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Background  Optimal energy and protein provision through enteral nutrition is essential for critically ill patients. However, in clinical practice, the intake achieved is often far below the recommended targets. Because no polymeric formula with sufficient protein content is available, adequate protein intake can be achieved only by supplemental amino acids or semi-elemental formula administration. In the present study, we investigated whether protein intake can be increased with a new, very high intact-protein formula (VHPF) for enteral feeding.    Methods  In this randomized, controlled, double-blind, multicenter trial, 44 overweight (body mass index ≥ 25 kg/m 2 ) intensive care unit patients received either a VHPF (8 g/100 kcal) or a commercially available standard high protein formula (SHPF) (5 g/100 kcal). Protein and energy intake, gastrointestinal tolerance (gastric residual volume, vomiting, diarrhea, and constipation), adverse events, and serious adverse events were recorded. Total serum amino acid levels were measured at baseline and day 5.    Results  The primary outcome, protein intake at day 5, was 1.49 g/kg body weight (95% CI 1.21–1.78) and 0.76 g/kg body weight (95% CI 0.49–1.03,  P  < 0.001) for VHPF and SHPF, respectively. Daily protein intake was statistically significantly higher in the VHPF group compared with the SHPF group from day 2 to day 10. Protein intake in the VHPF group as a percentage of target (1.5 g/kg ideal body weight) was 74.7% (IQR 53.2–87.6%) and 111.6% (IQR 51.7–130.7%) during days 1–3 and days 4–10, respectively. Serum amino acid concentrations were higher at day 5 in the VHPF group than in the SHPF group ( P  = 0.031). No differences were found in energy intake, measures of gastrointestinal tolerance, and safety.    Conclusions  Enteral feeding with VHPF (8 g/100 kcal) resulted in higher protein intake and plasma amino acid concentrations than an isocaloric SHPF (5 g/100 kcal), without an increase in energy intake. This VHPF facilitates feeding according to nutritional guidelines and is suitable as a first-line nutritional treatment for critically ill overweight patients.    Trial registration  Netherlands Trial Register,  NTR5643 . Registered on 2 February 2016.    Electronic supplementary material  The online version of this article (10.1186/s13054-018-2070-5) contains supplementary material, which is available to authorized users.

critical care

Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial