Prescribing practice and evaluation of appropriateness of enteral nutrition in a university teaching hospital

Figures & data

Table 1 Nutritional composition of eight enteral nutrition formulas

	Type of enteral nutrition
	Total protein type						Short peptide type	Amino acid type
	Nutrison Fibre^® (500 mL)	Fresubin Energy Fibre^® (500 mL)	Fresubin^® (500 mL)	Supportan^® (200 mL)	Fresubin Diabetes^® (500 mL)	Ensure^® (400 g)	Peptison^® (500 mL)	Vivonex^® (80.4 g)
Energy density kCal/mL)	1.5	1.5	1.0	1.3	1.0	1.0 (55.8 g/250 mL)	1.0	1.0 (80.4 g/300 mL)
NPC:N	133:1	167:1	184:1	139:1	165:1	174:1	172.4:1	138:1
Pro:Fat:Car	16:35:49	15:35:50	15:30:55	18:50:32	15:32:53	14:32:54	16:9:75	15:3:82
Protein (g)	30	28	19	11.7	17	63.6	20 (hydrolyzed whey protein)	14.2 (crystalline amino acid)
Carbohydrates (g)	92.5	94	69	20.8	60	242.8	88	63
Lipids (g)	29.5	29	17	14.4	16	63.6	8.5	0.51
Fiber (g)	7.5	10	0	2.6	7.5	0	0	0
Omega-3 fatty	1.53	0	0	0.6	0	0	0	0
acids (g)
Osmolality (mOsm/L)	300	320	250	330	320	320	470	610

Abbreviations: NPC, nonprotein calorie to nitrogen ratio; Pro, protein; Car, carbohydrate.

Table 2 Combination use of different enteral nutrition formulas in hospitalized patients

Combination mode	n	Relative %
Total	2928
Triple therapy	2129	72.7
Dual therapy	726	24.8
Quadruple therapy	63	2.2
Monotherapy	9	0.3

Table 3 Pharmacoeconomic indices of eight enteral nutrition formulas for hospitalized patients

Type	Drug name	DDD	DDDs	Total expenditure (CNY)	Daily expenditure (CNY)
TP	Nutrison Fibre^®	1333 mL	9078	1,929,000	212.5
TP	Fresubin Energy Fibre^®	500 mL	8874	675,000	76.1
TP	Fresubin Diabetes^®	500 mL	8839	819,000	92.6
TP	Supportan^®	1200 mL	4970	1,714,000	345
TP	Ensure^®	171 g	2430	75,000	30.8
TP	Fresubin^®	1000 mL	684	55,000	80.4
SP	Peptison^®	2000 mL	2743	1,099,000	400.9
AA	Vivonex^®	482.4 g	992	442,000	445.6

Abbreviations: DDD, defined daily dose; DDDs, total dose consumed/DDD; daily expenditure, overall expenditure/DDD; TP, total protein; SP, short peptide; AA, amino acid; CNY: Chinese Yuan Renminbi.

Table 4 The strength and shortcomings of eight enteral nutrition formulas

Nitrogen source	Enteral nutrition	Strength	Shortcomings
Total protein	Nutrison Fibre^® (500 mL)	• It is more suitable for patients who need water restriction and patients with high demand of energy and protein. • It can be used for patients with diabetes mellitus. • It can be used for patients over 1 year old. • It contains more DDD-based quantity of omega-3 fatty acid which may have beneficial effects in critically ill patients than Supportan^®.	• It is not suitable for patients requiring low residue diet. • Monitoring of fluid balance is required during the course of treatment.
	Fresubin Energy Fibre^® (500 mL)	• It is more suitable for patients who need water restriction and patients with high demand of energy and protein. • The fiber-rich formula facilitates the maintenance of intestinal structure and function, and thus it is suitable for long-term application.	• It is not suitable for patients requiring low residue diet. • Monitoring of fluid balance is required during the course of treatment. • It is only indicated for adult patients.
	Fresubin^® (500 mL)	• This product does not contain dietary fiber so that it can be used for serious gastrointestinal stenosis patients, patients with intestinal fistula and bowel preparation before the colonoscopy.	• It is not suitable for patients with high demand of energy and protein. • Long-term use of this product is only suitable for patients who should not take dietary fiber.
	Ensure^® (400 g)	• It is the cheapest product with the lowest daily expenditure among 8 formulas. • It can be used for children over 4 years old besides adults. • Due to powder characteristics it is convenient for storage. Unlike other emulsions which can be kept up to 24 hours in a refrigerator after opening, it can be stored at room temperature for three weeks once it has been opened. • It is low-residue formula.
	Supportan^® (200 mL)	• It is a special immunonutrition for cancer patients or patients with increased demands for omega-3 fatty acids.	• Routine use of Supportan^® in ICU is not an economic choice. • It is only indicated for adult patients. • It is disease-specific formula and thus there are strict indications.
	Fresubin Diabetes^® (500 mL)	• This diabetes specific formula can reduce glucose load in patients with diabetes or glucose intolerance. • It is rich in dietary fiber content and helps to maintain the function of gastrointestinal tract.	• It is disease-specific formula and thus there are strict indications.
Short peptide	Peptison^® (500 mL)	• The peptides can be easily absorbed by enzyme hydrolysis in intestinal brush border. • It may decrease inflammation and increase antioxidant defenses in elderly patients with ischemic stroke, compared to casein containing formula (eg, Nutrison Fibre^®). • It can be indicated for diabetes.	• Compared with total protein-based formula, it is not economic for patients with normal or almost normal gastrointestinal digestion and absorption function.
Amino acid	Vivonex^® (80.4 g)	• It is amino acid based formula which can be directly absorbed via enteral mucosa. It is suitable for patients with severe metabolic disorders and gastrointestinal dysfunction. • Due to powder characteristics it is convenient for storage. • The formula has no residue.	• It is the most expensive formula with the highest daily expenditure. • It has obviously higher osmolality and thus theoretically higher occurrence of osmotic diarrhea compared with total protein-based and peptide-based formulas. • It is not indicated in children below 10 years old.