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Nutrients
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Enteral Nutrition—Current Insights and Future Direction
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Enteral Nutrition—Current Insights and Future Direction

A Special Issue of Nutrients (ISSN 2072-6643) belonging to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (5 June 2026) | Viewed by 4818

Editors

Dr. Osman Mohamed Elfadil

E-Mail Website
Guest Editor
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
Interests: clinical nutrition; enteral nutrition; peptide-based formula; enteral therapies; microbiome; body composition; enteral access; enteral feeding systems; enteral tubes; translational nutrition research; obesity; nutrition care
Special Issues, Collections and Topics in MDPI journals
Dr. Jithinraj Edakkanambeth Varayil

E-Mail Website
Guest Editor
Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
Interests: enteral nutrition; parenteral nutrition; nutrition support; malnutrition; enteral formulations

Special Issue Information

Dear Colleagues,

Enteral nutrition (EN) is an essential aspect of clinical nutrition, especially for patients who cannot fulfill their nutritional needs through regular eating. As advances in nutritional science and technology progress, our comprehension of EN and its effects on patient outcomes have expanded considerably. This issue, titled “Enteral Nutrition—Current Insights and Future Direction”, aims to shed light on recent research, clinical applications, and creative methods in enteral nutrition while tackling upcoming challenges.

In examining the current state of enteral nutrition, we will cover key topics, including the creation of newer enteral formulations, improvements in access devices, and the influence of nutrition on the microbiome and body composition. The rising awareness of malnutrition as a critical factor contributing to morbidity and mortality across various medical scenarios highlights the necessity for thorough nutritional support. This issue will emphasize the significance of customized enteral feeding plans, particularly for vulnerable groups like the elderly, critically ill patients, and individuals with chronic gastrointestinal conditions.

Additionally, we aim to connect translational nutrition research with clinical practice. By offering insights into existing evidence-based guidelines and exploring future directions, we hope to encourage dialog among researchers, clinicians, and healthcare professionals about emerging themes in the field.

In summary, this Special Issue is designed not only to share innovative research but also to stimulate meaningful discussion regarding the future of enteral nutrition. Together, we can deepen our knowledge and application of EN in clinical settings, ultimately enhancing patient outcomes and overall quality of life.

Dr. Osman Mohamed Elfadil
Dr. Jithinraj Edakkanambeth Varayil
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • enteral nutrition
  • tube feeding
  • malnutrition
  • enteral formula
  • feeding systems
  • bioimpedance analysis
  • gut microbiota
  • microbiome
  • critical care
  • home enteral nutrition
  • nutrition care
  • pediatric nutrition
  • enteral access
  • feeding tubes
  • nutrition support

