Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial
ObjectivesSemi-elemental enteral nutrition (EN) might theoretically improve gastrointestinal tolerance in critically ill patients; however, it is associated with an increased risk of diarrhea when delivered postpylorically. This study aimed to assess whether the use of semi-elemental formula compare...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2025.1587270/full |
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| author | Wei Wei Wen Lu Guofeng Chen Jindan Gao Jun Zhang Defeng Zhang Ruiqin He Jingjing Huang Rong Cai Rongrong Yuan Xun Wang Jinxia Yu Zilong Li Lu Ke Lin Gao Zhengquan Wang |
| author_facet | Wei Wei Wen Lu Guofeng Chen Jindan Gao Jun Zhang Defeng Zhang Ruiqin He Jingjing Huang Rong Cai Rongrong Yuan Xun Wang Jinxia Yu Zilong Li Lu Ke Lin Gao Zhengquan Wang |
| author_sort | Wei Wei |
| collection | DOAJ |
| description | ObjectivesSemi-elemental enteral nutrition (EN) might theoretically improve gastrointestinal tolerance in critically ill patients; however, it is associated with an increased risk of diarrhea when delivered postpylorically. This study aimed to assess whether the use of semi-elemental formula compared to polymeric formula may provide benefits in patients receiving gastric tube feeding.MethodsThis is a post-hoc analysis of data from a multicenter, cluster-randomized, controlled, investigator-initiated trial (NEED trial). Patients were eligible if they stayed in the participating intensive care units (ICUs) and received gastric EN exclusively during the first week of enrollment. A directed acyclic graph (DAG) was used to identify potential confounders. Propensity score matching (PSM) was applied to control for the detected confounders. The primary outcome was the incidence of intolerance-related symptoms, including nausea/vomiting, aspiration, abdominal distension/pain, and diarrhea.ResultsPSM created 516 matched pairs from 1,548 eligible patients. The incidence of abdominal distension/pain was significantly lower in the semi-elemental group compared to the polymeric group (9.1% versus 13.8%, risk ratio, 0.66; 95% CI, 0.46 to 0.93; p = 0.027). No significant differences were observed in the incidence of nausea/vomiting, aspiration, or diarrhea between groups.ConclusionIn critically ill patients receiving EN via gastric access, the semi-elemental formula was associated with a reduced incidence of abdominal distension/pain, but not with an increased incidence of diarrhea, compared to the polymeric formula.Clinical trial registrationhttps://www.isrctn.com/ISRCTN12233792?q=ISRCTN12233792&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10, Identifier ISRCTN12233792. |
| format | Article |
| id | doaj-art-cdffb1acea644a0195465587d5d64e5e |
| institution | Kabale University |
| issn | 2296-861X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj-art-cdffb1acea644a0195465587d5d64e5e2025-08-20T03:51:35ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2025-07-011210.3389/fnut.2025.15872701587270Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trialWei Wei0Wen Lu1Guofeng Chen2Jindan Gao3Jun Zhang4Defeng Zhang5Ruiqin He6Jingjing Huang7Rong Cai8Rongrong Yuan9Xun Wang10Jinxia Yu11Zilong Li12Lu Ke13Lin Gao14Zhengquan Wang15Department of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaDepartment of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, ChinaDepartment of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, ChinaDepartment of Emergency Medicine, Yangming Hospital Affiliated to Ningbo University (The People’s Hospital of Yuyao City), Yuyao, Zhejiang, ChinaObjectivesSemi-elemental enteral nutrition (EN) might theoretically improve gastrointestinal tolerance in critically ill patients; however, it is associated with an increased risk of diarrhea when delivered postpylorically. This study aimed to assess whether the use of semi-elemental formula compared to polymeric formula may provide benefits in patients receiving gastric tube feeding.MethodsThis is a post-hoc analysis of data from a multicenter, cluster-randomized, controlled, investigator-initiated trial (NEED trial). Patients were eligible if they stayed in the participating intensive care units (ICUs) and received gastric EN exclusively during the first week of enrollment. A directed acyclic graph (DAG) was used to identify potential confounders. Propensity score matching (PSM) was applied to control for the detected confounders. The primary outcome was the incidence of intolerance-related symptoms, including nausea/vomiting, aspiration, abdominal distension/pain, and diarrhea.ResultsPSM created 516 matched pairs from 1,548 eligible patients. The incidence of abdominal distension/pain was significantly lower in the semi-elemental group compared to the polymeric group (9.1% versus 13.8%, risk ratio, 0.66; 95% CI, 0.46 to 0.93; p = 0.027). No significant differences were observed in the incidence of nausea/vomiting, aspiration, or diarrhea between groups.ConclusionIn critically ill patients receiving EN via gastric access, the semi-elemental formula was associated with a reduced incidence of abdominal distension/pain, but not with an increased incidence of diarrhea, compared to the polymeric formula.Clinical trial registrationhttps://www.isrctn.com/ISRCTN12233792?q=ISRCTN12233792&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10, Identifier ISRCTN12233792.https://www.frontiersin.org/articles/10.3389/fnut.2025.1587270/fullcritically illenteral nutritionsemi-elementalgastric feedinggastrointestinal intolerance |
| spellingShingle | Wei Wei Wen Lu Guofeng Chen Jindan Gao Jun Zhang Defeng Zhang Ruiqin He Jingjing Huang Rong Cai Rongrong Yuan Xun Wang Jinxia Yu Zilong Li Lu Ke Lin Gao Zhengquan Wang Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial Frontiers in Nutrition critically ill enteral nutrition semi-elemental gastric feeding gastrointestinal intolerance |
| title | Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial |
| title_full | Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial |
| title_fullStr | Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial |
| title_full_unstemmed | Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial |
| title_short | Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: a secondary analysis of a multicenter cluster-randomized controlled trial |
| title_sort | semi elemental versus polymeric formula for enteral nutrition in critically ill patients a secondary analysis of a multicenter cluster randomized controlled trial |
| topic | critically ill enteral nutrition semi-elemental gastric feeding gastrointestinal intolerance |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2025.1587270/full |
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