Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study
Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to...
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| Veröffentlicht in: | Clinical nutrition ESPEN 2024-02, Vol.59, p.270-278 |
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| creator | Nguyen, Douglas L Schott, Laura L Lowen, Cynthia C Desai, Amarsinh M Baumer, Dorothy L Miranowski, Mary K Cao, Zhun Torres, Krysmaru Araujo |
| description | Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to feeding intolerance and healthcare resource utilization.
A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions.
Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P |
| doi_str_mv | 10.1016/j.clnesp.2023.12.007 |
| format | Article |
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A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions.
Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P < 0.03). In secondary analysis, odds of hyperglycemia were 81% higher for the other peptide-based group compared with the subgroup of very high-protein/low carbohydrate 100% whey-peptide (P < 0.001).
Lower GI intolerance and greater glycemic control were associated with the use of 100% whey-peptide formulas relative to other formulas. Appropriate and optimal delivery of EN using specialized peptide-based formulas is a strategy to minimize feeding intolerance and benefit critically ill patients.</description><identifier>ISSN: 2405-4577</identifier><identifier>EISSN: 2405-4577</identifier><identifier>DOI: 10.1016/j.clnesp.2023.12.007</identifier><identifier>PMID: 38220386</identifier><language>eng</language><publisher>England</publisher><subject>Adult ; adults ; clinical nutrition ; Critical Illness - therapy ; Cross-Sectional Studies ; disease severity ; enteral feeding ; Enteral Nutrition - adverse effects ; gastrointestinal system ; glucose ; glycemic control ; hospitals ; Humans ; Hyperglycemia ; Infant, Newborn ; patients ; Peptides ; Proteins ; Retrospective Studies ; whey</subject><ispartof>Clinical nutrition ESPEN, 2024-02, Vol.59, p.270-278</ispartof><rights>Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c386t-6887721471a68732014ffccddefff788d608e0a21207c4ad5cf13ed25eae769c3</citedby><cites>FETCH-LOGICAL-c386t-6887721471a68732014ffccddefff788d608e0a21207c4ad5cf13ed25eae769c3</cites><orcidid>0000-0001-5857-5817 ; 0000-0001-8386-395X ; 0000-0002-9786-3069 ; 0000-0002-4898-6767 ; 0009-0000-6814-0438</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38220386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyen, Douglas L</creatorcontrib><creatorcontrib>Schott, Laura L</creatorcontrib><creatorcontrib>Lowen, Cynthia C</creatorcontrib><creatorcontrib>Desai, Amarsinh M</creatorcontrib><creatorcontrib>Baumer, Dorothy L</creatorcontrib><creatorcontrib>Miranowski, Mary K</creatorcontrib><creatorcontrib>Cao, Zhun</creatorcontrib><creatorcontrib>Torres, Krysmaru Araujo</creatorcontrib><title>Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study</title><title>Clinical nutrition ESPEN</title><addtitle>Clin Nutr ESPEN</addtitle><description>Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to feeding intolerance and healthcare resource utilization.
A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions.
Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P < 0.03). In secondary analysis, odds of hyperglycemia were 81% higher for the other peptide-based group compared with the subgroup of very high-protein/low carbohydrate 100% whey-peptide (P < 0.001).
Lower GI intolerance and greater glycemic control were associated with the use of 100% whey-peptide formulas relative to other formulas. Appropriate and optimal delivery of EN using specialized peptide-based formulas is a strategy to minimize feeding intolerance and benefit critically ill patients.</description><subject>Adult</subject><subject>adults</subject><subject>clinical nutrition</subject><subject>Critical Illness - therapy</subject><subject>Cross-Sectional Studies</subject><subject>disease severity</subject><subject>enteral feeding</subject><subject>Enteral Nutrition - adverse effects</subject><subject>gastrointestinal system</subject><subject>glucose</subject><subject>glycemic control</subject><subject>hospitals</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Infant, Newborn</subject><subject>patients</subject><subject>Peptides</subject><subject>Proteins</subject><subject>Retrospective