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Effects of Small-Peptide and Whole-Protein Enteral Feedings on Serum Proteins and Diarrhea in Critically III Patients: A Randomized Trial

Department of Nutrition Sciences, University of Alabama at Birmingham, Department of Medicine, University of Alabama at Birmingham

Wilma J. Geels, MSN, CNSN

Department of Nursing, University of Alabama at Birmingham

Jodie Bilbrey, MS, RD, CNSD

Department of Dietetics, Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham

David T. Redden, PHD

Department of Biostatistics Unit, Comprehensive Cancer Center, University of Alabama at Birmingham

Carolyn Keeney, RD

Department of Food and Nutrition Services, University of Alabama Hospital, Birmingham, Homewood City Schools, Homewood, AL

Background: It has been proposed that enteral feeding formulas containing small peptides are more efficacious and better tolerated than whole-protein formulas in critically ill patients. Methods: Intensive care unit patients were stratified with regard to treatment with antibiotics and serum albumin and randomized to treatment with a small-peptide enteral diet or an isoenergetic, isonitrogenous whole-protein diet for 10 days. To assess efficacy, we measured serum prealbumin and fibronectin, and to assess tolerance, we monitored the incidence of diarrhea. A protocol was followed to ascertain all causes of diarrhea (defined as >200 g stool or 3 liquid stools on 2 consecutive days). Results: Fifty subjects completed the trial. Serum prealbumin and fibronectin increased between 21% and 36% in both groups, but the increase was significant only in the small-peptide group. The change in fibronectin between days 5 and 10 was significantly greater in the small-peptide group (p = .02). Diarrhea occurred in 10 subjects (17.8% of days) receiving small-peptide feeding and 4 subjects (7.5% of days) receiving whole-protein feeding (p = .07 for incidence and 0.03 for prevalence), but the difference was explained by the coincidental use of more diarrhea-causing medications in the former. Only one case of diarrhea could be attributed to tube feeding. Conclusions: During 10 days of feeding, the small-peptide diet produced slightly greater increases in serum rapid-synthesis proteins than did the whole-protein diet, especially between days 5 and 10. The clinical implications of this difference between the diets are unknown. Both small-peptide and whole-protein diets were well tolerated. (Journal of Parenteyal and Enteral Nutrition 21:162-167, 1997)

Journal of Parenteral and Enteral Nutrition, Vol. 21, No. 3, 162-167 (1997)
DOI: 10.1177/0148607197021003162


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