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Logrippo S, Ganzetti R, Sestili M, Perinelli DR, Cespi M, Bonacucina G. Enteral Delivery of Pravastatin Sodium Tablets: Effect of Compounding into a Liquid Form and Co-Administration of Enteral Nutrition. Pharmacy (Basel) 2024; 12:32. [PMID: 38392939 PMCID: PMC10892702 DOI: 10.3390/pharmacy12010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Compounding solid oral dosage forms into liquid preparations is a common practice for administering drug therapy to patients with swallowing difficulties. This is particularly relevant for those on enteral nutrition, where factors such as the administration procedure and co-administration of enteral nutrition play crucial roles in effective drug delivery. Due to the limited studies focused on this practice, the impact of co-administered nutrition remains unclear. METHODS Pravastatin tablets were compounded into two liquid formulations and administered through three independent tubes for ten cycles. The drug amount was quantified upstream and downstream of the tubes both with and without different (fiber content) nutritional boluses. RESULTS The compounding procedure did not lower the drug amount with respect to the original tablets. However, when the liquid formulation was pumped through the tubes, a statistically significant reduction in the pravastatin administered (between 4.6% and 11.3%) was observed. The co-administration of different nutritional boluses or the compounding procedure did not affect the general results. CONCLUSIONS Pravastatin loss appears unavoidable when administered via the enteral tube. Although, in this case, the loss was of limited clinical relevance, it is important not to underestimate this phenomenon, especially with drugs having a narrow therapeutic index.
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Affiliation(s)
- Serena Logrippo
- Hospital Pharmacy, Santa Maria della Stella Hospital, USL Umbria 2, 05018 Orvieto, Italy;
- Hospital Pharmacy, Engles Profili Hospital, AST Ancona, 60044 Fabriano, Italy
| | - Roberta Ganzetti
- Hospital Pharmacy, Carlo Urbani Hospital, AST Ancona, 60035 Jesi, Italy;
| | - Matteo Sestili
- Territorial Pharmaceutical Service, AST Ancona, 60035 Jesi, Italy;
| | - Diego Romano Perinelli
- CHIP Building, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (D.R.P.); (G.B.)
| | - Marco Cespi
- CHIP Building, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (D.R.P.); (G.B.)
| | - Giulia Bonacucina
- CHIP Building, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (D.R.P.); (G.B.)
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2
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Hahn M, Wood A, Hasse JM. Nutrition support management of organ transplant recipients in the acute posttransplant phase. Nutr Clin Pract 2024; 39:45-58. [PMID: 38081296 DOI: 10.1002/ncp.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024] Open
Abstract
Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant-specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.
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Affiliation(s)
- Michaelann Hahn
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Abby Wood
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeanette M Hasse
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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3
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Downs EM, Brun A, Bellin MD. Nutrition support in the pediatric total pancreatectomy with islet autotransplantation recipient. Nutr Clin Pract 2024; 39:100-108. [PMID: 38073153 DOI: 10.1002/ncp.11101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/13/2024] Open
Abstract
For children with diminished quality of life and chronic pain caused by acute recurrent or chronic pancreatitis who are undergoing total pancreatectomy with islet autotransplantation, postoperative nutrition support has several unique characteristics. Surgical complications may lead to delays in nutrition support initiation or require modifications to the regimen. Early postoperative dysmotility requires the use of temporary enteral nutrition until this improves. The resultant complete exocrine pancreatic insufficiency necessitates lifelong pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation. A low-oxalate diet is recommended to prevent kidney stones. Carbohydrate counting is needed for the provision of short-term insulin dosing and possibly long-term as well, depending on the transplanted islet yield. Children should have careful nutrition assessment and monitoring at several follow-up visits during the first year, then annually, and at any time with concerns.
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Affiliation(s)
- Elissa M Downs
- Pediatric Gastroenterology, Hepatology, and Nutrition, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Amanda Brun
- Nutrition Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Melena D Bellin
- Pediatric Endocrinology and Transplant Surgery, M Health Fairview, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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4
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Murayi JAO, Goday PS. Current topics in pediatric enteral nutrition safety. Nutr Clin Pract 2023; 38:1220-1224. [PMID: 37635448 DOI: 10.1002/ncp.11066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/24/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Enteral nutrition is a cornerstone of nutrition support therapy in patients of all ages and across the care continuum. Safe delivery of enteral nutrition to patients is paramount. This review article will focus on current topics in enteral nutrition safety primarily in children including safety with home-made blenderized feeds, recent infant and enteral formula shortages largely due to formula contamination at the manufacturer level, and concerns with importing infant formulas.
