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. 2025 Feb 28;17(5):845.
doi: 10.3390/nu17050845.

Strategies to Maximize the Benefits of Evidence-Based Enteral Nutrition: A Narrative Review

Ken-Ichi Kano  1 , Ryo Yamamoto  2 , Minoru Yoshida  3   4 , Takeaki Sato  5 , Yoshihiro Nishita  6 , Jiro Ito  7 , Kazuki Nagatomo  8 , Hiroyuki Ohbe  9 , Kanako Takahashi  10 , Masayuki Kaku  11 , Hideaki Sakuramoto  12 , Nobuto Nakanishi  13 , Kazushige Inoue  14 , Junji Hatakeyama  15 , Hidenori Kasuya  16 , Minoru Hayashi  17 , Takefumi Tsunemitsu  18 , Hiroomi Tatsumi  19 , Naoki Higashibeppu  7 , Kensuke Nakamura  20
Affiliations

Strategies to Maximize the Benefits of Evidence-Based Enteral Nutrition: A Narrative Review

Ken-Ichi Kano et al. Nutrients. .

Abstract

Enteral nutrition (EN) has been reported to have some physiological importance for critically ill patients. However, the advantage of EN over parenteral nutrition remains controversial in recent paradigms. To maximize the benefits and efficiency of EN, implementing measures based on comprehensive evidence is essential. Here, we systematically reviewed EN-related studies and integrated them into the best and most up-to-date EN practices. We extracted studies from 13 systematic reviews during the development of Japanese Critical Care Nutrition Guidelines, summarizing findings on the assessment of enteral feeding intolerance (EFI), the timing of EN, formula composition and nutrients, and method of administration in critically ill adult patients. Multifaceted EFI assessment may be needed in patients for high-risk patients. Early EN may reduce infectious complications, and initiating EN even earlier may offer an additional advantage. High protein intake (≥1.2 g/kg/day) could maintain muscle mass and physical function without increasing gastrointestinal complications. Probiotics, prebiotics, and synbiotics may serve as beneficial options for preventing infection and gastrointestinal complications, although their efficacy depends on the strains, types, and combinations used. For patients with EFI, post-pyloric feeding could be an effective approach, while intermittent feeding may be a safer approach. Both methods should be utilized to achieve nutritional targets. Integrating these nutritional interventions into EN strategies may help maximize their effectiveness and minimize complications. However, careful consideration regarding timing, dosage, nutrient selection, administration methods, and patient selection is required.

Keywords: enteral feeding intolerance; gastrointestinal complications; intensive care unit; nutritional therapy.

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Conflict of interest statement

Author Hiroomi Tatsumi received an honorarium from Otsuka Pharmaceutical Co., Ltd. Author Hidenori Kasuya was employed by the Social Medical Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
This key diagram summarizes essential strategies for minimizing enteral feeding intolerance and achieving target EN delivery. Priorities are arranged in descending order from top to bottom. EN, enteral nutrition; PUFAs, polyunsaturated fatty acids.
See this image and copyright information in PMC

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