title: Diarrhoea during enteral nutrition is predicted by the poorly absorbed short-chain carbohydrate (FODMAP) content of the formula.
abstract: BACKGROUND
  Although it is recognized that diarrhoea commonly complicates enteral nutrition, the causes remain unknown.
  
  
  OBJECTIVE
  To identify factors associated with diarrhoea in patients receiving enteral nutrition with specific attention to formula composition.
  
  
  METHODS
  Medical histories of in-patients receiving enteral nutrition were identified by ICD-10-AM coding and randomly selected from the year 2003 to 2008. Clinical and demographic data were extracted. Formulas were classified according to osmolality, fibre and FODMAP (fermentable oligo-, di- and mono-saccharides and polyols) content.
  
  
  RESULTS
  Formula FODMAP levels ranged from 10.6 to 36.5 g/day. Of 160 patients receiving enteral nutrition, 61% had diarrhoea. Univariate analysis showed diarrhoea was associated with length of stay >21 days (OR 4.2), enteral nutrition duration >11 days (OR 4.0) and antibiotic use (OR 2.1). After adjusting for influencing variables through a logistic regression model, a greater than five-fold reduction in risk of developing diarrhoea was seen in patients initiated on Isosource 1.5 (P = 0.029; estimated OR 0.18). The only characteristic unique to this formula was its FODMAP content, being 47-71% lower than any other formula.
  
  
  CONCLUSIONS
  Length of stay and enteral nutrition duration independently predicted diarrhoea development, while being initiated on a lower FODMAP formula reduced the likelihood of diarrhoea. As retrospective evaluation does not support a cause-effect relationship, an interventional study investigating FODMAPs in enteral formula is indicated.
authors.affiliation: Department of Medicine, Monash University, Box Hill, Vic., Australia. emma.halmos@monash.edu
authors.forename: E P
authors.initials: EP
authors.lastname: Halmos
authors.forename: J G
authors.initials: JG
authors.lastname: Muir
authors.forename: J S
authors.initials: JS
authors.lastname: Barrett
authors.forename: M
authors.initials: M
authors.lastname: Deng
authors.forename: S J
authors.initials: SJ
authors.lastname: Shepherd
authors.forename: P R
authors.initials: PR
authors.lastname: Gibson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003967:Diarrhea / Q000209:etiology*; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects* / Q000032:analysis; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D004040:Dietary Carbohydrates