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Affiliation(s)
| | - Praveen S Goday
- Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA
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5
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Klepper CM, Moore J, Gabel ME, Fleet SE, Kassel R. Pediatric formulas: Categories, composition, and considerations. Nutr Clin Pract 2023; 38:302-317. [PMID: 36815542 DOI: 10.1002/ncp.10954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023] Open
Abstract
Formulas, liquid nutrition, may be consumed orally or via a feeding tube to provide partial or complete nutrition that a given individual could not obtain using natural food stuffs in their native form. A wide range of commercially available formulas exist, which may be used as sole-source nutrition or in conjunction with other foods. Physicians and dietitians must understand the nature of and indications for specific formulas to treat diseases, provide complete nutrition to patients, and avoid harm. Products vary in macronutrient and micronutrient content and calorie concentration among many other factors. They are formulated specifically for patients of specific ages, correlating to nutritional needs and medical diagnoses. Additionally, formula availability, insurance coverage, mode of consumption, physiologic tolerance, and caregiver preference influence formula selection. Caregivers may also make their own pediatric formulas. We review commercial and homemade pediatric formulas.
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Affiliation(s)
- Corie M Klepper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joseph Moore
- Department of Clinical Nutrition and Lactation, Children's of Alabama, Birmingham, Alabama, USA
| | - Megan E Gabel
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah E Fleet
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Kassel
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.,Division of Gastroenterology, Hepatology and Nutrition, Birmingham, Alabama, USA
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6
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Church A, Zoeller S. Enteral nutrition product formulations: A review of available products and indications for use. Nutr Clin Pract 2023; 38:277-300. [PMID: 36787985 DOI: 10.1002/ncp.10960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/16/2023] Open
Abstract
When oral nutrition is not feasible, enteral nutrition (EN) therapy is often considered the preferred route of nutrition support to meet the nutrient needs of individuals with a functional gastrointestinal tract across multiple levels of care (critical care, acute care, and home care). Enteral formulations have progressively evolved over the last 50 years from the simple blending of hospital food thin enough to run through a feeding tube, to the development of commercial standard formulas, followed by specialized formulas with immune-modulating and disease-specific qualities, to the most recent shift to food-based or blenderized EN composed of natural, whole foods with perceived health benefits. With the vast number of enteral formulations on the market, clinicians may be overwhelmed trying to determine proven vs theoretical benefits. This review is intended to explore differences in enteral formulations, identify implications for clinical practice, and review evidenced-based clinical guidelines to assist clinicians in enteral formula selection.
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Affiliation(s)
- April Church
- Nutrition Services, Asante Rogue Regional Medical Center, Medford, Oregon, USA
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7
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Folwarski M, Kłęk S, Zoubek-Wójcik A, Szafrański W, Bartoszewska L, Figuła K, Jakubczyk M, Jurczuk A, Kamocki Z, Kowalczyk T, Kwella B, Matras P, Sonsala-Wołczyk J, Szopiński J, Urbanowicz K, Zmarzły A. Foods for Special Medical Purposes in Home Enteral Nutrition-Clinical Practice Experience. Multicenter Study. Front Nutr 2022; 9:906186. [PMID: 35873447 PMCID: PMC9301075 DOI: 10.3389/fnut.2022.906186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Enteral nutrition (EN) with foods for special medical purposes (FSMP) is recommended for most patients on home enteral nutrition (HEN). Although there are disease-specific guidelines for energy, protein, and micronutrient provision, only a few studies are showing real-life experience in the long-term use of FSMP. Methods In a multicenter study, the influence of the FSMP composition and administration technique (bolus vs. continuous) on protein and energy provision in HEN was analyzed. Provision of vitamins and minerals was compared to recommended daily allowance (RDA) and upper tolerable limit (UL). Results Approximately, 772 patients on HEN, mostly (88.6%) with oncological and neurological diseases, were enrolled. The patients on standard FSMP received less protein and energy than those on hypercaloric and protein enriched despite receiving higher volumes of EN (p < 0.05). No differences were observed in jejunal feeding with oligomeric vs. polymeric FSMP in terms of energy, protein, and volume. Continuous gastric feeding provided more protein, energy, and volume vs. bolus feeding (p < 0.05). Significant number of patients received less than 100% RDA of vitamin D (50.5%), vitamin B3 (49%), vitamin K (21.8%), vitamin B5 (64.3%), vitamin B9 (60%). Majority of the patients received less than 100% RDA of sodium (80.2%), potassium (99%), chloride (98%), calcium (67%), magnesium (87%), fluoride (99%), and iodine (43%). Approximately, 43.63% of cancer and 49.9% of neurological patients received less than 1 g/kg/day of protein and 51.7% of cancer and 55.5% of neurological patients received less than 25 kcal/kg/day. Conclusion Awareness of the available compositions of FSMP and advantageous profiles of specific diets may lead to the implementation of recommendations for EN. HEN professionals need to analyze all the patient's needs and requirements to provide more tailored matching of nutritional support.
