title: Gastrointestinal tolerance and plasma status of carotenoids, EPA and DHA with a fiber-enriched tube feed in hospitalized patients initiated on tube nutrition: Randomized controlled trial.
abstract: During the first days of tube feeding (TF) gastrointestinal (GI) complications are common and administration of sufficient nutrition is a challenge. Not all standard nutritionally complete formulas contain dietary fiber, fish oil or carotenoids, key dietary nutrients for health and wellbeing. The aim of this study was to investigate the effects of a fiber, fish oil and carotenoid enriched TF formula on diarrhea, constipation and nutrient bioavailability.
  
  
  
  A multi-center randomized, double-blind, controlled, parallel trial compared the effects of a dietary fiber, fish oil and carotenoid-enriched TF formula (test) with an isocaloric non-enriched formula (control) in 51 patients requiring initiation of TF. Incidence of diarrhea and constipation (based on stool frequency and consistency) was recorded daily. Plasma status of EPA, DHA and carotenoids was measured after 7 days.
  
  
  
  The incidence of diarrhea was lower in patients receiving the test formula compared with the control group (19% vs. 48%, p = 0.034). EPA and DHA status (% of total plasma phospholipids) was higher after 7 days in test compared with control group (EPA: p = 0.002, DHA: p = 0.082). Plasma carotenoid levels were higher after 7 days in the test group compared with control group (lutein: p = 0.024, α-carotene: p = 0.005, lycopene: p = 0.020, β-carotene: p = 0.054).
  
  
  
  This study suggests that the nutrient-enriched TF formula tested might have a positive effect on GI tolerance with less diarrhea incidence and significantly improved EPA, DHA and carotenoid plasma levels during the initiation of TF in hospitalized patients who are at risk of diarrhea and low nutrient status.
  
  
  
  This trial was registered at trialregister.nl; registration number 2924.
authors.affiliation: Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Denmark.
authors.forename: L H
authors.initials: LH
authors.lastname: Jakobsen
authors.affiliation: Department of Internal Medicine and Geriatrics, St.-Marien-Hospital Borken, Borken, Germany; Institute for Biomedicine of Aging, University Erlangen-Nürnberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Wirth
authors.affiliation: Department of Internal Medicine and Geriatrics, St.-Marien-Hospital Borken, Borken, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Smoliner
authors.affiliation: Nutricia Research, Nutricia Advanced Medical Nutrition, The Netherlands. Electronic address: Marianne.klebach@Nutricia.com.
authors.forename: M
authors.initials: M
authors.lastname: Klebach
authors.affiliation: Nutricia Research, Nutricia Advanced Medical Nutrition, The Netherlands.
authors.forename: Z
authors.initials: Z
authors.lastname: Hofman
authors.affiliation: Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Kondrup
mesh_terms: D000368:Aged; D001682:Biological Availability; D002338:Carotenoids / Q000008:administration & dosage / Q000097:blood*; D003967:Diarrhea / Q000517:prevention & control*; D004043:Dietary Fiber / Q000008:administration & dosage; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000097:blood*; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage / Q000097:blood*; D004750:Enteral Nutrition; D005217:Fat Emulsions, Intravenous / Q000737:chemistry; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010743:Phospholipids / Q000097:blood
chemical_list: D004043:Dietary Fiber; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D010743:Phospholipids; D004281:Docosahexaenoic Acids; D002338:Carotenoids; D015118:Eicosapentaenoic Acid
keywords: Carotenoids; Diarrhea; Fiber; Fish oil; Gastrointestinal tolerance; Tube feeding