Studies</subject><subject>whey</subject><issn>2405-4577</issn><issn>2405-4577</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9qFTEUxoMottS-QZEs3cw0_2aScVcu2goFN7oOaXJSc8nNjEmmcB_FtzXjreKunMU5Ib_vOxw-hK4o6Smh4_W-tzFBWXpGGO8p6wmRr9A5E2ToxCDl6__mM3RZyp6QppsmQclbdMYVY4Sr8Rz92v0w2dgKOZQabMEmOewBXEiPOKQ6R8gmWWgztjk0xMR4xCFGbNwaK15MDZBqwRkshKdNtsBSg4PuwRRwuH02i4jTWjf9nD7imwbXPJcFbA1P0IznUrqyvebU0FJXd3yH3ngTC1w-9wv0_fOnb7u77v7r7ZfdzX1n2wG1G5WSklEhqRmV5IxQ4b21zoH3XirlRqKAGEYZkVYYN1hPOTg2gAE5TpZfoA8n3yXPP1coVR9CsRCjSTCvRXMiWlE1sRdRNlHBBsYn3lBxQv_clsHrJYeDyUdNid4i1Ht9ilBvEWrKdIuwyd4_b1gfDuD-if4Gxn8DDQ-dbQ</recordid><startdate>202402</startdate><enddate>202402</enddate><creator>Nguyen, Douglas L</creator><creator>Schott, Laura L</creator><creator>Lowen, Cynthia C</creator><creator>Desai, Amarsinh M</creator><creator>Baumer, Dorothy L</creator><creator>Miranowski, Mary K</creator><creator>Cao, Zhun</creator><creator>Torres, Krysmaru Araujo</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7S9</scope><scope>L.6</scope><orcidid>https://orcid.org/0000-0001-5857-5817</orcidid><orcidid>https://orcid.org/0000-0001-8386-395X</orcidid><orcidid>https://orcid.org/0000-0002-9786-3069</orcidid><orcidid>https://orcid.org/0000-0002-4898-6767</orcidid><orcidid>https://orcid.org/0009-0000-6814-0438</orcidid></search><sort><creationdate>202402</creationdate><title>Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study</title><author>Nguyen, Douglas L ; Schott, Laura L ; Lowen, Cynthia C ; Desai, Amarsinh M ; Baumer, Dorothy L ; Miranowski, Mary K ; Cao, Zhun ; Torres, Krysmaru Araujo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-6887721471a68732014ffccddefff788d608e0a21207c4ad5cf13ed25eae769c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>adults</topic><topic>clinical nutrition</topic><topic>Critical Illness - therapy</topic><topic>Cross-Sectional Studies</topic><topic>disease severity</topic><topic>enteral feeding</topic><topic>Enteral Nutrition - adverse effects</topic><topic>gastrointestinal system</topic><topic>glucose</topic><topic>glycemic control</topic><topic>hospitals</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Infant, Newborn</topic><topic>patients</topic><topic>Peptides</topic><topic>Proteins</topic><topic>Retrospective Studies</topic><topic>whey</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyen, Douglas L</creatorcontrib><creatorcontrib>Schott, Laura L</creatorcontrib><creatorcontrib>Lowen, Cynthia C</creatorcontrib><creatorcontrib>Desai, Amarsinh M</creatorcontrib><creatorcontrib>Baumer, Dorothy L</creatorcontrib><creatorcontrib>Miranowski, Mary K</creatorcontrib><creatorcontrib>Cao, Zhun</creatorcontrib><creatorcontrib>Torres, Krysmaru Araujo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>AGRICOLA</collection><collection>AGRICOLA - Academic</collection><jtitle>Clinical nutrition ESPEN</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyen, Douglas L</au><au>Schott, Laura L</au><au>Lowen, Cynthia C</au><au>Desai, Amarsinh M</au><au>Baumer, Dorothy L</au><au>Miranowski, Mary K</au><au>Cao, Zhun</au><au>Torres, Krysmaru Araujo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study</atitle><jtitle>Clinical nutrition ESPEN</jtitle><addtitle>Clin Nutr ESPEN</addtitle><date>2024-02</date><risdate>2024</risdate><volume>59</volume><spage>270</spage><epage>278</epage><pages>270-278</pages><issn>2405-4577</issn><eissn>2405-4577</eissn><abstract>Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to feeding intolerance and healthcare resource utilization.
A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions.
Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P < 0.03). In secondary analysis, odds of hyperglycemia were 81% higher for the other peptide-based group compared with the subgroup of very high-protein/low carbohydrate 100% whey-peptide (P < 0.001).
Lower GI intolerance and greater glycemic control were associated with the use of 100% whey-peptide formulas relative to other formulas. Appropriate and optimal delivery of EN using specialized peptide-based formulas is a strategy to minimize feeding intolerance and benefit critically ill patients.</abstract><cop>England</cop><pmid>38220386</pmid><doi>10.1016/j.clnesp.2023.12.007</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5857-5817</orcidid><orcidid>https://orcid.org/0000-0001-8386-395X</orcidid><orcidid>https://orcid.org/0000-0002-9786-3069</orcidid><orcidid>https://orcid.org/0000-0002-4898-6767</orcidid><orcidid>https://orcid.org/0009-0000-6814-0438</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult adults clinical nutrition Critical Illness - therapy Cross-Sectional Studies disease severity enteral feeding Enteral Nutrition - adverse effects gastrointestinal system glucose glycemic control hospitals Humans Hyperglycemia Infant, Newborn patients Peptides Proteins Retrospective Studies whey |
| title | Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study |
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