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Affiliation(s)
- Marcin Folwarski
- Department of Clinical Nutrition and Dietetics, Medical University of Gdańsk, Gdańsk, Poland
- Home Enteral and Parenteral Nutrition Unit, Department of General Surgery, Nicolaus Copernicus Hospital, Gdańsk, Poland
| | - Stanisław Kłęk
- Surgical Oncology Clinic, Maria Skłodowska-Curie National Cancer Institute, Kraków, Poland
| | | | - Waldemar Szafrański
- Home Enteral and Parenteral Nutrition Unit, Department of General Surgery, Nicolaus Copernicus Hospital, Gdańsk, Poland
| | - Lidia Bartoszewska
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | | | - Marlena Jakubczyk
- Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
- Nutritional Team, Home Enteral and Parenteral Nutrition Clinic University Hospital No. 1 in Bydgoszcz, Toruń, Poland
| | - Anna Jurczuk
- Outpatient Clinic of Nutritional Therapy Clinical Hospital of Białystok, Białystok, Poland
| | - Zbigniew Kamocki
- 2nd Department of General, Gastroenterological and Oncological Surgery Medical University of Białystok, Białystok, Poland
| | | | - Bogna Kwella
- Department of Clinical Nutrition, Provincial Specialist Hospital, Olsztyn, Poland
| | - Przemysław Matras
- First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland
| | | | - Jacek Szopiński
- Department of General Hepatobiliary and Transplant Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
- General Surgery and Clinical Nutrition Ward, Community Hospital Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | | | - Anna Zmarzły
- Gromkowski City Hospital Wrocław, Clinical Nutrition Unit, Wrocław, Poland
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8
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Koretz RL. JPEN Journal Club 65. Selective citation. JPEN J Parenter Enteral Nutr 2021; 46:958-960. [PMID: 34486136 DOI: 10.1002/jpen.2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ronald L Koretz
- Olive View-UCLA Medical Center, Sylmar, California, USA.,David Geffen-UCLA School of Medicine, Los Angeles, California, USA
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9
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Brown T, Zelig R, Radler DR. Clinical Outcomes Associated With Commercial and Homemade Blenderized Tube Feedings: A Literature Review. Nutr Clin Pract 2020; 35:442-453. [PMID: 32319708 DOI: 10.1002/ncp.10487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There is emerging evidence in the pediatric population that blenderized tube feeding (BTF) may improve gastrointestinal intolerance; however, not much is known about the impact of BTF on clinical outcomes in adults. This article presents a review of the literature published in the past 10 years that explored the impact of BTF on nutrition status (ie, weight status, body mass index, and upper-arm circumference) and nutrition adequacy in adults. The results indicate that BTF, compared with commercial enteral formula (CEF), may be inadequate in calories, macronutrients, and some micronutrients, given variability in BTF formula composition. As a result, BTF may result in significantly more weight loss than CEF. Thus, BTF may not be appropriate for adult patients who are malnourished or are at risk for malnutrition due to the potential worsening of clinical outcomes.
