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New results on first clinical trial with very high intact-protein enteral formula in critically ill patients

For the first time clinical research has shown that an intact-protein enteral formula made it possible to provide adequate protein in a population of ICU patients, without overfeeding these patients with energy.

The scientific peer-reviewed journal Critical Care has published the paper ‘Successful provision of protein according to nutritional recommendations with a very high intact-protein formula in overweight critically ill patients: a double-blind randomized controlled trial’ .

The study investigated the use of a new very high intact-protein enteral nutrition formula in overweight critically ill patients. The results show that this new formula facilitates health care professionals in feeding their critically ill patients according to nutritional recommendations (ASPEN guidelines – American Society of Enteral and Parenteral Nutrition, ESPEN guidelines – European Society of Enteral and Parenteral Nutrition and the International Protein Summit consensus statement for care).

Proven evidence for protein intake
Recent recommendations indicate that achieving protein intake targets is more important than energy intake.1,2 In current practice, protein intake in ICU patients is often much lower than the amounts recommended by nutritional guidelines.

The objective of the trial was to investigate whether protein intake can be improved in critically ill patients with a new, very high protein enteral formula (8 g/100 kcal) based on intact proteins. This new formula was compared to a standard high protein formula commonly used in critically ill patients (5 g/100 kcal). Results show that the intervention led to higher protein intake and plasma amino acid concentrations without increasing energy intake or showing any signs of gastrointestinal intolerance.

Enteral nutrition
Enteral nutrition is an important therapeutic strategy in the management of critically ill patients and it has been shown to have a positive impact on morbidity, length of hospital stay and mortality. 3,4,5

The principle investigator of the study Dr. Arthur van Zanten, intensivist at the Gelderse Vallei hospital (Ede, The Netherlands): “Medical nutrition plays a crucial role in improving the nutritional intake, and by that also for the recovery and quality of life in critically ill patients throughout their patient journey. This trial is a step forward as to date, there was no intact-protein formula available, providing adequate protein intake without overfeeding patients with energy.”

1.
Hurt et al, Summary points and consensus recommendation from the international protein summit, Nutrition in Clinical Practice 2017.
2.
Nicolo M, Heyland DK, Chittams J, Sammarco T, Compher C: Clinical Outcomes Related to Protein Delivery in a Critically Ill Population: A Multicenter, Multinational Observation Study. JPEN Journal of parenteral and enteral nutrition 2016, 40(1):45-51.
3.
Weimann et al. Espen guideline, Clinical nutrition in surgery. Clinical Nutrition 2017.
4.
SCCM & ASPEN Guidelines – Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN).
5.
Kreymann, K.G. et al, ESPEN guidelines intensive care, Clinical Nutrition 2006 Apr;25(2):210-23.