Blenderized Tube Feeding: A Survey of Dietitians' Perspectives, Education, and Perceived Competence

State-of-the-art review of blenderized diets-Status and future directions

This state-of-the-art review was produced by a multidisciplinary team composed of pediatric gastroenterology and nutrition healthcare providers to provide a comprehensive overview of the use of blenderized tube feeds (BTFs). The team developed 12 vital questions to address gaps in the current understanding and practice of using BTFs, then performed a comprehensive search of literature published between 2000 and 2023 using PubMed, MEDLINE, Embase databases, and an individual search of references. There was a scarcity of well-designed randomized clinical trials, and most of the studies were prospective or retrospective observational reports from heterogeneous patient demographics, varieties of BTFs, and medical conditions. Use of BTFs was associated with improved outcomes, including higher satisfaction, reduced gastroesophageal reflux, retching, gagging, constipation, frequency of hospitalization for respiratory disease, and greater diversity of the gut microbiome. However, homemade and commercially manufactured BTFs varied in nutrient composition and physical properties, such as viscosity, which posed challenges related to ease of administration and comparison of clinical outcomes. Therefore, whereas the use of BTFs as an alternative to standard commercial formulas has become increasingly popular, further evidence is warranted to provide guidelines on best practices for usage, monitoring, and comparing clinical outcomes. Pediatric dietitians and clinician practitioners must regularly monitor children receiving BTFs to ensure nutritional adequacy, optimize safe and effective delivery, and promote optimal growth. The team proposed future directions regarding best practices for using BTFs, primarily related to clinical application and nutritional outcomes in children and adolescents.

A study of professional practices, attitudes and barriers to blended tube feeding in Australia and New Zealand

AIMS

This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement.

METHODS

A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes.

RESULTS

Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice.

CONCLUSIONS

This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

A Narrative Review of Home Enteral Nutrition in Australia with a Focus on Blended Tube Feeding

Enteral nutrition, commonly known as tube feeding, is a life-sustaining intervention for individuals who cannot meet their nutritional needs orally due to medical conditions affecting swallowing, digestion, or nutrient absorption. Since its introduction in the 1970s, home enteral nutrition (HEN) has enabled the safe delivery of complete or supplemental nutrition in community settings, enhancing both quality of life and healthcare outcomes. The HEN landscape in Australia is rapidly evolving, driven in part by the renewed interest in blended tube feeding (BTF). This narrative review explores the current state of HEN care and BTF support in Australia, focusing on prevalence, funding models, provider and client perspectives, clinical guidelines, and advocacy efforts.

Exploring Dietitians' Experience of Blended Tube Feed in Paediatric Inpatient Settings: National Cross-Sectional Survey, United Kingdom

BACKGROUND

Enteral tube feeding is used for children who are unable to meet their nutritional requirements orally. Gastrointestinal symptoms are some complications that can occur in enteral tube-fed patients. Blended tube feeds (BTFs) for children who are gastrotomy tube-fed have significantly increased in the last decade. BTF refers to homemade food that has been liquidised for enteral tube feeds. An increasing amount of evidence suggests that children on BTF have improved feed tolerance. It is unknown whether children admitted to a hospital established on a BTF can continue a BTF due to the potential barriers such as catering processes, staffing hours (limited to syringe bolus feeding) and food safety concerns. This national cross-sectional survey aimed to explore the use of BTF in a paediatric hospital setting.

METHODS

This was a prospective, cross-sectional, practice-based survey of registered paediatric dietitians who work in an inpatient care setting to explore the use of BTF. The final survey consisted of 13 questions and took dietitians approximately 15 min to complete. The questions focused on the dietitian's experience, knowledge and confidence in children on a BTF.