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Affiliation(s)
- Terry Brown
- HealthTrust Supply Chain, Coppell, Texas, USA.,Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Jersey, USA
| | - Rena Zelig
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Jersey, USA
| | - Diane Rigassio Radler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Jersey, USA
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10
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Mundi MS, Velapati S, Kuchkuntla AR, Hurt RT. Reduction in Healthcare Utilization With Transition to Peptide-Based Diets in Intolerant Home Enteral Nutrition Patients. Nutr Clin Pract 2020; 35:487-494. [PMID: 32149433 DOI: 10.1002/ncp.10477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Since the introduction of percutaneous endoscopic gastrostomy in the 1980s, the prevalence of home enteral nutrition (HEN) support has increased significantly. Despite these increases, many patients are unable to tolerate standard polymeric formulas (SPFs), resulting in significant healthcare resource utilization. Peptide-based diets (PBDs) have emerged as a viable option in SPF-intolerant patients; however, data in the HEN population are lacking. METHODS Retrospective review of our prospectively maintained HEN database was conducted to assess tolerance, efficacy, and impact on healthcare utilization in patients on PBDs. RESULTS From January 1, 2016, to May 1, 2018, 95 patients were placed on PBDs, with 53 patients being started directly and 42 patients being transitioned from SPFs. In patients transitioned to PBDs, symptoms of nausea and vomiting, diarrhea, abdominal pain, and distention improved significantly. Healthcare utilization also declined significantly, including mean number of phone calls (1.8 ± 1.6 to 1.1 ± 0.9, P = 0.006), mean number of emergency room visits (0.3 ± 0.6 to 0.09 ± 0.3, P = 0.015), and mean number of provider visits (1.3 ± 1.3 to 0.3 ± 0.5, P < 0.0001). CONCLUSIONS Overall, PBDs were well tolerated and resulted in significant improvements in symptoms of gastrointestinal distress and healthcare utilization in patients intolerant to SPFs.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Saketh Velapati
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Aravind R Kuchkuntla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Weston S, Clarke T. Determining Viscosity of Blenderized Formula: A Novel Approach Using the International Dysphagia Diet Standardisation Initiative Framework. JPEN J Parenter Enteral Nutr 2020; 44:1140-1143. [PMID: 32017164 DOI: 10.1002/jpen.1788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Blenderized formula (BF) can be used in place of standard enteral formula and is composed of blenderized whole foods and purees. Benefits of using BF include reduced vomiting and retching, in part related to a higher viscosity. Commercially prepared BFs vary significantly in viscosity when comparing available products. Viscosity can be measured using a viscometer, although this requires expensive and sophisticated equipment. We proposed an alternative method to describe viscosity of BFs using the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. This flow test provides a simple and objective method to describe liquid thickness and requires only a 10-mL luer tip syringe and stopwatch. METHODS Full-strength BFs were measured using the IDDSI flow test and compared with a standard enteral formula. BFs were then diluted until a slightly thick viscosity was achieved, which correlated to the viscosity of the reference formula. RESULTS IDDSI flow-test results indicated that undiluted BFs ranged in viscosity, from slightly thick to extremely thick, when measured at room temperature. The volume of water required to achieve a slightly thick viscosity ranged from 0 to 270 mL per serving, resulting in a wide variation in dilution of formula. CONCLUSION The IDDSI flow test was simple to perform and can serve as a tool to determine the viscosity of BFs.
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Affiliation(s)
- Sharon Weston
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tracie Clarke
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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12
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Maruyama M, Goshi S, Kashima Y, Mizuhara A, Higashiguchi T. Clinical Effects of a Pectin-Containing Oligomeric Formula in Tube Feeding Patients: A Multicenter Randomized Clinical Trial. Nutr Clin Pract 2019; 35:464-470. [PMID: 31606903 DOI: 10.1002/ncp.10392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A pectin-containing oligomeric formula (POF) is a unique type of enteral formula that transforms from a liquid to a gel after reacting with gastric acid. Reports on its clinical effects have been limited. The present study was conducted to examine and verify the clinical effects of POF. METHODS The study subjects were 201 stable patients receiving intragastric tube feeding. They were randomized into 2 groups to receive either POF or a standard polymeric formula (SPF) as a control. The duration of observation was 1 week. Analyses were conducted for the incidence of predefined composite events, including diarrhea, defecation treatments, and other enteral nutrition (EN) management-related events. RESULTS Composite events occurred in 15 of 98 patients in the POF group and 30 of 100 patients in the SPF group, with a significantly lower incidence in the POF group compared with the SPF group (P = 0.011). In particular, diarrhea occurred in 2 patients in the POF group and 13 patients in the SPF group, with a significantly lower incidence in the POF group compared with the SPF group (P = 0.003). CONCLUSIONS The results of this study suggest that POF is less likely to cause EN-related events, especially diarrhea, than SPF is.
