Lecture 6

By
Dr. Anam Aman
Enteral nutrition:
• The provision of nutrients using the GI tract, including the use of tube
feedings and oral diets.

• Enteral feedings are preferred over intravenous feedings because they

help to stimulate or maintain gut function, cause fewer complications,
and are less costly.
• Similarly, oral feedings are preferred to tube feedings when the
person is able to drink enteral formulas, because drinking the
formulas prevents the stress, complications, and expense associated
with tube feedings
 Types of Enteral nutrition:
1. Standard Formulas also called polymeric formulas,
• Provided to individuals who can digest and absorb nutrients without
difficulty.
• They contain intact proteins extracted from milk or soybeans or a
combination of protein isolates (proteins isolated from foods).
• The carbohydrate sources include modified starches, glucose polymers
(such as maltodextrin), and sugars.
• A few formulas, called blenderized formulas, are made from whole foods
and derive their protein primarily from pureed meat or poultry.
2. Elemental formulas:
• Enteral formulas that contain carbohydrates and proteins that are partially or
fully hydrolyzed; also called hydrolyzed, chemically defined, or monomeric
formulas
• Prescribed for patients who have compromised digestive or absorptive
functions.
• Elemental formulas contain proteins and carbohydrates that have been
partially or fully broken down to fragments that require little (if any)
digestion.
• The formulas are often low in fat and may contain medium-chain triglycerides
(MCT) to ease digestion and absorption
• MCT: triglycerides that contain fatty acids that are 8 to 10 carbons in length.
MCT do not require digestion and can be absorbed in the absence of lipase or
bile.
3. Specialized Formulas
• also called disease-specific formulas, are designed to meet the specific
nutrient needs of patients with particular illnesses.
• Products have been developed for individuals with liver, kidney, and lung
diseases; glucose intolerance; and metabolic stress.
• Disease-specific formulas are generally expensive, and their effectiveness is
controversial
4. Modular Formulas
• created from individual macronutrient preparations called modules, are
prepared for patients who require specific nutrient combinations to treat
their illnesses. Vitamin and mineral preparations are also included in these
formulas so that they can meet all of a person’s nutrient needs.
• In some cases, one or more modules are added to other enteral formulas to
adjust their nutrient composition.
 Formula Characteristics
Macronutrient Composition
• The percentages of protein, carbohydrate, and fat vary substantially among
enteral formulas.
• The protein content of most formulas ranges from 12 to 20 percent of total
kcalories.
• protein needs are high in patients with severe metabolic stress, whereas
protein restrictions are necessary for patients with kidney disease.
• Carbohydrate and fat provide most of the energy in enteral formulas;
standard formulas generally provide 40 to 60 percent of kcalories from
carbohydrate and 30 to 40 percent of kcalories from fat.
Energy Density
• The energy density of enteral formulas ranges from 0.5 to 2.0 kcalories per
milliliter of fluid.
• Standard formulas typically provide 1.0 to 1.2 kcalories per milliliter and
are appropriate for patients with average fluid requirements.
• Formulas that have higher energy densities can meet energy and nutrient
needs in a smaller volume of fluid and thus benefit patients who have high
nutrient needs or fluid restrictions.
• Individuals with high fluid needs can be given a formula with low energy
density or be supplied with additional water via the feeding tube or
intravenously
Fiber Content
• The fiber content must be taken into account when selecting an
enteral formula. Fiber-containing formulas can be helpful for
normalizing intestinal function, treating diarrhea or constipation, and
maintaining blood glucose control.
• Conversely, fiber-containing formulas are avoided in patients with
acute intestinal conditions, pancreatitis, or procedures involving the
intestines.
Osmolality Osmolality refers to the moles of osmotically active solutes
(osmoles) per kilogram of solvent.
• An enteral formula with an osmolality similar to that of blood serum
(about 300 milliosmoles per kilogram) is an isotonic formula,
• whereas a hypertonic formula has an osmolality greater than that of
blood serum
• Most enteral formulas have osmolalities between 300 and 700 milliosmoles
per kilogram; generally, hydrolyzed formulas and nutrient-dense formulas
have higher osmolalities than standard formulas.
• Most people are able to tolerate both isotonic and hypertonic feedings
without difficulty.
• When medications are infused along with enteral feedings, however, the
osmotic load increases substantially and may contribute to the diarrhea
experienced by many tube-fed patients.