The role of protein in nutrition, with particular reference to the composition and use of enteral feeding formulas. A consensus report.

In its proposed classification scheme for reimbursement for enteral feeding formulas, the United States Health Care Financing Administration (HCFA) has neglected to consider the importance of making available formulas of varying protein content. In responding to HCFA's proposal, this consensus report reviews information currently available regarding different protein requirements in healthy, ill, and undernourished adults and elderly individuals. HCFA's reimbursement guidelines should reflect sound medical and nutritional practice rather than influencing it adversely, which its original proposal could do. Clinicians should have at their disposal enteral feeding formulas of varying protein/calorie ratios, especially since the following groups often have higher than average protein requirements relative to calorie requirements: the elderly, individuals with physiologic stress such as infection and injury, and patients with protein-calorie undernutrition.