From Ancient Enemas to Tube Feeding, II: Clinical Outcomes and Future Directions Surrounding Commercial Versus Food-Based Formulas in Critical Illness

Sanil N Gandhi; Yeonsu Song; Matthew J Landry; Atul Malhotra; Rohit Loomba; Jennifer L Martin; Biren B Kamdar

doi:10.4037/ajcc2025636

From Ancient Enemas to Tube Feeding, II: Clinical Outcomes and Future Directions Surrounding Commercial Versus Food-Based Formulas in Critical Illness

Am J Crit Care. 2025 Nov 1;34(6):469-476. doi: 10.4037/ajcc2025636.

Authors

Sanil N Gandhi¹, Yeonsu Song², Matthew J Landry³, Atul Malhotra⁴, Rohit Loomba⁵, Jennifer L Martin⁶, Biren B Kamdar⁷

Affiliations

¹ Sanil N. Gandhi was a medical student at Boston University School of Medicine, Massachusetts, during the writing of this article and is currently a resident in internal medicine at the University of California, Irvine.
² Yeonsu Song is an associate professor, School of Nursing, University of California, Los Angeles, an adjunct associate professor, Department of Medicine, University of California, Los Angeles, and an affiliated investigator, Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California.
³ Matthew J. Landry is an assistant professor, Department of Population Health and Disease Prevention, Joe C. Wen School of Population & Public Health, University of California, Irvine, Irvine, California.
⁴ Atul Malhotra is a professor of medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, California.
⁵ Rohit Loomba is a research director, MASLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, and a professor of medicine and chief, Division of Gastroenterology and Hepatology, University of California, San Diego, La Jolla, California.
⁶ Jennifer L. Martin is a professor, Department of Medicine, University of California, Los Angeles, and associate director, Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California.
⁷ Biren B. Kamdar is an associate professor, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, and a staff physician, Pulmonary and Critical Care, VA San Diego Healthcare System, La Jolla, California.

Abstract

This article is the second in a 2-part series examining the role of commercial and food-based enteral formulas in critical illness. Part I (published in the September 2025 issue of AJCC) reviewed the historical evolution, administration, and nutritional content of formulas; part II focuses on clinical outcomes and future directions. Enteral feeding is essential in the intensive care unit to support patients who cannot meet nutritional needs orally. Although commercial formulas remain the standard of care, the use of food-based formulas is expanding. In this part of the review, we examine the evidence comparing commercial versus food-based formulas across gastrointestinal symptoms (eg, constipation, diarrhea, reflux), renal effects (eg, electrolyte disturbances, uremia), and endocrine effects (eg, hyperglycemia, insulin resistance). We also explore nonclinical outcomes such as patient satisfaction, circadian rhythm effects, environmental considerations, and access disparities. Notably, much of the current evidence arises from pediatric or outpatient settings, underscoring the need for high-quality research in intensive care unit populations. These evolving patterns highlight critical gaps in knowledge that must be addressed to optimize intensive care unit nutrition practices. Together with part I, this article offers a comprehensive overview to guide evidence-based selection and implementation of enteral nutrition in critical care.

Publication types

Review

MeSH terms

Critical Care / methods
Critical Illness* / therapy
Enteral Nutrition* / methods
Food, Formulated*
Humans
Intensive Care Units

Abstract

Publication types

MeSH terms

Grants and funding