ADULT

ENTERAL
FORMULA

CHS 431 Presented By: SAMAHER ALSADHAN

 Enteral Nutrition

Nutrition support is a vital component of medical care.

Enteral nutrition (EN) can be defined as the provision

of nutrient via the gastrointestinal (GI) tract through a
feeding tube, catheter or stoma.

It is the preferred route for the provision of nutrient for

patients who cannot meet their nutrition needs through
voluntary oral intake.
Classification of Enteral Formula

Standard ( polymeric )

Elemental & Semi-Elemental

Disease - Specific

Blenderized

Modular
Standard ( polymeric )

 Formula containing intact nutrition ( protein, fat,

and CHO) which require normal or near normal
digestive and absorptive capacity and are
complete with respect to vitamin, minerals, and
trace elements at specified volume .
 Most are lactose free, gluten free, low viscosity
300- 500 mOsm/kg.
 Contain 1-1.2 kcal/ ml and are used as over the
counter oral supplement and tube feeding
formula. protein content 30 – 40 gm/L
Example of Standard Formula

Nutren1.0
ENSURE OSMOLITE

Isosource HN IMPACT
Calorie Dense

Standard formula are often concentrated to

provide 1.5-2 kcal/ml when fluid restriction is
required for patient.
Example of Calorie Dense Formula

ENSURE Nutren® 2.0 Isosource 1.5

Plus

IMPACT
1.5 TwoCal® HN
FortiCare
 FortiCare is a nutritionally complete, high energy
(1.6 kcal/ml), high protein, ready to drink, milk
shake style nutritional supplement.
 It is enriched with n-3 fatty acids, antioxidants and
fiber.
 for the dietary management of cachexia in
oncology patients.
Blenderized Feeding

 Used for patient that cannot tolerate semi-

synthetic formulas or who wish to consume
family food.
 Formulize with a mixture of blenderized food
source .
 Maintenance of aseptic technique is essential
to prevent bacterial contamination.
Blenderized Feeding

 Natural feeding contain

 Starch ( rice): ½ cup = 1 ex.

 Milk ( powder whole fat/ low)
 Fruit (apple juice): ½ cup = 1 ex.
 Veg ( ½ cup = 1 ex.)
 Meat ( lean; chicken ½ cup = 1ex.)
 Fat ( 1 tsp = 1 ex – 1 Tbs = 3 ex.)
 Blenderized Feeding

 Developed for Patients with Intolerance to Standard

Formulas.
 Formulated with real food:
 chicken, peas, carrots, tomatoes and cranberry juice cocktail

 Cranberry Juice helps support urinary tract health

 The fiber blend with BENEFIBER®♦ soluble fiber helps

promote beneficial bacterial growth and normal bowel function
Elemental & Semi-Elemental

