Effect of high-fat, low-carbohydrate enteral formula versus standard enteral formula in hyperglycemic critically ill patients: a randomized clinical trial

  • Davoud Vahabzadeh
  • Mohammad Amin Valizadeh Hasanloei
  • Zahra Vahdat ShariatpanahiEmail author
Original Article


High-fat, low-carbohydrate diets may attenuate the hyperglycemia in critically ill patients. This study was performed to compare the effects of high-fat, low-carbohydrate enteral nutrition on glycemic control and clinical outcomes in new identified hyperglycemic patients. Eighty-eight new identified hyperglycemic patients with no history of diabetes or diagnosed hyperglycemia were randomly allocated to a standard (protein 20%, fat 30%, and carbohydrate 50%) or high-fat (protein 20%, fat as equal amount of olive and sunflower 45%, and carbohydrate 35%) kitchen formulas. Duration of intervention was 15 days. Baseline characteristics of patients were the same. Forty-one patients in the high fat and 39 patients in the standard group completed the study. Mean blood glucose, mean infused insulin, final blood glucose, and final infused insulin were not differed significantly between groups. Repeated measure showed that the average blood glucose declined in the high-fat formula group, as well as standard one, but with more decline at the end of the first week, and with a higher rate in the high-fat formula group. The mean blood triglyceride level on the final day was lower in the high-fat formula group (p = 0.001). There were no significant differences between groups in clinical outcomes. Although the high-fat formula declined blood glucose and triglyceride levels more than the standard group, yet the decrease in blood glucose was not significant. Also, it has no significant effect on clinical outcomes.


Olive Lipid ICU Ventilator 



Our thanks go to Shahid Beheshti University of Medical Science and Urmia University of Medical Science Vice Chancellor of Research and Technology for their help in providing study field and giving study ethics approval for execution. Thanks to all patients guardians, nurses, staff, physicians, and ICU attendants for their cooperation in the study protocol accomplishment.