RESULTS

Across the United Kingdom, 51 hospitals completed the survey. Of these, 16 of 19 were specialist children's hospitals (79% response rate) and 35 of 89 were general paediatric hospitals (39% response rate). All responders were paediatric dietitians. 49 of 51 (96%) dietitians knew of the British Dietetic Association (BDA) Practice Toolkit for Blended diets. Dietitians were asked to estimate on average per month how many children were admitted on a BTF; 41% (21 of 51) of dietitians reported that on average there are one to five children admitted on a BTF. There was no significant difference in the number of children admitted on a BTF between a specialist and a general children's hospital (χ2 statistic = 4.96, p value < 0.08). The number of dietitians who had clinical guidelines to support children admitted on a BTF was 49% (25 of 51). Specialist children's hospitals were more likely to have a clinical guideline compared with a general hospital (χ2 statistic = 6.348, p value = 0.01). However, only 18 of 51 (35%) dietitians reported being confident or very confident to review a child on a BTF. The most common perceived benefit was that parents/carers could incorporate family foods into their child's diet. 26% reported that a varied diet was beneficial in relation to the gut microbiome. If a BTF was contraindicated for children admitted to a hospital (immunocompromised, post-pyloric feeding or intensive care), 49 of 51 (96%) dietitians reported they would use an enteral formula with food-derived ingredients (Compleat paediatric-Nestle Health Science) as an alternative to a BTF.

CONCLUSION

BTF continues to grow in popularity. Our survey reported that children on BTF are frequently admitted to the hospital. There is growing evidence to support BTF in relation to family psychosocial health and feed tolerance. Dietitians must keep abreast of this fast-evolving area practice to ensure that they are the experts in BTF. When a BTF is contraindicated, an enteral formula with food-derived ingredients is a suitable alternative. Issues such as microbial contamination, nutritional composition, and adequacy of diluted BTF need further exploration.

Attitudes of health and social care professionals towards the use of blended diets for enteral tube feeding for children and young people

Using a blended diet as an alternative to commercial formula is becoming more popular amongst parents and carers of children and young people (CYP) requiring long-term enteral tube feeding (ETF). Emerging evidence has demonstrated physiological and social benefits; however, families report feeling unsupported to use a blended diet in settings outside the home. This study aimed to explore the attitudes of health and social care staff towards the use of blended diets for CYP. Health and social care professionals with experience of blended diets were invited to partake in an online semi-structured qualitative interview. Thematic analysis was used to identify themes. Five participants from health, education and social care settings were interviewed. Online interviews worked effectively for data collection to allow flexibility to accommodate participants' care roles and avoid face-to-face contact necessary with Coronavirus disease 2019 restrictions. Three themes were identified in the data:• Change from medicalised enteral tube feeding practice.• Individual, person-centred approach.• Open support networks and responsibility.Findings showed that blended diets can be accommodated; however, barriers to implementation remain. Medicalisation of ETF continues to impair acceptance of blended diets whilst effective multi-disciplinary team communication and support facilitates its use in settings outside the home.

Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings

BACKGROUND

Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs.

METHODS

A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs.

RESULTS

The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95).

CONCLUSION

Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.

Clinical outcomes associated with blenderized tube feedings in adults: A systematic review

Nearly half a million individuals in the United States are dependent on enteral nutrition to meet their nutrition needs. Public interest in blenderized tube feeding (BTF) has increased over the past decade; however, medical professionals indicate a lack of knowledge about these products and their effects. The purpose of this review is to analyze clinical outcomes in adults who use a BTF formula as their primary nutrition source. A literature search was conducted in PubMed, Scopus, and CINAHL using search terms "adult," "enteral nutrition," "tube feeding," "BTF," blenderized," "blended," "homemade," and "pureed." Nine studies met the inclusion criteria and were analyzed in the review. Under close monitoring, BTF does not pose a higher risk for deterioration in anthropometric measurements. Furthermore, BTF use is consistently associated with improvements in diarrhea. As such, clinicians should consider the use of these formulas in the acute care or rehabilitation settings. Additional research is needed in patients with diverse clinical backgrounds in free-living communities. Larger populations sizes and longer intervention time frames are crucial to providing statistically significant results needed to strengthen the quality of evidence on this topic.

