Plant protein dominant enteral nutrition, containing soy and pea, is non-coagulating after gastric digestion in contrast to casein dominant enteral nutrition

Enteral Nutrition (EN) is used for the dietary management of patients requiring tube feed and who are at risk of disease related malnutrition. Previously, EN with a dairy-dominant p4 protein blend (DD-P4: 20% soy, 20% pea, 25% casein and 35% whey) was shown to not coagulate in the stomach, increase gastric emptying rate and reduce gastric residual volume compared to EN with casein-dominant protein blends (CD; 80% casein and 20% whey), which is relevant for upper gastrointestinal tolerance. In line with the EAT-Lancet report, a new plant-dominant protein blend (PD-P4: 46% soy, 32% pea, 16% casein and 6% whey) was developed. Coagulating properties of PD-P4 are compared to DD-P4 and dairy proteins in protein solutions as well as in EN matrices, using a semi-dynamic in vitro gastric model simulating adult conditions, followed by solid particle (> 0.25 mm) separation using analytical sieving. Sieve retentates and filtrates were assayed for weight, dry matter, and protein content where possible. Whey protein, PD-P4 and DD-P4 protein solutions as well as PD-P4 and DD-P4 EN variants had minimal total particle weights. In contrast, casein protein solution coagulation amounted to similar to 21 % of its initial wet weight, containing similar to 51 % of its initial protein content, and CD EN coagulation amounted to 21 %- 45 % of the initial wet weight, containing 59-65 % of the initial protein content. EN with the new PD-P4 blend can be considered non-coagulating after in-vitro gastric digestion, similar to the DD-P4 blend. This was independent of energy density, protein content, and the presence of dietary fiber. EN with a non-coagulating plant-dominant protein blend might support upper gastrointestinal tolerance and promote the worldwide protein transition.