title: Effects of small-peptide and whole-protein enteral feedings on serum proteins and diarrhea in critically ill patients: a randomized trial.
abstract: BACKGROUND
  It has been proposed that enteral feeding formulas containing small peptides are more efficacious and better tolerated than whole-protein formulas in critically ill patients.
  
  
  METHODS
  Intensive care unit patients were stratified with regard to treatment with antibiotics and serum albumin and randomized to treatment with a small-peptide enteral diet or an isoenergetic, isonitrogenous whole-protein diet for 10 days. To assess efficacy, we measured serum prealbumin and fibronectin, and to assess tolerance, we monitored the incidence of diarrhea. A protocol was followed to ascertain all causes of diarrhea (defined as > 200 g stool or > or = 3 liquid stools on 2 consecutive days).
  
  
  RESULTS
  Fifty subjects completed the trial. Serum prealbumin and fibronectin increased between 21% and 36% in both groups, but the increase was significant only in the small-peptide group. The change in fibronectin between days 5 and 10 was significantly greater in the small-peptide group (p = .02). Diarrhea occurred in 10 subjects (17.8% of days) receiving small-peptide feeding and 4 subjects (7.5% of days) receiving whole-protein feeding (P = .07 for incidence and 0.03 for prevalence), but the difference was explained by the coincidental use of more diarrhea-causing medications in the former. Only one case of diarrhea could be attributed to tube feeding.
  
  
  CONCLUSIONS
  During 10 days of feeding, the small-peptide diet produced slightly greater increases in serum rapid-synthesis proteins than did the whole-protein diet, especially between days 5 and 10. The clinical implications of this difference between the diets are unknown. Both small-peptide and whole-protein diets were well tolerated.
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Heimburger
authors.forename: V J
authors.initials: VJ
authors.lastname: Geels
authors.forename: J
authors.initials: J
authors.lastname: Bilbrey
authors.forename: D T
authors.initials: DT
authors.lastname: Redden
authors.forename: C
authors.initials: C
authors.lastname: Keeney
mesh_terms: D001798:Blood Proteins / Q000032:analysis*; D016638:Critical Illness; D003967:Diarrhea / Q000209:etiology*; D004044:Dietary Proteins / Q000008:administration & dosage*; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005353:Fibronectins / Q000032:analysis; D005526:Food, Formulated / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage; D011228:Prealbumin / Q000032:analysis
chemical_list: D001798:Blood Proteins; D004044:Dietary Proteins; D005353:Fibronectins; D009842:Oligopeptides; C073248:Peptamen; D011228:Prealbumin