Blenderized food tube feeding in very young pediatric patients with special healthcare needs

BACKGROUND

Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake.

METHODS

In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program.

RESULTS

Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation.

CONCLUSION

Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.

Experiences and perceptions of multidisciplinary paediatric teams of blended tube feeding in children

Background: Blended tube feeding (BTF) is the administration of pureed whole foods via gastric feeding tubes. There is some evidence to suggest that BTF may have clinical and psychosocial benefits when compared to commercial formula, but further investigation of how BTF is understood and recommended by health professionals is needed. This study aims to investigate awareness and knowledge of BTF among multi-disciplinary paediatric staff in Ireland. Methods: A cross-sectional observational study was conducted among paediatric staff in Children's Health Ireland (CHI). The 16-item anonymous online survey gathered information on awareness of BTF, willingness to recommend BTF, confidence in BTF knowledge, and self-assessed competence in managing BTF. Results: Of the 207 responses, doctors (n68), nurses (n66), and dietitians (n32) provided 80.3% of responses. Two-thirds (n136, 66%) of the total group were aware of BTF. Of these, 68.1% had cared for a child on BTF and 70% (n = 63/90) were willing to recommend BTF. Three in five (n = 39/63, 61.9%) stated they were somewhat confident in their BTF knowledge and one in five (n = 12/56, 21.4%) were not yet competent in managing children on BTF. The most common reasons for recommending BTF were parental desire (n17, 39.5%) and commercial formula intolerance (n15, 34.9%). The most common barrier to recommending BTF was family logistics (n18, 41.9%). The most valuable sources of information on BTF for two-thirds (68.3%) of participants were other healthcare professionals (HCPs) and patients/caregivers. Conclusion: Healthcare settings should provide evidence-based training to HCPs on BTF to optimise the treatment and safety of children under their care.

Blended feeding in gastrostomy-fed children-A scoping review

BACKGROUND

Blended feeding has become increasingly prevalent in recent years with its practice gaining some momentum. With anecdotal reports of benefits and little evidence of harm in the literature regarding blended feeding, this scoping review was deemed important. The aim of this scoping review was to summarise the published evidence about blended feeding in gastrostomy-fed children.

METHOD

The scoping review methodology used included searches in specific online databases: PUBMED, PsychINFO, CINAHL, SCOPUS, AMED and EMBASE for articles that addressed issues pertaining to blended feeds in gastrostomy-fed children. Grey literature was also considered. Inclusion criteria included papers that pertained to information and research on blended feeding in gastrostomy-fed children. Studies published in English over the past 11 years (2011-2022) were included. This resulted in 59 papers being included in this scoping review.

RESULTS

Thematic analysis of the literature identified eight overall themes. It was clear that parents found blended feeding promoted the normalising of feeding, their own involvement in decision-making around foods and promotion of a socially inclusive mealtime. The need for dietician and health professional input and support is key, whereas a lack of guidelines acts as a barrier to blended feeding. Furthermore, risks associated with blended feeding are identified but also the benefits to the physical well-being of the child are considered.

CONCLUSION

The review was comprehensive in that it identified a broad range of literature, exploring the extent, range and nature of research activity related to the use of blended feeds. The lack of original research is a concern. However, it is expected this review will provide direction for researchers, and in particular inform policy and practitioners working in the field where blended feeds may be an option for gastrostomy-fed children.

Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition

Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022-2023 Board of Directors.

Understanding the use and tolerance of a pediatric and an adult commercial blenderized enteral formula through real-world data

BACKGROUND

Home enteral nutrition (HEN) is frequently prescribed to individuals who cannot consume adequate food orally. Commercial blenderized enteral formulas (CBEF) containing real-food ingredients are becoming more popular and more widely available; however, the demographics of patients receiving these formulas have rarely been evaluated, and little data are available on patient tolerance in the community.

