Background

Gastrointestinal intolerance and hyperglycemia, often associated with enteral nutritional support, may lead to inadequate delivery of nutrients and related poor clinical outcomes.

Objective

The objective of this real world study was to examine characteristics, disease severity and enteral nutrition (EN) formulas as they related to enteral feeding intolerance (EFI) and healthcare resource utilization (HCRU) in adult critically ill patients.

Methods

This retrospective, cross-sectional study used real world data from PINC AI^TM Healthcare Database representing 25% of US hospitals and captured information from the years 2015-2019. Adult hospitalized patients who were critically ill and received ≥3 days of EN were included. Comparator groups were comprised of those patients who received 100% whey-peptide EN, other peptide-based EN, and intact protein standard or diabetic EN formulas. Primary outcomes included assessment of EFI, both GI intolerance and hyperglycemia, as related to type of formula received. GI intolerance was defined as presence of abdominal distention, abdominal pain, constipation, diarrhea, nausea or vomiting.

Results

There were 19,679 inpatients from 67 US hospitals included in this study, receiving a median of 6 days of EN. Breakdown of formulas received were as follows:

• 3,242 inpatients received 100% whey-peptide EN
• 3,121 inpatients received other peptide-based EN
• 13,316 inpatients received standard or diabetic intact-protein EN

The 100% whey-peptide EN group had higher frequencies of co-morbidities and severity of illness, as compared to the other EN groups.

After controlling for severity characteristics, visit and demographics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group, as compared to the 100% whey-peptide EN group. Odds of hyperglycemia were 81% higher for the other peptide-based group versus the very high protein/low carbohydrate 100% whey-peptide group.