Risk of Gastrointestinal Intolerance and Complications Associated with Homemade versus Commercial Enteral Nutrition in Critically Ill Patients: A Single-Center Retrospective Cohort Study

Why It Matters

If hospital‑prepared formulas can reliably improve gastrointestinal tolerance, they could lower ICU complications, enhance nutritional adequacy, and potentially shorten critical‑care stays.

Key Takeaways

• ICF reduced diarrhea risk by 73% compared with commercial formulas
• Feeding interruptions fell 71% with ICF, boosting daily caloric delivery
• Hyperglycemia incidence dropped from 99.6% to 25% under ICF
• Gastric residual volume median was zero for ICF patients
• Study limited by single‑center, small ICF sample, and retrospective design

Pulse Analysis

Enteral nutrition remains a cornerstone of supportive care for critically ill patients, yet gastrointestinal intolerance—manifested as diarrhea, high gastric residual volumes, and feeding interruptions—continues to impede optimal caloric delivery. Guidelines from ESPEN and ASPEN endorse early tube feeding, but the choice of formula can influence tolerance. Commercially manufactured feeds offer standardized nutrient profiles and safety assurances, yet their high osmolarity and limited fiber content have been implicated in worsening intolerance for vulnerable ICU cohorts.

The recent single‑center analysis of 605 patients provides compelling real‑world evidence that hospital‑compounded individualized commercial formulations (ICF) can markedly improve tolerance metrics. Compared with standard commercial formulas, ICF cut the odds of diarrhea by 73%, reduced feeding interruptions by 71%, and achieved a higher average caloric intake despite a shorter feeding duration. Mechanistically, the lower osmolar load, preservation of natural food matrices, and diversified fiber sources in ICF likely support colonic short‑chain fatty acid production and mucosal integrity, thereby mitigating osmotic diarrhea and promoting smoother gastric emptying. The dramatic drop in hyperglycemia incidence also suggests more favorable carbohydrate handling, though the study’s glucose threshold may overstate clinical relevance.

While the findings are promising, the study’s retrospective nature, modest ICF sample size, and single‑center scope limit generalizability. Robust, multicenter randomized trials are needed to confirm safety—particularly microbial contamination risks—and to evaluate cost‑effectiveness compared with off‑the‑shelf products. Until such data emerge, institutions with dedicated nutrition compounding capabilities may consider ICF for patients who demonstrate poor tolerance to standard feeds, but should implement strict preparation protocols and ongoing monitoring to ensure patient safety.