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The role of proteins in enteral nutrition

5 November 2021


Enteral nutrition replaces the oral intake of food and drink and is the process of feeding by tube directly into the stomach. It is also known as tube feeding.


The tube is passed through the nose or mouth into the stomach as a short-term feeding solution and can be used intermittently with oral feeding. For long-term patient care, tubes are inserted into the stomach or small intestine.  Enteral nutrition can only be used when the gut is working correctly and can absorb the nutrients.


This form of feeding is a quick and efficient way to deliver protein and other nutrients to patients who are critically ill, suffer from a chronic disease or are malnourished or protein deficient.


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When are proteins used in enteral nutrition?


Liquid protein is used in enteral nutrition when a patient is unable to feed by mouth or needs extra protein, carbohydrates, fat, water and other nutrients.


Tube feeding occurs for several reasons, depending on the situation. This includes muscle deterioration in critically ill patients, as muscles begin to waste when they are not used. This can be a problem for patients who survive or endure a long-term critical illness as muscles can take several years to repair, particularly if the patient is no longer active.


Using liquid protein in enteral nutrition can assist with muscle repair.

Products are formulated using different volumes of the source nutrients, which can be administered depending on the patient’s needs.

Protein sources for enteral nutrition products include milk protein, whey protein, caseins and soy protein.

Protein-rich formulas can also be developed to address specific diseases and medical situations, for example, high protein products can promote wound healing.



Why is protein used in enteral nutrition?


Protein can be delivered to the body fast by way of enteral nutrition. This is particularly important when patients are undergoing critical care. The body needs protein to repair and survive and cannot function without it.


With tube feeding, the amount of protein intake can be controlled to ensure the correct quantity is absorbed.


Common situations requiring protein-supplemented enteral nutrition include:

  • After operations on the face, neck, throat, gullet or stomach
  • Strokes or other neurological conditions causing swallowing to be


difficult or impossible

  • After radiotherapy to the throat
  • When there is a stomach blockage




Both whey and casein-based protein products can be used to tube-feed critically ill patients. The body absorbs whey at a faster rate than casein. Sometimes both ingredients are combined to obtain a particular nutritional composition.


Casein is beneficial to muscle restoration as it is slowly absorbed and can work continuously over a long recovery period, particularly when a patient has limited mobility. Casein is also a high-quality protein delivery method derived from cow’s milk, and is considered to be more efficient than vegetable protein.


However, some studies have shown that whey protein is better able to stimulate the initial muscle restoration process. This is because the amino acid, leucine, is the substance that triggers the process and whey protein contains more leucine than casein.


Therefore, whey promotes muscle restoration and casein enhances it.

Casein-based protein formulas are also commonly used when coagulation is required to encourage the body to retain and absorb nutrients.



Proteins play an essential role in enteral nutrition, alongside other ingredients required to provide patients with the right balance of nutrients. Different formulations are developed according to/depending on patients’ specific nutritional requirements.


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Burrin, D. G. (2004). Proteins and amino acids in enteral nutrition. PubMed.


https:\/\/\/enteral-nutrition-overview-formula-selection-considerations\/#author. (2020, December 17). Enteral Nutrition Overview + Formula Selection Considerations. Dietitians On Demand | Professional Recruiting Services for Contract and Permanent-Hire Positions.


Reinhold, S. (2020, August 25). Protein delivery in intermittent and continuous enteral nutrition with a protein-rich formula in critically ill patients—a protocol for the prospective randomized controlled proof-of-concept Protein Bolus Nutrition (Pro BoNo) study. Trials.


Savino, P. (2018, February 1). Knowledge of Constituent Ingredients in Enteral Nutrition Formulas Can Make a Difference in Patient Response to Enteral Feeding. American Society for Parenteral and Enteral Nutrition.


van de Walle, M. G. S. (2021, June 16). What Is Casein, and Does It Aid Muscle Growth? Healthline.