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

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.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2070-5) contains supplementary material, which is available to authorized users.

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

“…These results are in contrast to Heyland et al 2014 INS of 187 ICUs which found on average patients were prescribed 94 g protein/d or approximately 1.3 g/kg/d, and only 16.1% of patients received >80% of prescribed protein amounts . Although the protein targets in our study were higher (1.9 g/kg/d vs 1.2 g/kg/d or 1.5 g/kg/d), our findings are similar to 2 recent publications which both demonstrated that reaching protein targets is feasible . In the first study, at a single center, the researchers aimed to deliver 1.2 g protein/kg/d; on average, 86% of protein targets were met .…”

“…In a single‐center study with 886 patients, 27% of whom were receiving parenteral nutrition, Weijs et al achieved a higher protein delivery with an average protein intake of 76 g/d or 1.02 g/kg/d . In a recent multicenter RCT, a higher‐protein EN formula delivered 1.54 g/kg IBW/d in 22 critically ill patients . We demonstrated an average enteral protein intake of 116.9 g/d or 1.6 g/kg/d.…”

“…32 In a recent multicenter RCT, a higher-protein EN formula delivered 1.54 g/kg IBW/d in 22 critically ill patients. 33 We demonstrated an average enteral protein intake of 116.9 g/d or 1.6 g/kg/d. To our knowledge, this is the first published data to demonstrate these levels of protein delivery via exclusive enteral nutrition in real world practice.…”

“…In the first study, at a single center, the researchers aimed to deliver 1.2 g protein/kg/d; on average, 86% of protein targets were met . The second study, a small multicenter RCT, aimed to deliver 1.5 g protein/kg/d and achieved 74.7% of protein targets on days 1–3 and over 100% on days 4–10 using a 32% protein enteral formula . Although our study was a multicenter project across 6 ICUs, these Canadian centers may be similar to other centers where nutrition is a strong focus.…”

Is protein intake saturated at doses recommended by the feeding guidelines for critically ill patients?

“…Recently, van Zanten et al [4] studied the feasibility of a high-protein diet in obese critically ill patients. Patients in the intervention group received, on average, 1.49 g protein/kg/day, compared to 0.76 g/kg/day in the control group.…”