Chapter 18 Nutrition Support

TABLE 18.1 Selection of Tube-Feeding Formulas Type

Description

Standard/ polymeric

Nutritionally complete Low-residue Lactose-free Isotonic

1–1.2 kcal/mL 80%–85% water

Fiber- supplemented

Nutritionally complete Lactose-free

Fiber sources added Contains 5–14 g fiber/1,000 mL 1–1.2 kcal/mL

High nitrogen

Nutritionally complete Lactose-free Low-residue

Protein > 15% total kcal 1–1.2 kcal/mL

Concentrated

Nutritionally complete Lactose-free Low-residue

Osmolality of 450-600 mOsm/kg of water 70%–80% water 1.5–2 kcal/mL

Disease-specific Specific organ

dysfunction and/or hypercatabolism

Semi-elemental/ elemental

Nutritionally complete Low residue

Peptide– and/or amino acid–based

Lower fat content (1%–15% of kcal) Osmolality of 450– 700 mOsm

Renal failure Diabetes

Respiratory failure Immune enhancing Hepatic failure

Malabsorption Maldigestion Transition from total parenteral nutrition to enteral nutrition

Fluid restrictions Limited formula volume tolerance

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Indications for Use Advantages

General tube- feeding needs Supplement

inadequate oral intake

Normalize bowel function

Long-term feeding

Fiber added—soy polysaccharide,

Adequate water needed to minimize

gastrointestinal side effects

Increased protein requirements

Increased protein content without increased caloric level

Allows provision of energy and nutrient needs in a limited volume of formula

Tolerated in most patients

Alteration of macro- and micronutrients for clients with specific diseases

Easily digested and absorbed

MCT as fat component in some

Increased renal solute load may increase water requirements

Hypertonic

Lower percentage of water may increase risk of dehydration

Higher cost Controversial efficacy

Higher cost Less palatable Hypertonic

Less expensive Readily available

Disadvantages

Requires normal digestion and absorption

pulmonary, stress/trauma, and immune-enhancing), although disease-specific formulas should be used judiciously and on the advice of the physician/dietitian team (19).

Semielemental/Elemental Enteral Formulas

The macronutrients in elemental and semielemental formulas are hydrolyzed to maximize absorption.

Minimal digestion is required for the absorption of ele- mental formulas. The carbohydrate source is typically glucose oligosaccharides, and protein is provided as short-chain peptides and/or free amino acids. “These formulas are usually low in fat and provide a portion of fat in the form of medium-chain triglycerides” (19). Due to hydrolyzation, these formulas tend to have a higher osmolality.