Comparison of Energy and Nutrient Contents of Commercial and Noncommercial Enteral Nutrition Solutions

Document Type : Original Article


1 Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Food Security Research Center and Department of Food Science and Technology, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

6 Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences; Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran


Background: Nutritional support plays a major role in the management of critically ill patients. This study aimed to compare the nutritional quality of enteral nutrition solutions (noncommercial vs. commercial) and the amount of energy and nutrients delivered and required in patients receiving these solutions. Materials and Methods: This cross-sectional study was conducted among 270 enterally fed patients. Demographic and clinical data in addition to values of nutritional needs and intakes were collected. Moreover, enteral nutrition solutions were analyzed in a food laboratory. Results: There were 150 patients who fed noncommercial enteral nutrition solutions (NCENS) and 120 patients who fed commercial enteral nutrition solutions (CENSs). Although energy and nutrients contents in CENSs were more than in NCENSs, these differences regarding energy, protein, carbohydrates, phosphorus, and calcium were not statistically significant. The values of energy and macronutrients delivered in patients who fed CENSs were higher (P < 0.001). Energy, carbohydrate, and fat required in patients receiving CENSs were provided, but protein intake was less than the required amount. In patients who fed NCENSs, only the values of fat requirement and intake were not significantly different, but other nutrition delivered was less than required amounts (P < 0.001). CENSs provided the nutritional needs of higher numbers of patients (P < 0.001). In patients receiving CENSs, nutrient adequacy ratio and also mean adequacy ratio were significantly higher than the other group (P < 0.001). Conclusion: CENSs contain more energy and nutrients compared with NCENSs. They are more effective to meet the nutritional requirements of entirely fed patients.


Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States ][1985],[1986],[1987],[1988],[1989],[1990],[1991],[1992],[1993],[1994],[1995],[1996],[1997],[1998],[1999],[2000]: An analysis of bed numbers, use, and costs. Crit Care Med 2004;32:].  Back to cited text no. 1
Fernández-Ortega JF, Herrero Meseguer JI, Martínez García P; Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Indications, timing and routes of nutrient delivery. Nutr Hosp 2011;26 Suppl 2:7-11.  Back to cited text no. 2
McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945-8.  Back to cited text no. 3
Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: The Brazilian national survey (IBRANUTRI): A study of 4000 patients. Nutrition 2001;17:573-80.  Back to cited text no. 4
Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235-9.  Back to cited text no. 5
Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P; Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003;27:355-73.  Back to cited text no. 6
Parrish CR, McCray SF. Nutrition support for the mechanically ventilated patient. Crit Care Nurse 2003;23:77-80.  Back to cited text no. 7
McVay-Smith C. Nutrition assessment. Nutrition 2001;17:785-6.  Back to cited text no. 8
Kubrak C, Jensen L. Malnutrition in acute care patients: A narrative review. Int J Nurs Stud 2007;44:1036-54.  Back to cited text no. 9
Neelemaat F, Kruizenga HM, de Vet HC, Seidell JC, Butterman M, van Bokhorst-de van der Schueren MA. Screening malnutrition in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population? Clin Nutr 2008;27:439-46.  Back to cited text no. 10
Prins A. Nutritional assessment of the critically ill patient. S Afr J Clin Nutr 2010;23:11-8.  Back to cited text no. 11
Ahsan B, Khaledi S. Knowledge and mortality of ICU impatients in Tohid Hospital of Sanandaj in 2001. Med Sci Kordestan Univ 2005;9:20-5.  Back to cited text no. 12
Daneshzad E, Azadbakhat L, Neamani F, Abasi S, Shirani F, Adibi P. Nutritional assessment of ICU impatients in Alzahra Hospital. J Health Syst Res 2014;10:655-68.  Back to cited text no. 13
Shayesteh F, Poudineh S, Mohammad-Zadeh M, Pouryazdanpanah-Kermani M, Sadat Ayoudi S, Norouzy A. Assessment of nutritional intake in intensive care unit patients of Ghaem Hospital. Med J Mashhad 2015;58:217-24.  Back to cited text no. 14
Arabi YM, Haddad SH, Aldawood AS, Al-Dorzi HM, Tamim HM, Sakkijha M, et al. Permissive underfeeding versus target enteral feeding in adult critically ill patients (PermiT Trial): A study protocol of a multicenter randomized controlled trial. Trials 2012;13:191.  Back to cited text no. 15
Hajishafiee M, Azadbakht L, Adibi P. Energy and nutrient requirements in the intensive care unit inpatients: A narrative review. J Nutr Sci Diet 2015;1:63-70.  Back to cited text no. 16
Kalantari H, Barekat SM, Maracy MR, Azadbakht L, Shahshahan Z. Nutritional status in patients with ulcerative colitis in Isfahan, Iran. Adv Biomed Res 2014;3:58.  Back to cited text no. 17
[PUBMED]  [Full text]  
Mnuter PA. Nutritional assessment of the critically ill patient. S Afr J Clin Nutr 2010;23:11-8.  Back to cited text no. 18
Berger MM, Revelly JP, Cayeux MC, Gersbach P, Chioléro RL. Malnutrition and intensive care: Discussion on a difficult case. Rev Med Suisse Romande 2003;123:383-6.  Back to cited text no. 19
Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions and general topics. Clin Nutr 2006;25:180-6.  Back to cited text no. 20
Cangelosi MJ, Auerbach HR, Cohen JT. A clinical and economic evaluation of enteral nutrition. Curr Med Res Opin 2011;27:413-22.  Back to cited text no. 21
Mokhalalati JK, Druyan ME, Shott SB, Comer GM. Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia. Saudi Med J 2004;25:331-41.  Back to cited text no. 22
Sullivan MM, Sorreda-Esguerra P, Platon MB, Castro CG, Chou NR, Shott S, et al. Nutritional analysis of blenderized enteral diets in the Philippines. Asia Pac J Clin Nutr 2004;13:385-91.  Back to cited text no. 23
Jalali M, Sabzghabaee AM, Badri SS, Soltani HA, Maracy MR. Bacterial contamination of hospital-prepared enteral tube feeding formulas in Isfahan, Iran. J Res Med Sci 2009;14:149-56.  Back to cited text no. 24
Sullivan MM, Sorreda-Esguerra P, Santos EE, Platon BG, Castro CG, Idrisalman ER, et al. Bacterial contamination of blenderized whole food and commercial enteral tube feedings in the Philippines. J Hosp Infect 2001;49:268-73.  Back to cited text no. 25
Lucia Rocha Carvalho M, Beninga Morais T, Ferraz Amaral D, Maria Sigulem D. Hazard analysis and critical control point system approach in the evaluation of environmental and procedural sources of contamination of enteral feedings in three hospitals. JPEN J Parenter Enteral Nutr 2000;24:296-303.  Back to cited text no. 26
Lindell MK, Whitney DJ. Accounting for common method variance in cross-sectional research designs. J Appl Psychol 2001;86:114-21.  Back to cited text no. 27
Zhang LN, Wang XT, Ai YH, Guo QL, Huang L, Liu ZY, et al. Epidemiological features and risk factors of sepsis-associated encephalopathy in intensive care unit patients: 2008-2011. Chin Med J (Engl) 2012;125:828-31.  Back to cited text no. 28
Polderman KH, Jorna EM, Girbes AR. Inter-observer variability in APACHE II scoring: Effect of strict guidelines and training. Intensive Care Med 2001;27:1365-9.  Back to cited text no. 29
Mahan LK, Escott-Stump S, Raymond JL, Krause MV. Krause's Food and the Nutrition Care Process. 13th ed. USA: Elsevier Health Sciences; 2012.  Back to cited text no. 30
Mahan LK, Raymond JL, Escott-Stump S, editors. Nutrition assessment, intake: Analysis of the diet. In: Krause's Food and the Nutrition Care Process. 13th ed. Philadelphia, PA: Saunders; 2011.  Back to cited text no. 31
Borghi R, Dutra Araujo T, Airoldi Vieira RI, Theodoro de Souza T, Waitzberg DL. ILSI task force on enteral nutrition; estimated composition and costs of blenderized diets. Nutr Hosp 2013;28:2033-8.  Back to cited text no. 32
Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992;216:172-83.  Back to cited text no. 33
Berger MM, Chioléro RL, Pannatier A, Cayeux MC, Tappy L. A 10-year survey of nutritional support in a surgical ICU: 1986-1995. Nutrition 1997;13:870-7.  Back to cited text no. 34
Binnekade JM, Tepaske R, Bruynzeel P, Mathus-Vliegen EM, de Hann RJ. Daily enteral feeding practice on the ICU: Attainment of goals and interfering factors. Crit Care 2005;9:R218-25.  Back to cited text no. 35
Drover JW, Cahill NE, Kutsogiannis J, Pagliarello G, Wischmeyer P, Wang M, et al. Nutrition therapy for the critically ill surgical patient: We need to do better! JPEN J Parenter Enteral Nutr 2010;34:644-52.  Back to cited text no. 36
Kemper M, Weissman C, Hyman AI. Caloric requirements and supply in critically ill surgical patients. Crit Care Med 1992;20:344-8.  Back to cited text no. 37
De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, et al. Aprospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered? Crit Care Med 2001;29:8-12.  Back to cited text no. 38
Hegazi RA, Wischmeyer PE. Clinical review: Optimizing enteral nutrition for critically ill patients – A simple data-driven formula. Crit Care 2011;15:234.  Back to cited text no. 39
Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 2005;62:1663-82.  Back to cited text no. 40
Escuela MP, Guerra M, Añón JM, Martínez-Vizcaíno V, Zapatero MD, García-Jalón A, et al. Total and ionized serum magnesium in critically ill patients. Intensive Care Med 2005;31:151-6.  Back to cited text no. 41
Safavi M, Honarmand A. Admission hypomagnesemia – Impact on mortality or morbidity in critically ill patients. Middle East J Anaesthesiol 2007;19:645-60.  Back to cited text no. 42
Soliman HM, Mercan D, Lobo SS, Mélot C, Vincent JL. Development of ionized hypomagnesemia is associated with higher mortality rates. Crit Care Med 2003;31:1082-7.  Back to cited text no. 43