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

15 pages, 1508 KB  
Article
Non-Inferiority of a Ready-to-Drink Enteral Formula on Nutritional Status in Patients with Head and Neck Cancer: A Randomized Controlled Trial
by Manupol Tangthongkum, Ploychanok Cherngwiwatkij, Saowakon Wattanachant, Pakjira Benyapanya, Peesit Leelasawatsuk, Chaitong Churuangsuk, Kanjana Chimrung, Theepat Wongkittithaworn and Sittidet Nualnim
Nutrients 2026, 18(13), 2105; https://doi.org/10.3390/nu18132105 - 28 Jun 2026
Viewed by 723
Abstract
Background/Objectives: Malnutrition affects 20–71% of patients with head and neck cancer (HNC), owing to tumor location, treatment-induced toxicities, and systemic inflammation. Enteral nutrition is preferred when oral intake is inadequate, yet standard powdered formulas require labor-intensive reconstitution and carry a contamination risk. [...] Read more.
Background/Objectives: Malnutrition affects 20–71% of patients with head and neck cancer (HNC), owing to tumor location, treatment-induced toxicities, and systemic inflammation. Enteral nutrition is preferred when oral intake is inadequate, yet standard powdered formulas require labor-intensive reconstitution and carry a contamination risk. PSU Blen, a ready-to-drink chicken-protein-based polymeric formula, was developed to address these limitations. Methods: In this single-center study, thirty clinically stable patients with HNC on tube feeding were randomized 1:1 to PSU Blen or a commercial powdered polymeric formula (Blendera) for 4 weeks. The primary outcome was change in Patient-Generated Subjective Global Assessment (PG-SGA) score from baseline to week 4, analyzed under a prespecified non-inferiority framework (margin δ = 2 points, selected as a clinically acceptable upper bound based on published PG-SGA data). Secondary outcomes were handgrip strength, body weight, body mass index, serum albumin, hemoglobin, and platelet count. Results: The mean change in PG-SGA score was −1.13 (SD 0.92) and −0.87 (SD 1.36) in the PSU Blen and Blendera groups; the between-group difference was −0.27 points (two-sided 90% CI: −0.99 to +0.45), with the upper bound below the non-inferiority margin. Sensitivity analyses yielded consistent results. No significant between-group differences were observed for secondary outcomes, and both formulas were well tolerated, with no gastrointestinal intolerance or serious adverse events. Conclusions: PSU Blen demonstrated non-inferior nutritional outcomes based on the PG-SGA endpoint over 4 weeks, with comparable tolerability. Longer-term and multicenter studies are warranted to further evaluate its clinical utility and practical advantages in routine enteral nutrition practice. Full article
(This article belongs to the Special Issue Enteral Nutrition—Current Insights and Future Direction)
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11 pages, 782 KB  
Article
Changes in Anthropometric and Biochemical Parameters Following High-Protein and High-Density Enteral Nutrition in Chronically Ventilated Patients: A Retrospective Study
by Jenny Nahman Sichin, Lena Valetzky, Yosef Mishal and Oren Froy
Nutrients 2026, 18(13), 2076; https://doi.org/10.3390/nu18132076 - 24 Jun 2026
Viewed by 421
Abstract
Background/Objectives: Nutritional support is a key component in the management of chronically ventilated patients, who are at high risk of malnutrition due to prolonged illness and metabolic stress. Enteral nutrition, particularly high-protein formulas (HPFs) and high-density formulas (HDFs), is commonly used to [...] Read more.
Background/Objectives: Nutritional support is a key component in the management of chronically ventilated patients, who are at high risk of malnutrition due to prolonged illness and metabolic stress. Enteral nutrition, particularly high-protein formulas (HPFs) and high-density formulas (HDFs), is commonly used to improve clinical outcomes; however, their effects on anthropometric and biochemical parameters remain incompletely understood. Our objective was to evaluate the association of HPFs and HDFs with changes in anthropometric and biochemical parameters in chronically ventilated patients receiving enteral nutrition. Methods: This retrospective study evaluated chronically ventilated patients receiving long-term enteral nutrition. Patients were categorized into four groups based on feeding strategy: continuous HPF, transition to HPF, transition from HPF and transition to HDF. Body weight, serum albumin and total protein were assessed at baseline and follow-up (up to 6 months). Within-group changes were analyzed using paired statistical tests. Results: Within-group analyses demonstrated changes in body weight, body mass index and serum albumin levels over time. Body weight increased significantly across all groups. The greatest increase was observed in patients transitioning to an HPF (70.82–75.35 kg, p = 0.00019), with a significant increase also following HDF administration (59.51–62.57 kg, p = 0.0389). Serum albumin increased significantly only in the transition-to-HPF group. HDF administration showed a non-significant increase in albumin and a near-significant rise in total protein. Conclusions: Enteral nutrition strategies were associated with changes in anthropometric and biochemical parameters in chronically ventilated patients. HPFs and HDFs were associated with improved body weight, with biochemical improvements most evident after HPF initiation and favorable trends observed with HDF administration. Future prospective studies with standardized protocols and objective nutritional markers are warranted. Full article
(This article belongs to the Special Issue Enteral Nutrition—Current Insights and Future Direction)
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13 pages, 884 KB  
Article
Refeeding Syndrome May Increase the Risk of Anemia of Prematurity: Is Early Enteral Nutrition the Solution?
by Maria Di Chiara, Caterina Spiriti, Gaia Loffredo, Fabiana Russo, Daniela Regoli, Cecilia Betto, Francesco Crispino and Gianluca Terrin
Nutrients 2026, 18(9), 1380; https://doi.org/10.3390/nu18091380 - 28 Apr 2026
Viewed by 816
Abstract
