transaminase / blood
  • Aspartate Aminotransferases / blood
  • Bilirubin / blood
  • C-Reactive Protein / metabolism
  • Carnitine / administration & dosage
  • China / epidemiology
  • Critical Illness / mortality*
  • Critical Illness / therapy*
  • Dietary Carbohydrates / administration & dosage
  • Dietary Fats / administration & dosage*
  • Dietary Fiber / administration & dosage
  • Dietary Proteins / administration & dosage
  • Enteral Nutrition*
  • Fat Emulsions, Intravenous / administration & dosage*
  • Feeding and Eating Disorders / epidemiology*
  • Feeding and Eating Disorders / therapy
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Incidence
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Prospective Studies
  • Single-Blind Method
  • Taurine / administration & dosage
  • Treatment Outcome
  • Triglycerides / administration & dosage
  • Young Adult

Substances

  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Fiber
  • Dietary Proteins
  • Fat Emulsions, Intravenous
  • Triglycerides
  • Taurine
  • C-Reactive Protein
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin
  • Carnitine

Associated data

  • ChiCTR/ChiCTR‐TRC‐12002334