Selection of Enteral Formulas for Malabsorption

A number of commercially available formulas are designed for patients with malabsorption, and these differ with regard to energy density, macronutrient composition, and indicated age. Since infant formulas are often handled in a separate regulatory manner by governments, infant formulas are usually considered separately from formulas designed for older children and adults. In addition, formulas are also conventionally categorized by the extent of the hydrolysis of their protein source. Categories include intact protein formulas, protein hydrolysate formulas, and amino acid-based formulas. Protein hydrolysate formulas are also sometimes referred to as 'semielemental' formulas, and amino acid formulas are sometimes called 'elemental' formulas. However, these terms suffer from vagueness and inaccuracies since not all of their macronutrients are semi- or completely elemental. Marketing strategies often compound the confusion with misleading formula names. These terms should be discouraged, and the terms that refer to the composition and/or biochemical processing should be used instead.

Patients who have carbohydrate malabsorption from lactose intolerance should use lactose-free formula. Fat malabsorption calls for MCT-enriched formula. In cases of protein malabsorption or severe enteropathy, a formula that is a protein hydrolysate or amino acid-based would be most appropriate. Since many malabsorption syndromes overlap in terms of the macronutrient affected, as in cases of severe mucosal disease, some formulas are designed for fat, protein, and carbohydrate malabsorption. For example, all formulas designed for use in adults are lactose-free, and several formulas contain both hydrolyzed proteins and MCT oils.

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