Clinical Nutrition Open Science · Published 2026-05-07 · DOI 10.1016/j.nutos.2026.100676
Summary: Background & Aims: Critical illness drives catabolism, muscle loss, and increased glucose, making both underfeeding and overfeeding harmful and highlighting the need for moderate, progressive nutritional support. Enteral nutrition (EN) standard-protein formulas often fail to meet protein targets, while polymeric formulas are frequently associated with gastrointestinal (GI) intolerance. Peptide-based EN formulas with high medium-chain triglycerides (MCT) content improve tolerance and absorption. This study evaluated a very high-protein (VHP), low-carbohydrate EN formula containing hydrolyzed 100% whey protein and 50% MCT. The study aimed to assess its ability to achieve alignment between prescribed nutritional targets and actual intake, in accordance with nutritional guidelines, and to evaluate enteral feeding tolerance in adult patients admitted to the Intensive Care Unit (ICU). This design was chosen to provide practical information on nutritional adequacy and tolerance in a real clinical setting. Methods: A European, multicenter, prospective, and observational single-cohort study was conducted in patients admitted to two Italian ICUs. Eligible patients with higher protein requirements received exclusively the EN formula for up to 5 days. The primary outcome was the daily proportion of patients reaching at least 80% of their prescribed protein target. Other outcomes included daily protein, energy (including and excluding propofol-derived calories), and for the first time, carbohydrate intake, as well as the proportion of patients reaching at least 80% of their daily energy target and GI intolerance, assessed by recording EN feeding interruptions and GI symptoms. Daily intakes were calculated from administered EN volumes and as ratios of actual to prescribed protein and energy targets. Data were summarized descriptively using means ± standard deviations, medians (interquartile range) and percentages. Results: Overall, a cohort of 22–30 patients was included over the 5-day study period. The ratio of actual to target protein intake exceeded 86% on each study day, with progressive increase in protein intake (range: 0.8–1.26 g/kg/day), in line with ESPEN guidelines. As a result, 79–100% of patients achieved at least 80% of their target protein intake without requiring modular protein supplementation. Energy intake, with and without lipid-based medications (maximum: 17 kcal/kg/day), was consistent with international guidance, with more than 79% of patients achieving ≥80% of their energy target. Only 5 EN interruptions in 3 patients (all receiving propofol) were reported over 137 feeding days due to elevated gastrointestinal residual volume. Twenty-five GI symptoms across 137 feeding days (18%) were experienced by 10 patients (10–23%; 90% receiving propofol), less than previously reported. Conclusions: This VHP EN formula effectively enabled ICU patients to achieve protein targets without requiring modular protein supplementation. Its low carbohydrate content met energy requirements in accordance with nutritional guidelines, while hydrolyzed whey protein and 50% MCT content supported EN tolerance.
Abstract from DOAJ. Public domain (CC0 1.0).
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