Pediatric and adult commercial blenderized and real-food ingredient enteral formulas: A comparison study

Traditional pediatric, cow milk-based formulas provide >90% of dietary reference intakes ("complete" nutrition) when a child receives a standard amount of formula. We aimed to assess the adequacy of essential nutrients provided to children by commercial real-food ingredient formulas and commercial blenderized formulas.

We systematically identified all US-based real-food-based formulas via Google searches. We analyzed macronutrient and micronutrient nutriture by simulating feeds to 3-, 8-, 13-, and 18-year-olds and compared these with the dietary reference intakes and tolerable upper intake limits. We assessed the amounts provided by 1000 ml and 1000 kcal (at ages 3 and 8 years), 1500 ml and 1500 kcal (at all ages) and 2000 ml and 2000 kcal (at ages 13 and 18 years).

We identified 33 formulas (20 pediatric; 13 adult) of which 70% were vegan. Different nutrients, including essential amino acids and polyunsaturated fatty acids, were deficient at various volume and energy amounts. At age 13, adult formulas more consistently met dietary reference intakes (vs pediatric formulas). Nonvegan formulas were more likely to meet dietary reference intakes at various age groups (vs vegan formulas) but were also more likely to exceed tolerable upper intake limits.

Nutrition provided by food-based formulas may not meet all the needs of children, particularly those exclusively fed these formulas. Adult formulas should be considered in teens and nonvegan formulas may increase nutrient adequacy. Children with gastrointestinal diseases or low energy needs may be at higher risk of nutrient deficiencies when on these formulas.