From Ancient Enemas to Tube Feeding, II: Clinical Outcomes and Future Directions Surrounding Commercial Versus...

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.