Adults: Boost, Ensure,† Isocal, Jevity 1.2, Nutren 1.0,† Osmolite, Osmolite 1.2

Children: Boost Kid Essentials, † Pediasure,† Nutren Junior†

Intended for patients with normal gastrointestinal tracts who cannot ingest adequate nutrients and calories

A retrospective study of patients receiving normocaloric or calorically dense formula (both diets isocaloric) found that patients receiving normocaloric formula had reduced length of ICU stay and ventilator days, and average glucose levels³⁵

Adults: Deliver 2.0,† Novasource 2.0,† Nutren 2.0,† Twocal HN†

Children: Boost Kid Essentials 1.5,† Resource Just for Kids 1.5†

Uses: patients with fluid restrictions (e.g., congestive heart failure, syndrome of inappropriate antidiuretic hormone) or high caloric requirements (e.g., trauma, critically ill)

No clear benefit of concentrated formulas³⁵

Boost High Protein,† Ensure Plus HN,†Isocal HN, Isosource HN, Osmolite 1.2 CAL,† Replete,†Sustacal HC†

Uses: patients with hypercatabolic state or high protein requirements, wound healing

Some small studies show that enriched protein,arginine, and zinc enteral formulas or oral supplement formulas may accelerate pressure ulcer healing in institutionalized older patients³⁶

Adults: Ensure with Fiber,† Fibersource HN, Jevity, Ultracal

Children: Nutren Junior with Fiber,† Pediasure with Fiber†

Maintains bowel regularity, particularly in preventing constipation with long-term enteral nutrition and decreasing diarrhea with short-term enteral nutrition; data on the effects on diarrhea are inconclusive

May be beneficial for microbiota when used long term³⁵

Adults: Criticare HN, Peptamen,† Perative, Subdue,† Tolerex,†Vital HN,† Vivonex TEN,† Vivonex Plus†

Children: Peptamen Junior,†Vivonex Pediatric†

Uses: malabsorptive syndromes and pancreatic insufficiency

Expensive and often cause diarrhea because of higher osmolarity

No significant differences found when compared with a standard formula in patients with Crohn disease; in patients with pancreatitis, elemental formula led to significantly reduced length of hospitalization compared with standard formula³⁵

Choice DM,† Diabetisource, Glucerna,†Glytrol†

The clinical benefits of diabetic formulas are unclear, although they may help manage blood glucose levels in the short term; no long-term outcomes have been evaluated³⁵

Alitraq,† Crucial, Impact

Suggested benefits: supporting the immune system, promoting anti-inflammatory process, enhancing the preservation of enterocytes

Some studies show these formulas may decrease mortality, length of hospitalization, and infections in ICU patients with major elective surgery, trauma, or burns and in critically ill patients on mechanical ventilation³⁸

Immunonutrition supplementation may increase the overall risk of mortality in patients with sepsis³⁵

Proteins: Beneprotein Instant Protein Powder, Promod

Carbohydrate: Moducal, Polycose

Fat: MCT Oil, Microlipid

Fiber: Benefiber

Modular formulations may be used individually to treat a specific deficiency or combined with other formulas to completely satisfy nutritional requirements (oral or enteral)

Nutren, Nutrivent, Oxepa, Pulmocare†

Uses: reduce carbon dioxide produced by carbohydrate in patients with chronic pulmonary disease, assist with weaning from mechanical ventilation, but the evidence is inconclusive overall (attempts to avoid overfeeding is key)

Pulmonary enteral formula enriched with a high omega-3/omega-6 fatty acid ratio and additional antioxidants should be considered in patients with acute lung injury and acute respiratory distress syndrome³⁵

High protein: Magnacal Renal,† Nepro†

Low protein: Novasource Renal, Renalcal,† Suplena†

Use: renal failure

No comparative effectiveness trials have demonstrated superiority of renal formulas over standard formulas³⁷

Because of the hypercatabolism associated with continuous dialysis and losses that occur in the filtrate, protein intake up to 2.5 g per kg of body weight should be provided to maintain positive nitrogen balance