Background/Objectives: Preterm infants are particularly vulnerable to nutritional deficiencies and electrolyte imbalances during the early stages of extrauterine life. To ensure optimal metabolic support, they often require the early initiation of “aggressive” parenteral nutrition (PN), which is a known risk factor for Refeeding [...] Read more.
Background/Objectives: Preterm infants are particularly vulnerable to nutritional deficiencies and electrolyte imbalances during the early stages of extrauterine life. To ensure optimal metabolic support, they often require the early initiation of “aggressive” parenteral nutrition (PN), which is a known risk factor for Refeeding Syndrome (RS), a potentially serious metabolic condition characterized by fluid and electrolyte disturbances, the most significant of which is hypophosphatemia. Hypophosphatemia can impair the metabolism, survival, and function of red blood cells, leading to a reduction in key intracellular metabolites and the development of a metabolic block that alters their quality and decreases their stability. It is therefore hypothesized that RS may contribute to the development of anemia of prematurity (AOP). At the same time, early enteral nutrition (EN) may promote metabolic adaptation and reduce exposure to the complications of prolonged parenteral support, potentially protecting against AOP. The primary aim of this study was to determine whether preterm infants who develop RS are at increased risk of AOP. A secondary aim was to evaluate whether early EN may act as a protective factor against the development of AOP. Methods: This retrospective observational study was conducted on infants with a gestational age ≤ 34 weeks and/or birth weight ≤ 1500 g, admitted to the Neonatal Intensive Care Unit of Policlinico Umberto I—Sapienza University of Rome, between January 2015 and November 2022. Infants diagnosed with AOP were classified as cases, while those without AOP served as the control group. Results: A total of 412 preterm infants were enrolled (110 cases, 302 controls). Refeeding Syndrome was significantly more frequent in infants with AOP (30.9% vs. 11.6%, p < 0.001). In the logistic regression model adjusted for gestational age, RS was independently associated with AOP (OR = 2.81; 95% CI: 1.55–5.10; p < 0.001), along with gestational age ≤ 34 weeks (OR = 7.10; 95% CI: 2.13–24.0; p = 0.001). Early enteral nutrition during the first week of life was associated with a significantly lower risk of AOP (OR = 0.12; 95% CI: 0.029–0.52; p = 0.005). The association between RS and AOP was confirmed in the model adjusted for birth weight (OR = 2.06; 95% CI: 1.16–3.79; p = 0.021). Infants with AOP showed significantly higher parenteral nutrition intake, delayed initiation of enteral feeding, and later achievement of full enteral nutrition compared with controls (all p < 0.001). Conclusions: RS is significantly associated with AOP in preterm infants, likely through pathophysiological mechanisms related to hypophosphatemia. Importantly, early EN may be a protective factor against AOP, suggesting that timely initiation and advancement in enteral feeding may counteract the metabolic derangements associated with intensive parenteral support. These findings support a nutritional approach that prioritizes early and progressive enteral nutrition as a strategy to reduce the risk of both RS and AOP. Further prospective studies are needed to confirm these associations and to define optimal EN protocols for this population. Full article
(This article belongs to the Special Issue Enteral Nutrition—Current Insights and Future Direction)
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11 pages, 211 KB  
Article
Implementation of an Electronic Medical Record-Embedded Refeeding Risk Order Set and Its Impact on Refeeding Syndrome Among Adults Receiving Enteral Nutrition: A Retrospective Cohort Study in an Inpatient Hospital Setting
by Emma Peterson, Audrey Arnold, Kristen Payzant, Leslie Wills, Mariah Jackson, Corri Hanson, Megan Timmerman, Rachel Lietka, Kaiti George and Jana Ponce
Nutrients 2026, 18(2), 226; https://doi.org/10.3390/nu18020226 - 11 Jan 2026
Cited by 1 | Viewed by 1116
Abstract
Background/Objectives: Refeeding syndrome (RFS) is challenging to prevent and manage in hospitalized patients receiving enteral nutrition (EN). Nebraska Medicine implemented an Electronic Medical Record (EMR) Refeeding Risk Order Set (RROS) to standardize prevention measures, including structured electrolyte monitoring, thiamine supplementation, and conservative EN [...] Read more.
Background/Objectives: Refeeding syndrome (RFS) is challenging to prevent and manage in hospitalized patients receiving enteral nutrition (EN). Nebraska Medicine implemented an Electronic Medical Record (EMR) Refeeding Risk Order Set (RROS) to standardize prevention measures, including structured electrolyte monitoring, thiamine supplementation, and conservative EN initiation. This study evaluated whether RROS implementation reduced RFS occurrence or severity and assessed its operational impact. Methods: In this retrospective cohort study, adults receiving EN before and after RROS implementation were compared. Primary outcomes were RFS occurrence and severity; secondary outcomes included EN initiation and advancement rates, electrolyte trends, lab frequency, and electrolyte repletion. Results: RFS occurrence did not differ significantly between groups (92.3% vs. 91.3%, p = 0.694), nor did severity (p = 0.535). The post-RROS group received more electrolyte boluses on EN Day 0 (p = 0.027) and had a lower EN starting rate (15.7 vs. 18.3 mL/h, p = 0.045). Conclusions: Although the RROS did not reduce RFS occurrence or severity, integrating American Society for Parenteral and Enteral Nutrition (ASPEN)-based guidance into the EMR was highly feasible and adopted immediately. Automating electrolyte monitoring, micronutrient supplementation, and conservative feeding initiation reduces the risk of errors and promotes consistent care. These benefits improve workflow efficiency and support providers during high census periods, limited staffing, or when experience varies. Future research should explore combining EMR tools with predictive analytics to optimize early risk identification and individualized management. Full article
(This article belongs to the Special Issue Enteral Nutrition—Current Insights and Future Direction)
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