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Improving enteral nutrition with plant-dominant protein formulas 

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  • Specialised Nutrition

Enteral nutrition (EN) via tube feeding is a key means of managing the nutritional intake of patients at risk of disease-related malnutrition. However, despite its necessity, EN can be hard for patients to tolerate. Now, this study explores how a plant-dominant nutritional blend could serve as an innovative solution: one that’s good for people and the planet alike.

Upper gastrointestinal (GI) intolerance, which may cause uncomfortable symptoms like nausea, vomiting, reflux, and a sense of fullness, is a common side effect of EN. In fact, it is one of the main reasons why healthcare professionals might reduce or even stop EN treatment – but this can have a negative impact on patient nutrient status, their gastrointestinal tract, and even hamper their recovery. Instead, it is crucial to find new EN formulas with better GI tolerance.

Harnessing plant power for patients

For many years, EN protein content was predominantly sourced from cows’ milk, consisting of up to 80% casein. The conditions in the stomach, however, can cause casein to coagulate into a solid, delaying gastric emptying and contributing to GI intolerance. To address this issue, a non-coagulating protein blend was developed, featuring a higher proportion of whey and replacing much of the casein with soy and pea proteins. In recent years, this solution has been proven to be significantly better tolerated than casein-dominant alternatives.

 Danone Research & Innovation formulated a new EN blend that’s composed mostly of soy and pea protein, with an even lower percentage of casein compared to the widely used dairy-dominant formulations. We knew this blend was nutritionally well balanced in terms of amino acids, but we needed to investigate its coagulation characteristics to understand how well it would be tolerated by patients.

The plant-dominant formulation was tested in an in vitro stomach model. Comparing the coagulation of the plant-dominant solution to casein- and dairy-dominant formula, researchers found that the plant-dominant innovation significantly outperformed casein and showed similar performance to the previous dairy dominant EN blend, and even across all four investigated EN matrices: standard and high energy, with and without fiber.”

As theorized in the new paper, the non-coagulation can be attributed to the molecular structures of soy, pea, and whey proteins, which differ from that of casein. The paper also suggests, for the first time, that the interaction between different protein types plays a role in coagulation during gastric digestion.