METHODS

US claims data were obtained for children and adolescents/adults who used the CBEF of interest as the sole source of nutrition via enteral feeding tube in the community setting following discharge from acute care. Demographics, concomitant medications, clinical diagnoses, and Charlson Comorbidity Index scores were tabulated using descriptive statistics. Gastrointestinal (GI) symptoms before and after hospital discharge were compared using significance tests.

RESULTS

The study included 231 participants (180 children, 51 adolescents/adults). CBEFs were prescribed to patients with a variety of diagnoses, of which the most common were digestive and respiratory disorders. Children experienced significantly lower rates of diarrhea, nausea, vomiting, constipation, and abdominal distension in the weeks following hospital discharge compared with the baseline (all P < 0.001). Adolescents/adults experienced significantly lower rates of constipation, nausea, and vomiting (all P < 0.05). Neither group increased their usage of GI medications following hospital discharge.

CONCLUSION

These CBEFs, based on real-food ingredients, were prescribed to diverse patients in the community and were well tolerated. These formulas offer an alternative to standard polymeric formulas and an alternative or adjunct to homemade blenderized formulas.

Blenderized formulations in home enteral nutrition: a narrative review about challenges in nutritional security and food safety

Blenderized formulations (BFs) are prepared by homogenization of food that is normally used in oral nutrition. BFs are mainly used in home enteral nutrition (HEN), although their use has also been reported by hospitals when commercial enteral formulas are not available. HEN is applied when the patient has been discharged from the hospital. This nutritional therapy promotes the patient's reintegration into the family nucleus and promotes humanized care, and decreases treatment costs. However, the patient should continue to receive health and nutritional care, ranging from periodic nutritional re-evaluation to adaptation of the dietary plan. HEN provides the patient a greater contact with the family, whereas BFs promote the adaptation of the diet with food, respecting the food diversity and culture, lower cost, and easier access to food. Disadvantages of BFs include more time spent by the professional to calculate the dietary plan, greater difficulty in adjusting daily needs, and less microbiological and chemical stability. In this review, the nutritional, food security, and safety aspects of BF used in HEN are discussed. Technological quality aspects that are essential knowledge in the preparation of the patient's dietary plan also are presented.

Blenderized Tube Feeding and Enterostomy Tube Occlusions Among Adults with Amyotrophic Lateral Sclerosis and Primary Lateral Sclerosis

Adults with amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS) may develop swallowing difficulties and elect to receive an enterostomy feeding tube for nutrition support. Blenderized tube feeding (BTF) appeals to those interested in a homemade enteral nutrition option, but there are concerns of feeding tube occlusion and limited research on this potential risk. Therefore, our purpose was to determine the frequency of, and risk factors for, feeding tube occlusions among adults with ALS or PLS who use BTF. For this retrospective study, the electronic medical records of tube-fed adults with ALS or PLS who received outpatient care at a provincial ALS clinic during a two-year period were reviewed (n = 651). There were 97 tube-fed patients identified, of which 20 (21%) used BTF. Average duration of BTF use was 11.25 ± 7.5 months. Seven subjects (35%) used BTF exclusively, while 13 (65%) used a combination of BTF and commercial enteral formula. All received BTF by gastrostomy tube, sized 14 to 24 French. BTF administration methods and compliance with water flush recommendations varied. Despite the perceived risk of feeding tube occlusions with blenderized tube feeding, no occlusions were found to have occurred in this study.

Introduction of blended diet for enteral tube feeding in paediatrics: A case report

Background: Advances in medical technology have resulted in changes to enteral tube feeding (ETF). Standard practice in the UK is to use commercial formula for ETF via the stomach or small intestine; however, blended diets are becoming increasingly popular. Emerging evidence shows benefits of a blended diet although evidence informing clinical guidance is sparse. Consequently, there is disparity in practice, and it remains unclear which patient groups may benefit most from a blended diet. Aim: To demonstrate the initiation of a blended diet in clinical practice. Methods: This case report features a 2-year-old child requiring ETF in the context of hypotonia, developmental delay and faltering growth. Results: In this instance, a blended diet resulted in improved gastrointestinal symptoms and adequate growth. Conclusion: This case demonstrates the successful implementation of a blended diet and associated benefits. Blended diets may benefit others requiring ETF and should be considered on an individualised basis.

