I have the same question. I am currently using enfacare 22kcal as well.

Hi Lindsay! ByHeart is 20kcal/oz. In terms of fortification, any modification of the caloric ratio should only be under the supervision of a healthcare professional, but you (and your healthcare practitioner!) can use our dilution chart for specific recommendations for fortification. You can find that chart on the bottom of our ByHeart for Medical Professionals page, here: https://byheart.com/pages/medical-professionals Let us know if you have any other questions!