Efficacy of commercial formulas in comparison with home-made formulas for enteral feeding: A critical review

Background: In several disease conditions, patients must inevitably be nourished by enteral feeding (EF). Though in many countries, commercial formulas are routinely used for EF, in Iran still home-made formulas are commonly employed as commercial formulas are not covered by insurance. This may pose patients to malnutrition and bring about further costs.  The aim of this study was to evaluate the efficacy of EF commercial formulas in comparison with home-made formulas and thus to make further evidence for insurance policy-making  Methods: Medline, Cochrane, Embass and Center for Review & Dissemination (CRD) as well as IranDoc and SID databases were searched. Keywords included formula, ICU, and enteral nutrition or tube feeding. No clinical trial study on the efficacy of EF formulas was found. Therefore, the compositions of available formulas and their cost-effectiveness were evaluated based on the clinical guidelines of scientific bodies such as American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and Enteral Nutrition (ESPEN) and relative articles available in PubMed. In addition, the expert opinions were also taken into consideration. Results: Domestic commercial formulas seemed to less merit dietary recommended intakes, i.e. the amount of some nutrients were much higher, and some others were much lower than the recommended values. The amount of several micronutrients including vitamins B1, B6, C, D and K, as well as iron, calcium and magnesium were not sufficient to meet the body needs in most commercial formulas upon receiving 2000 kilocalories and less. Conclusion: Clinical studies on the efficacy of commercial formulas in comparison with home-made formulas are needed. Meanwhile, making suitable conditions for increasing the diversity of artificial nutrition products in the market would help clinical nutritionists to make better choices according to their patients conditions and to reduce the costs, as well.