Suitability of isomaltulose for oral & enteral nutrition

Clinical nutrition products are described and characterized by their nutritional composition, caloric density, and osmolality.

Clinical nutrition or so-called foods for special medical purposes (FSMP) serve the purpose to treat or prevent deficiencies in energy or nutrient supply, and to provide appropriate balanced nutrition to a person, until he can resume to the normal diet. Consumed under the supervision of healthcare professionals, such products can either supplement or replace the diet entirely. They can be taken as drinks or shakes or, where patients are unable to consume foods, they may be administered via a feeding tube. Accordingly, clinical nutrition categories distinguishes between foods for oral intake, tube feeds for enteral nutrition, or tube feeds for parenteral nutrition:

  • Oral nutrition comprises the group of “oral nutritional supplements” or so-called “sip feed”. This describes clinical nutrition products, which are consumed like regular foods and which are given in addition to the normal diet with the aim to increase nutritional intake. Oral nutritional supplements usually come in liquid form, like in case of “sip feed” products, but they are also available as instant drink powders, pudding- or dessert-style products or bars.
  • Enteral nutrition describes clinical nutrition products which provide nutrients into the gastrointestinal tract through a tube or catheter. These products are used when oral intake is inadequate or compromised.
  • Parenteral nutrition refers to clinical nutrition products which provide nutrients directly into the bloodstream intravenously. With this form, nutrient digestion and absorption in the gastrointestinal tract are by-passed. Therefore, protein, fat and carbohydrate must be present in their hydrolysed (“digested”) form, vitamins and minerals in their bioactive form.

As a disaccharide carbohydrate, isomaltulose needs to be split by digestive enzymes before it can be taken up into the body. Therefore, it can be found in oral nutritional supplements (ONS) and in enteral nutrition tube feeds while, however, isomaltulose is not suitable for parenteral nutrition.

Owing to its slow release properties, isomaltulose can serve various clinical nutrition categories as a source of carbohydrate energy with distinct physiological benefits. It finds applications in diabetes-specific formulations as well as in products targeted to the nutritional treatment of renal failure (kidney disease), and also standard formulas and other disease-specific formulas may benefit from the replacement of traditional readily-digestible carbohydrates for isomaltulose as appropriate.