Blenderized food tube feeding in patients with head and neck cancer

Background

Patients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions.

Methods

In this open‐label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement.

Results

Of the 16 patients who completed the 6‐week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6‐week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC.

Conclusion

BTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

Caregivers' Perceptions of Real-Food Containing Tube Feeding: A Canadian Survey

Caregivers of children requiring tube feeding show growing interest in real-food containing formula, including home-blenderized tube feeding (HBTF) and commercial real-food containing formulas (CRFCF). This study aimed to understand caregivers' perceptions of both. Caregivers using real-food containing tube feeding were recruited through the Feeding Tube Awareness Foundation Facebook group. A 13-question online survey asked about use of HBTF and CRFCF, beliefs about their choices, and what resources guided formula use. Forty-one completed the survey, with mean child age of 7 years. Overall, 54% (n = 22) used HBTF formulas, 34% (n = 14) CRFCF, and 12% (n = 5) used both. For 70% (n = 29), presence of whole foods, nutritional completeness, and natural ingredients were most important. Challenges with CRFCF use included lack of variety (n = 10, 53%) and cost (n = 9, 47%). HBTF challenges were difficulty preparing away from home (n = 19, 70%) and need for special blenders (n = 15, 56%). Participants believed CRFCF are convenient (n = 35, 85%) and nutritionally consistent (n = 25, 61%), but do not contain enough real-food ingredients (n = 26, 63%). Facebook or other social media was the most valued resource guiding formula use (n = 25, 61%). Caregivers desire formulas that are nutritionally complete and made of whole foods. CRFCF offers convenience and consistency, yet caregivers prefer more real-food ingredients.

Effectiveness of Diet Habits and Active Life in Vocational Training for Higher Technician in Dietetics: Contrast between the Traditional Method and the Digital Resources

Vocational training of students in diet habits and active lifestyle habits has recently become an important issue, given the health problems caused as a result of a poor diet. The objective of this study is to analyze the effectiveness of different training actions (traditional method and digital resources) carried out in a program of dietary habits and active lifestyle at the vocational training stage. A quasi-experimental design of the pre-post type was developed. A sample of 177 participants was chosen. The instrument to collect the data was the validated ECHAES questionnaire. The results show that all study groups demonstrated similar averages across all dimensions, except in the digital resource post-test design, where the averages were higher than the rest. There was a significant relationship between the traditional teaching method and the post-test digital resources design in all dimensions. There was also a significant relationship between the pre-test and post-test of the traditional teaching method and the digital resource group in the dimensions. It can be concluded that both the traditional and the innovative method lead to learning in the vocational training student, although the values achieved by the group where the innovative method was adopted were much higher than in the traditional group.

Education and Diet in the Scientific Literature: A Study of the Productive, Structural, and Dynamic Development in Web of Science

Nutrition-related education is necessary to protect and improve the health status of schoolchildren and to minimize the risk of future diseases. The objective of this research was to analyze the trajectory and transcendence of the concepts “education” and “diet” in the Web of Science literature. The methodology focused on bibliometry, analyzing both the performance and the structural and dynamic development of the concepts through a co-word analysis. A total of 1247 documents were analyzed, and the results show that scientific production experienced a turning point in 2009, in comparison to the level of production reported in previous years. The medium of papers and the language of English were the most common. In relation to the research topic, before 2014, scientific production focused on medical and disease-related aspects; however, since 2014, it has focused on disease prevention and feeding. It was therefore concluded that the theme “diet and education” has been researched for more than 20 years, although it is only in the last decade that it has become more relevant—particularly studies focusing on disease prevention and the type of food, specifically fruit, which is presented as the most outstanding issue for researchers in this field of knowledge.