Frontiers in nutrition · 2026
Risk of gastrointestinal intolerance and complications associated with homemade versus commercial enteral nutrition in critically ill patients: a single-center retrospective cohort study.
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Wang Yingying, He Quanquan, Xia Ming, Ni Weiwei, Zhu Shichao
Аннотация
BACKGROUND: Critically ill ICU patients often fail to achieve target caloric intake due to gastrointestinal intolerance. Although commercial enteral nutrition (CEN) formulas are the standard of care, emerging evidence suggests they may worsen intolerance in certain susceptible populations. Individualized commercial formulation (ICF) may help reduce related complications, but its safety and effectiveness compared to commercial formulas remain insufficiently validated.
OBJECTIVE: To compare the associations of CEN, mixed feeding, and ICF with gastrointestinal tolerance and complication risk in ICU patients.
METHODS: In this single-center retrospective cohort study, 605 adult ICU patients receiving tube-fed EN at Henan Provincial People's Hospital between January 2023 and January 2025 were included. Patients were classified into Commercial (n = 477), Mixed (n = 84), and ICF (n = 44) groups according to EN source. The primary outcome was diarrhea. Secondary outcomes included feeding interruption, gastric residual volume, constipation, hyperglycemia, and composite gastrointestinal complications. Multivariable logistic regression was used to adjust for baseline and feeding-related factors. Missing data were handled by multiple imputation. Propensity score matching and APACHE II-stratified analyses were performed as sensitivity analyses.
RESULTS: Compared with the Commercial group, the ICF group had a lower incidence of diarrhea (13.6% vs. 41.5%; aOR = 0.27, 95% CI 0.11-0.68; p = 0.005), fewer feeding interruptions (IRR = 0.29, 95% CI 0.18-0.45; p < 0.001), higher mean daily caloric intake (951 ± 218 vs. 893 ± 272 kcal/day, p < 0.001), and lower gastric residual volume (median 0 vs. 0-150 mL; p < 0.001). Hyperglycemia was also less frequent in the ICF group (25.0% vs. 99.6%, aOR < 0.001), although the overall incidence was high under the study definition. The risk of composite gastrointestinal complications was reduced by approximately 64% (aOR = 0.36, 95% CI 0.19-0.70; p = 0.002). No significant differences were observed in the Mixed group. Results were consistent in sensitivity analyses.
CONCLUSION: In critically ill ICU patients, ICF was associated with improved gastrointestinal tolerance and lower risks of diarrhea and selected complications compared with CEN. However, these findings should be interpreted cautiously given the observational design.
OBJECTIVE: To compare the associations of CEN, mixed feeding, and ICF with gastrointestinal tolerance and complication risk in ICU patients.
METHODS: In this single-center retrospective cohort study, 605 adult ICU patients receiving tube-fed EN at Henan Provincial People's Hospital between January 2023 and January 2025 were included. Patients were classified into Commercial (n = 477), Mixed (n = 84), and ICF (n = 44) groups according to EN source. The primary outcome was diarrhea. Secondary outcomes included feeding interruption, gastric residual volume, constipation, hyperglycemia, and composite gastrointestinal complications. Multivariable logistic regression was used to adjust for baseline and feeding-related factors. Missing data were handled by multiple imputation. Propensity score matching and APACHE II-stratified analyses were performed as sensitivity analyses.
RESULTS: Compared with the Commercial group, the ICF group had a lower incidence of diarrhea (13.6% vs. 41.5%; aOR = 0.27, 95% CI 0.11-0.68; p = 0.005), fewer feeding interruptions (IRR = 0.29, 95% CI 0.18-0.45; p < 0.001), higher mean daily caloric intake (951 ± 218 vs. 893 ± 272 kcal/day, p < 0.001), and lower gastric residual volume (median 0 vs. 0-150 mL; p < 0.001). Hyperglycemia was also less frequent in the ICF group (25.0% vs. 99.6%, aOR < 0.001), although the overall incidence was high under the study definition. The risk of composite gastrointestinal complications was reduced by approximately 64% (aOR = 0.36, 95% CI 0.19-0.70; p = 0.002). No significant differences were observed in the Mixed group. Results were consistent in sensitivity analyses.
CONCLUSION: In critically ill ICU patients, ICF was associated with improved gastrointestinal tolerance and lower risks of diarrhea and selected complications compared with CEN. However, these findings should be interpreted cautiously given the observational design.