How Can a Polymeric Formula Induce Remission in Crohn’s Disease Patients?

Crohn’s disease is an inflammatory bowel disease whose prevalence is increasing worldwide. Among medical strategies, dietary therapy with exclusive enteral nutrition is recommended as a first-line option, at least for children, because it induces clinical remission and mucosal healing. Modulen®, a polymeric TGF-β2 enriched formula, has good palatability and is widely used. For the first time in the literature, this review outlines and discusses the clinical outcomes obtained with this therapy, as well as the potential mechanisms of action of its compounds. It can be explained by its TGF-β2 content, but also by its protein and lipid composition. Further well-designed studies are required to improve our knowledge and to optimize therapeutic strategies.

Semi-elemental versus polymeric formula for enteral nutrition in brain-injured critically ill patients: a randomized trial

Background The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis. The purpose of this study was to compare the efficacy and tolerance of a semi-elemental versus a polymeric formula for enteral nutrition (EN) in brain-injured critically ill patients. Methods Prospective, randomized study including brain-injured adult patients [Glasgow Coma Scale (GCS) ≤ 8] with an expected duration of mechanical ventilation > 48 h. Intervention: an enteral semi-elemental (SE group) or polymeric (P group) formula. EN was started within 36 h after admission to the intensive care unit and was delivered according to a standardized nurse-driven protocol. The primary endpoint was the percentage of patients who received both 60% of the daily energy goal at 3 days and 100% of the daily energy goal at 5 days after inclusion. Tolerance of EN was assessed by the rate of gastroparesis, vomiting and diarrhea. Results Respectively, 100 and 95 patients were analyzed in the SE and P groups: Age (57[44–65] versus 55[40–65] years) and GCS (6[3–7] versus 5[3–7]) did not differ between groups. The percentage of patients achieving the primary endpoint was similar (46% and 48%, respectively; relative risk (RR) [95% confidence interval (CI)] = 1.05 (0.78–1.42); p = 0.73). The mean daily energy intake was, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (p = 0.42). Protein intakes were 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day (p < 0.0001). Respectively, 18% versus 12% patients presented gastroparesis (p = 0.21), and 16% versus 8% patients suffered from diarrhea (p = 0.11). No patient presented vomiting in either group. Conclusion Semi-elemental compared to polymeric formula did not improve daily energy intake or gastrointestinal tolerance of enteral nutrition. Trial registration EudraCT/ID-RCB 2012-A00078-35 (registered January 17, 2012).

The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

Background: The requirement of a hospital-made, blenderized diet, as a generally used and complete polymeric formula, is increasing beyond supply availability and accessibility. A ready-to-use blenderized diet with chicken and pumpkin in a retort pouch was developed from regular use formula by nutritionists and dietitians to solve these problems. However, its clinical outcomes should be evaluated. Objectives: To assess the efficacy and safety of a ready-to-use blenderized diet, and to examine the satisfaction of patients and caregivers. Methods: Thirty adult patients in Ramathibodi Hospital with absolute tube feeding were included in a pre-post treatment comparative study and fed with the study formula for 14 days. Body composition measurements, nutritional status, clinical parameters, and biochemical tests were collected at baseline and day 14 after feeding. Complications were monitored daily. Satisfaction was evaluated at day 14. Results: This study reported statistically significant improvements in nutritional status (P < .001), albumin (P = .003), prealbumin (P = .007), total lymphocytic count (P = .004), and phase angle (P = .02) after 14-day feeding. No major complications were reported. Satisfaction of product use was evaluated in the level of satisfied (27%) and very satisfied (73%). Conclusions: The present study revealed that a ready-to-use blenderized diet with chicken and pumpkin was efficacious in ameliorating nutritional status, nutrition-related blood tests, and phase angle without any major complications.

The effect of polymeric formula on enterocyte differentiation

Exclusive enteral nutrition is established as an initial therapy to induce remission in active Crohn’s disease (CD), especially in children, but the mechanisms of action of this therapy are yet to be fully defined. Intestinal alkaline phosphatase (IAP), a recognised marker of enterocyte differentiation, is implicated in the innate gut immune response to enteric pathogens. Using the Caco-2 human adenocarcinoma cell line, this study showed that the incubation of human cells with a polymeric formula (PF) resulted in a dose-dependent increase in the expression of IAP on the cell surface. While further investigation is required to determine the pathway(s) involved, this finding suggests that cell surface-associated IAP may be an aspect of the gut’s innate immune response to pathogenic bacteria that is strengthened by PF in the setting of CD.