From the Guidelines
The best tube feed for nutrition is a standard whole protein formula, which is appropriate for most patients requiring enteral nutrition. This recommendation is based on the most recent and highest quality study, which suggests that standard whole protein formulas are suitable for most patients 1. The use of home-made diets for tube feeding is not recommended due to technical reasons, such as tube clotting and the risk of infection 1.
When selecting a tube feed, it is essential to consider the individual patient's needs and medical conditions. For example:
- Diabetic patients may benefit from specialized formulas like Glucerna to manage blood sugar levels
- Patients with kidney disease may require renal formulas like Nepro
- Patients with impaired digestion may benefit from peptide-based formulas like Peptamen
The feeding regimen typically starts at 10-40 mL/hour and gradually increases to the goal rate, usually 50-100 mL/hour, providing 1500-2000 calories daily. Continuous feeding is often better tolerated than bolus feeding, especially for critically ill patients. Regular monitoring of tolerance and periodic assessment of nutritional status through weight measurements and laboratory values are crucial for optimal outcomes 1. The formula choice should be reassessed regularly as the patient's condition changes. According to the most recent guideline, for patients without diarrhea, constipation, or diabetes, standard commercial tube feeds should be used according to the direction of a specialist 1.
From the Research
Types of Tube Feeds
- Peptide-based formulas: These formulas contain proteins that have been enzymatically hydrolyzed to dipeptides and tripeptides, making them easier to absorb and utilize 2, 3.
- Standard polymeric formulas: These formulas are commonly used for enteral nutrition and contain intact proteins, carbohydrates, and fats 4, 5.
- Fish oil structured lipid-based polymeric formulas: These formulas contain n-3 fatty acids from fish oil, which can alter eicosanoid and cytokine production, yielding an improved immunocompetence and a reduced inflammatory response to injury 6.
Clinical Applications and Benefits
- Peptide-based formulas have been shown to improve feeding tolerance and clinical outcomes in critically ill children and patients with enteral feeding intolerance 2, 3.
- Standard polymeric formulas have been shown to be safe and efficient in providing nutrition to children with neurologically impaired conditions and malnutrition 5.
- Fish oil structured lipid-based polymeric formulas have been shown to reduce gastrointestinal complications and infections, and improve liver and renal function in postsurgical cancer patients 6.
Key Considerations
- The choice of tube feed formula depends on the individual patient's needs and medical condition 2, 3, 4.
- Clinicians should consider the clinical applications and benefits of different tube feed formulas when making decisions about enteral nutrition 3, 4.
- Further research is needed to fully quantify the clinical benefits and optimize nutritional support with different tube feed formulas 2, 3, 6.