Use of Peptamen® formulas was associated with better tolerance and fewer healthcare visits in intolerant home enteral nutrition patients.
In a retrospective study, as compared to standard home enteral nutrition formulas, use of Peptamen® formulas is associated with significantly less nausea and vomiting, diarrhea and abdominal pain/cramping.6*
As compared to a standard formula home enteral nutrition regimen, patients using Peptamen® formulas had significantly fewer ER visits, calls to clinicians and scheduled care provider visits.6*
*89 of the 95 total patients in the study were on Peptamen® formulas
Enterally fed patients commonly experience intolerance, with up to 95% of enteral nutrition patients having at least one symptom of GI intolerance.1
GI intolerance is often seen as a normal side effect to enteral nutrition and can result in poor quality of life and inability to meet protein and caloric goals.
Enteral feeding success is dependent on a formula being well-tolerated and absorbed. Intolerance and inadequate feeding are associated with poor patient outcomes and increased mortality.2-5
Reduction in Healthcare Utilization With Transition to Peptide-Based Diets in Intolerant Home Enteral Nutrition Patients
Manpreet S. Mundi, MD1; Saketh Velapati, MBBS1; Aravind R. Kuchkuntla, MBBS1; and Ryan T. Hurt, MD, PhD2
Nutrition in Clinical Practice 2020;35:487-494
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA; 2Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Introduction
Enteral Nutrition (EN) is a life-sustaining therapy in patients with a functioning gastrointestinal (GI) tract who cannot meet nutrient needs with oral intake. The prevalence of home enteral nutrition (HEN) has increased significantly over the past few decades. Major clinical guidelines suggest the use of standard polymeric formulas (SPFs), but unfortunately, not all patients tolerate SPFs. GI intolerance has been reported to be approximately 75%, especially in critically ill EN patients.
EN intolerance is associated with morbidity and mortality and includes symptoms such as abdominal distention, bloating, nausea, vomiting and diarrhea, which leads to underfeeding
While medications and holding or discontinuing EN may be attempted to manage GI intolerance, a standardized approach to treatment has not been established. This study suggests a feeding approach that includes the use of peptide based formulas (PBDs) which often contain enzymatically hydrolyzed whey protein and a portion of the fat in the form of medium chain triglycerides (MCT).
Methods
A retrospective review of the electronic medical records (EMRs) was conducted for patients who received PBDs as exclusive EN from January 1, 2016-May 31, 2018. The objective of this study was to evaluate the tolerance of PBDs in patients at risk for malabsorption or in whom intolerance to SPFs were established.
Results
During the study period, 588 patients received HEN, and 16.1% of those patients received PBDs. A total of 95 patients received PBDs, with 53 starting directly on PBDs (“direct” PBDs) and 42 switching over from SPFs (“switch group”), following intolerance. The most common primary diagnosis in PBDs users included pancreatic adenocarcinoma (23%), pancreatitis (23%), and GI surgery-related malabsorption (12%). The most common indication for direct PBDs was fat malabsorption (30%), pancreatic insufficiency (25%) and post-operative chyle leak (17%). Eighty-nine percent of direct and 88% of switch PBDs patients received Peptamen® 1.5, Peptamen® with Prebio1™ or Peptamen® formulas, which contain enzymatically hydrolyzed 100% whey protein and a minimum of 50% of fat in the form of MCT.
The mean duration of PBDs was 42 days and 41 days in the direct PBDs and switch group, respectively. The major symptoms of intolerance including nausea and vomiting, diarrhea, abdominal pain, and abdominal distention decreased after switching to PBDs with significantly more patients free from any GI intolerance symptoms. Healthcare utilization decreased significantly after switching to PBDs, including patient-initiated phone calls related to HEN intolerance, average visits to the ER and average number of scheduled primary care provider/HEN provider visits.
Vomiting
Cramping
Distention
Bloating
Symptoms
*p-value <0.02
*p-value <0.02
Adapted from Mundi MS, et al. Nutrition in Clinical Practice 2020;35:487-494
Discussion
Both, those patients who were at risk for malabsorption and initially started on PBDs, as well as those transitioned from SPFs, tolerated PBDs well with significant improvement in symptoms and were able to meet nutritional needs. There was also a significant decrease in healthcare utilization.
PBDs are well-tolerated by patients at risk for malabsorption and in those who are intolerant to SPFs. While PBDs are increased in cost over SPFs, this cost can be significantly outweighed by the cost of health care utilization, including clinic visits, ER visits or hospitalization.