Funding information

Funding of this study was provided by the Urmia University of Medical Sciences.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Davidson P, Kwiatkowski CA, Wien M. Management of hyperglycemia and enteral nutrition in the hospitalized patient. Nutr Clin Pract. 2015;30(5):652–9.CrossRefGoogle Scholar
  2. 2.
    Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Current Diab Rep. 2013;13(1):155–62.CrossRefGoogle Scholar
  3. 3.
    Gale SC, Sicoutris C, Reilly PM, Schwab CW, Gracias VH. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg. 2007;73(5):454–60.Google Scholar
  4. 4.
    Hasanloei MAV, Shariatpanahi ZV, Vahabzadeh D, Vahabzadeh Z, Nasiri L, Shargh A. Non-diabetic hyperglycemia and some of its correlates in ICU hospitalized patients receiving enteral nutrition. Maedica. 2017;12:174.Google Scholar
  5. 5.
    Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol J-P, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681–7.Google Scholar
  6. 6.
    Mori Y, Ohta T, Tanaka T, Morohoshi Y, Matsuura K, Yokoyama J, et al. Effects of a low-carbohydrate diabetes-specific formula in type 2 diabetic patients during tube feeding evaluated by continuous glucose monitoring. e-SPEN. 2011;6(2).Google Scholar
  7. 7.
    Marik PE, Preiser J-C. Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis. CHEST J. 2010;137(3):544–51.CrossRefGoogle Scholar
  8. 8.
    Codner PA. Enteral nutrition in the critically ill patient. Surg Clin N Am. 2012;92(6):1485–501.CrossRefGoogle Scholar
  9. 9.
    León-Sanz M, García-Luna PP, Planas M, Sanz-París A, Gómez-Candela C, Casimiro C. Glycemic and lipid control in hospitalized type 2 diabetic patients: evaluation of 2 enteral nutrition formulas (low carbohydrate-high monounsaturated fat vs high carbohydrate). J Parenter Enter Nutr. 2005;29(1):21–9.Google Scholar
  10. 10.
    Alish CJ, Garvey WT, Maki KC, Sacks GS, Hustead DS, Hegazi RA, et al. A diabetes-specific enteral formula improves glycemic variability in patients with type 2 diabetes. Diabetes Technol Ther. 2010;12(6):419–25.Google Scholar
  11. 11.
    Yokoyama J, Someya Y, Yoshihara R, Ishii H. Effects of high-monounsaturated fatty acid enteral formula versus high-carbohydrate enteral formula on plasma glucose concentration and insulin secretion in healthy individuals and diabetic patients. J Int Med Res. 2008;36(1):137–46.CrossRefGoogle Scholar
  12. 12.
    de Azevedo JRA, de Araujo LO, da Silva WS, de Azevedo RP. A carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients. J Crit Care. 2010;25(1):84–9.CrossRefGoogle Scholar
  13. 13.
    Mesejo A, Acosta J, Ortega C, Vila J, Fernández M, Ferreres J, et al. Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin Nutr. 2003;22(3):295–305.Google Scholar
  14. 14.
    Wewalka M, Drolz A, Schmid M, Zauner C, editors. Glucose hemeostasis in critically ill patients is not affected by different enteral nutrition formulas intensive care medicine. New York, NY: Springer 233 Spring ST; 2014.Google Scholar
  15. 15.
    Huschak G, Zur Nieden K, Hoell T, Riemann D, Mast H, Stuttmann R. Olive oil based nutrition in multiple trauma patients: a pilot study. Intensive Care Med. 2005;31(9):1202–8.CrossRefGoogle Scholar
  16. 16.
    McMahon MM, Nystrom E, Braunschweig C, Miles J, Compher CASPEN. Clinical guidelines: nutrition support of adult patients with hyperglycemia. J Parenter Enter Nutr. 2013;37(1):23–36.CrossRefGoogle Scholar
  17. 17.
    Mesejo A, Montejo-González JC, Vaquerizo-Alonso C, Lobo-Tamer G, Zabarte-Martinez M, Herrero-Meseguer JI, et al. Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study. Crit Care. 2015;19(1):390.Google Scholar
  18. 18.
    Nourmohammadi M, Moghadam OM, Lahiji MN, Hatamian S, Shariatpanahi ZV. Effect of fat-based versus carbohydrate-based enteral feeding on glycemic control in critically ill patients: a randomized clinical trial. Indian J Crit Care Med. 2017;21(8):500–5.CrossRefGoogle Scholar
  19. 19.
    Wewalka M, Drolz A, Zauner C. Influence of fat-based versus glucose-based enteral nutrition formulas on glucose homeostasis. Crit Care. 2013;17(Suppl 2):250.Google Scholar
  20. 20.
    Tomoyoshi Mohri HM, Kubo N, Inadome N, Nakamori Y, Fujimi S, Yoshioka T. <The effect on glycemic control of a low-carbohydrate, high-fat enteral formulain critically ill patients admitted to a trauma and critical care center.pdf>. JJAAM. 2011;22:871–7.Google Scholar
  21. 21.
    Mori Y, Ohta T, Tanaka T, Morohoshi Y, Matsuura K, Yokoyama J, et al. Effects of a low-carbohydrate diabetes-specific formula in type 2 diabetic patients during tube feeding evaluated by continuous glucose monitoring. Eur J Clin Nutr Metab. 2011;6(2):e68–73.CrossRefGoogle Scholar
  22. 22.
    Pohl M, Mayr P, Mertl-Roetzer M, Lauster F, Haslbeck M, HipperHipper B, et al. Glycemic control in patients with type 2 diabetes mellitus with a disease-specific enteral formula: stage II of a randomized, controlled multicenter trial. J Parenter Enter Nutr. 2009;33(1):37–49.CrossRefGoogle Scholar
  23. 23.
    Vaisman N, Lansink M, Rouws CH, van Laere KM, Segal R, Niv E, et al. Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients. Clin Nutr. 2009;28(5):549–55.Google Scholar
  24. 24.
    Magnoni D, Rouws CH, Lansink M, van Laere KM, Campos AC. Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients. Diabetes Res Clin Pract. 2008;80(1):75–82.CrossRefGoogle Scholar
  25. 25.
    Pohl M, Mayr P, Mertl-Roetzer M, Lauster F. Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial. Eur J Clin Nutr. 2005;59(11):1221–32.CrossRefGoogle Scholar
  26. 26.
    Shahbazi S, Vahdat Shariatpanahi Z. Prevention of type 2 diabetes mellitus by changes in diet among subjects with abnormal glucose metabolism: a randomized clinical trial. Int J Diabetes Dev Ctries. 2018;38(1):69–74.CrossRefGoogle Scholar
  27. 27.
    Gerhard GT, Ahmann A, Meeuws K, McMurry MP, Duell PB, Connor WE. Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes. Am J Clin Nutr. 2004;80(3):668–73.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  • Davoud Vahabzadeh
    • 1
    • 2
  • Mohammad Amin Valizadeh Hasanloei
    • 3
  • Zahra Vahdat Shariatpanahi
    • 4
    Email author
  1. 1.Deptartment of Clinical Nutrition, Faculty of Nutrition and Food TechnologyInternational Branch of Shahid Beheshti University of Medical SciencesTehranIran
  2. 2.Patient Safety Research CenterUrmia University of Medical SciencesUrmiaIran
  3. 3.Department of Anesthesiology and Critical Care, Emam Khomeini HospitalUrmia University of Medical SciencesUrmiaIran
  4. 4.Deptartment of Clinical Nutrition, Faculty of Nutrition and Food TechnologyShahid Beheshti University of Medical ScienceTehranIran

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