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Fat-Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter, Single-Blind, Randomized Controlled Trial.
Qiu, Chunfang MSc 1,*; Chen, Chuanxi MSc 1,*; Zhang, Weixing MD, PhD 2; Kou, Qiuye MD, PhD 3; Wu, Shengnan MSc 4; Zhou, Lixin MSc 5; Liu, Jiyun BD 6; Ma, Gang MSc 7; Chen, Juan BD 1; Chen, Minying MD, PhD 1; Luo, Hua MSc 2; Zhang, Xiaofei MSc 3; Lai, Jianbo MSc 4; Yu, Zhihui MSc 5; Yu, Xiaochun BD 6; Liao, Wei MSc 7; Guan, Xiangdong MD, PhD 1; Ouyang, Bin MD, PhD 1,
[Article] Journal of Parenteral & Enteral Nutrition. 41(5):785-795, July 2017.

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Background: Improvement of fat digestion and absorption was supposed to relieve feeding intolerance. This trial aimed to evaluate the effect of a fat-modified enteral formula on feeding tolerance in critically ill patients. Materials and Methods: This trial was conducted in 7 hospitals in China. In total, 144 intensive care unit (ICU) patients with estimated need of enteral nutrition (EN) for at least 5 days were randomly given fat-modified enteral formula containing medium-chain triglycerides (MCT), carnitine, and taurine (interventional feed group, n = 71) or standard enteral formula (control feed group, n = 73). EN intake, feeding intolerance (diarrhea, vomiting, gastric retention, and abdominal distension) and outcomes (mechanical ventilator-free days of 28 days, length of ICU stay, length of hospital stay, and in-hospital mortality) were collected. Results: Daily calories and protein intake were increased in the interventional feed group compared with the control feed group (P < .01). Total incidence of feeding intolerance was 42.3% in the interventional feed group and 65.7% in the control feed group (P < .001). Daily incidence of feeding intolerance was 11.3%, 18.3%, 14.1%, 25.4%, and 26.1% in the interventional feed group and 31.5%, 32.9%, 34.2%, 34.2%, and 30.4% in the control feed group from study days 1-5 (P = .0083). Incidence of feeding intolerance without abdominal distention was 32.9% in the interventional feed group and 49.3% in the control feed group (P = .047), while the incidence of abdominal distension was 26.8% in the interventional feed group and 43.8% in the control feed group (P = .03). No significant differences existed in outcomes between the 2 groups. Conclusions: The fat-modified enteral formula containing MCT, carnitine, and taurine may improve feeding tolerance in critically ill patients.