 Contain partially or completely hydrolyzed nutrient

(elemental).
 Formula have been hydrolyzed to contain short
chain carbohydrate or simple sugar and peptides or
amino acid.
 The use of peptide based formula has been shown
to be superior to free A.A in promoting greater
nitrogen absorption in both healthy and disease gut.
 They are used with condition of maldigestion or
malabsorption.
 Example of Elemental & Semi-
Elemental
 Crucial :
 High calorie (1.5 kcal/mL) and 25%
protein.
 complete elemental peptide-based
formula.
 for immune support, wound healing,
trauma, major surgery, hypermetabolism,
burns, malabsorption, head injury and
chronic pressure ulcers.
 lactose-free, gluten-free, low-residue, for
fluid restricted patients
 Example of Elemental & Semi-
Elemental
 ALITRAQ:
 Is an elemental formula specifically
designed for metabolically stressed
patient with impaired GI function.
 helps maintain nutritional status and
provides supplemental glutamine to
nourish GI tract and help restore
glutamine depleted during catabolic
states.
 Glutamine is thought to be a
conditionally essential nutrient during
situations of metabolic stress.
 Example of Elemental & Semi-
Elemental
 Peptamen®:
 Balanced peptide profile promotes
proximal through distal GI
absorption and integrity
 Protein source is 100% whey,
enzymatically hydrolyzed, to
enhance absorption and facilitate
gastric emptying.
 70% of fat from MCT to decrease
potential for fat malabsorption
 Example of Elemental & Semi-
Elemental
 vivonex TEN:
 100% free amino acids diet for
severely compromised GI patients
 Only 3% of calories from fat to help
speed gastric emptying and
digestion, reduce pancreatic
stimulation and improve tolerance
 Enriched with glutamine to meet the
total nutritional needs of patients with
gastrointestinal impairment
 Complete oral or tube feeding.
 Example of Elemental & Semi-
Elemental
 PIVOT 1.5 Cal:
 Is a very-high-protein, calorically dense.
 Immune- enhancing, semi-elemental enteral formula
containing a peptide-based protein system.
 Added arginine, glutamine, structured lipid,
fructoligosaccharides (scFOS) and elevated levels of
antioxidants.
 Use in the metabolically stressed, immunosuppressed
patient & fluid restricted patients.
 Not for parenteral use.
 Example of Elemental & Semi-
Elemental
 PERATIVE:
 ready-to-feed formula designed for metabolically stressed patients
with pressure ulcers, multiple fractures, wounds, burns, or
surgery who can benefit from supplemental arginine.
 Calorically dense (1.3 Cal/mL) for the elevated energy needs of
metabolically stressed patients
 High in protein (20.5% of calories) for the elevated protein needs of
metabolically stressed patients
 Peptide-based, hydrolyzed protein for easier absorption. Well
tolerated as a tube feeding
 Gluten-free; suitable for lactose intolerance.
 Example of Elemental & Semi-
Elemental
 Vital® 1.0 Cal
 is a peptide-based elemental formula for patients experiencing
malabsorption, maldigestion, or impaired GI function and/or
feeding intolerance.
 For tube or oral feeding
 An advanced blend of hydrolyzed protein, structured lipid and
prebiotic to promote tolerance and absorption
 Elevated levels of antioxidant vitamins C and E to help reduce
free radical damage
 Gluten-free; suitable for lactose intolerance
 Disease Specific

 Used in organ dysfunction or specific metabolic

condition (for patients with specific disease
states).
 May not be nutritionally complete, most are
hyperosmolar.
 They are generally much more expensive than
standard formula.
 Disease Specific Formulas For
Immune-Enhancing
 Contain supplement amount of L-arginine, L- glutamine
nucleotide and EPA, DHA fatty acids
 The premise for these formula is they improve immune
cell function, modulate inflammation and reduce
infection.
 Appropriate for major elective surgery, trauma, burns,
head and neck cancer and ICU on mechanical
ventilation, wound healing.
 Caution in Pt with sever sepsis.
Disease Specific Formulas For
Immune-Enhancing
 Enteral Formula Categories
Fiber-Containing
Containing a source of fiber; reportedly beneficial for
prevention/treatment of altered bowel function in
enterally fed patients may be useful in the dietary
management of diarrhea and constipation

FIBERSOURCE HN®
Mostly for
for constipation
tube feeding
only
 Modular Product

 provides protein, fat, or carbohydrate as single

nutrients or modular mixtures to allow
adjustment of macronutrient mix.
 However these methods require more labor and
increase risk of microbial contamination.
 Modular Product
 MCT oil : is hydrolyzed fat, require less enzymes and
bile acids for digestion, use for decrease pancreatic
lipase

 Benefiber: Bowel management, high fiber

(3g /1 Tbsp or packet), lactose free
 Modular Product
 Beneprotein: High protein diet, renal (dialysis),
wound prevention and treatment programs, lactose
free.

 ProMod® : concentrated source of

high-quality protein for people with increased protein
needs or those who are unable to meet their protein
needs with a normal diet. Use as an addition to an
oral supplement or to tube-administered enteral
products.
 Modular Product
 Polycose: Source of CHO calorie for use when
additional calorie are required, lactose, gluten free and
low residue.

 Thicken up:
Dietary management for individuals with dysphagia, instant
thickener for hot and cold foods and beverages, thickens
quickly without lumping and its consistency
over time, lactose free and low residue.
 Oral Supplements

 Between meals
 Added to foods

 Added into liquids for medication pass

by nursing
 Enhances otherwise poor intake

 May be needed by children or teens to support

growth
 Oral Supplements

 Factor in the selection of oral supplement

include:
1. Taste : providing a variety of flavors can increase
intake.
2. Nutrient density: if Pt need Kcal supplement = 250
give 1kcal/ml but if he need more than 500kcal
provide > 1 kcal / ml.
3. Special nutrient requirement.
Oral Supplements