CLINICAL TRIAL article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1587270
Semi-elemental versus polymeric formula for enteral nutrition in critically ill patients: A secondary analysis of a multicenter cluster-randomized controlled trial
Provisionally accepted
Wei Wei1Wen Lu1Guofeng Chen1Jindan Gao1Jun Zhang1Defeng Zhang1Ruiqin He1Jingjing Huang1Rong Cai1Rongrong Yuan1Xun Wang1Jinxia Yu1Zilong Li1Lu Ke2
Lin Gao2*
Zhengquan Wang1*- 1Department of Emergency Medicine, Yuyao City People's Hospital, Yuyao, Zhejiang, China
- 2Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Objectives: Semi-elemental enteral nutrition (EN) might theoretically improve gastrointestinal tolerance in critically ill patients, but is associated with an increased risk of diarrhea when delivered postpylorically. This study aimed to test whether the use of semi-elemental formula compared to polymeric formula may provide benefits in patients receiving gastric tube feeding. Methods: This 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. Results: The PSM created 516 matched pairs out of 1548 eligible patients. The incidence of abdominal distension/pain was significantly lower in the semi-elemental group compared to the polymeric group (9.1% vs. 13.8%, risk ratio, 0.66; 95% CI, 0.46 to 0.93; p = 0.027). No difference was found in the incidence of nausea/vomiting, aspiration, or diarrhea between groups. Conclusion: In critically ill patients receiving EN via gastric access, semi-elemental formula was associated with a reduced incidence of abdominal distension/pain, but not with an increased incidence of diarrhea, compared to polymeric formula.
Keywords: Critically ill, Enteral Nutrition, Semi-elemental, Gastric feeding, Gastrointestinal intolerance
Received: 04 Mar 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Wei, Lu, Chen, Gao, Zhang, Zhang, He, Huang, Cai, Yuan, Wang, Yu, Li, Ke, Gao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lin Gao, Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
Zhengquan Wang, Department of Emergency Medicine, Yuyao City People's Hospital, Yuyao, Zhejiang, China
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