Vincenza Zurlo Journal Summary 3

A recent study published in the Journal of Parenteral and Enteral Nutrition examined gastric emptying with non-coagulating versus a coagulating enteral formula. This study was performed because previous studies have intimated that different protein content of enteral formulas may affect gastric emptying due to protein coagulation. This is thought to be especially true of protein blends that are mainly comprised of casein. Decreased gastric emptying time increases the risk for upper gastrointestinal problems and intolerance. This can ultimately lead to a poorer prognosis for patients and may affect overall nutrition status. This study was double-blind randomized crossover trial in design. It used 21 patients with an average age of 25. These patients were in good health and had BMIs that were within normal limits. Each patient received three different isocaloric feeds on three different days. Two of these formulas had high concentrations of casein proteins (coagulating formulas) while one had a different blend of proteins (non-coagulating formula). The study days were separated by 5 to 21 days and 300 milliliters (450 kilocalories) were administered over 5 minutes via a nasogastric tube. An MRI was then done in a standardized position at standardized times in order to assess gastric emptying. The dependent variable in this study was gastric emptying time while the independent variable was the type of formula received. The researchers controlled for several variables including: overall health of the patient, BMI, intake of medications that alter GI function and food allergies. They controlled for the timing and method of administration of feeds as well as the type of formula used. The researchers did not control for every co-morbidity however and did not control for gender. The results of the study show that when participants received a feeding with the casein heavy formula, their gastric emptying time was slower than when given the non-coagulating formula.

Specifically it took an average of 106 minutes for their coagulating formulas to be halfway emptied from the stomach and it took the non-coagulating formula 101 minutes to do so. The researchers suggest that the casein formulas coagulated more often because the isoelectric point of casein is close the acidity of what the stomach is in the second part of the postparandial period. Coagulated proteins would not be able to pass through the pylorus due to their size. This would then lead to delayed gastric emptying and as such, as higher risk for abdominal distention and other GI complications. It is important to note that this study has limited clinical relevance given the fact that most patients who are prescribed enteral feedings in the hospital setting are not otherwise healthy. Furthermore, the majority of patients in the United States do not have a BMI that is within normal limits. Also, although this was one of the larger studies of this kind to date, the sample size was still only 21 people. Given these facts, this study does not have significant impacts on clinical practice at this moment. However, future research should be done on a larger sample of patients who more accurately represent the typical hospital population. Reference 1. Kuyumeu S, Menne D, Curcic J et al. A Noncoagualting Enteral Formula Can Empty Faster From the Stomach: A Double-Blind, Randomized Crossover Trial Using Magnetic Resonance Imaging. JPEN. 2014; 1: 1-8. Doi: 10. 1177/0148607114528981