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Affiliation(s)
- Michio Maruyama
- Clinical Study Committee, Japanese Society of Parenteral and Enteral Nutrition, Tokyo, Japan.,Department of Surgery, Tanashi Hospital, Tokyo, Japan
| | - Satoshi Goshi
- Department of Gastroenterology and Hepatology, Joetsu General Hospital, Niigata, Japan
| | | | - Akihiro Mizuhara
- Department of Cardiovascular Surgery, Higashiwashinomiya Hospital, Saitama, Japan
| | - Takashi Higashiguchi
- Clinical Study Committee, Japanese Society of Parenteral and Enteral Nutrition, Tokyo, Japan.,Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Aichi, Japan
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13
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Abstract
Glycemic Index (GI) is a measure of carbohydrate quality and is recognised as a valid and reproducible method of classifying carbohydrate foods according to its effects on postprandial glycaemia. In this randomised crossover trial (RBR-7rjx3k) we determined the GI of nine enteral formulas, following the Food and Agriculture Organisation/World Health Organisation method. Forty healthy participants were included in the study (85% female mean age 27.1 ± 6.7 years). GI of the enteral formulas ranged from 40.5 to 85.2; four formulas had high GI (Nutrienteral 1.5®, Novasource GI Control®, Diamax®, Isosource Soya®), two intermediate GI (Fresubin 1.2 HP Fibre®, Nutrison Energy Multifiber 1.5®) and three low GI (Trophic 1.5®, Glucerna®, Novasource GC HP®). The GI coefficient of variation ranged from 22.9% to 83.6%. The effect of the enteral formulas with low GI in glycemic control of patients with enteral nutrition prescription needs to be test in future studies.
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Affiliation(s)
| | | | - Ann Kristine Jansen
- Nutrition Department, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
| | - Hugo Bernandes
- Risoleta Tolentino Neves Hospital, Belo Horizonte, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Postgraduation Program of Nutrition Science of Federal University of Healthy Science of Porto Alegre - UFCSPA, Porto Alegre, Brazil
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14
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Hopkins B, Cohen SS, Irvin SR, Alberda C. Achieving Protein Targets in the ICU Using a Specialized High-Protein Enteral Formula: A Quality Improvement Project. Nutr Clin Pract 2019; 35:289-298. [PMID: 31240750 DOI: 10.1002/ncp.10364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To meet protein needs in critical illness (CI), guidelines suggest ≥1.2-2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive ≤0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver ≥80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians' experience. METHODS This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula, patient's BMI (kg/m2 ), nutrition targets, daily protein and energy delivered, feeding interruptions, and general tolerance were recorded. RESULTS Forty-four of 49 patients received the formula ≥2 days. Average protein prescribed was 137.5 g/d (82.5-200) or 1.9 g/kg/d (1.5-2.5). Average protein delivered was 116.9 g/d (33.5-180) or 1.6 g/kg/d (0.4-2.4). Seventy-five percent to 83% of patients received ≥80% prescribed protein on days 2-5. Average energy prescribed was 1638.6 kcal/d (990-2500) or 17.8 kcal/kg (11-26). Average energy delivered was 1523.9 kcal/d (693.0-2557.5) or 17.3 kcal/kg/d (1.35-64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat-based medications. CONCLUSIONS We demonstrated in a QI study that a high-protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding.
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Affiliation(s)
- Bethany Hopkins
- Medical Affairs, Nestlé Health Science Canada, North York, Ontario, Canada
| | | | | | - Cathy Alberda
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada
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15
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Koretz RL. JPEN Journal Club 44. When Not to Combine Data. JPEN J Parenter Enteral Nutr 2019; 43:819-821. [PMID: 30900260 DOI: 10.1002/jpen.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Ronald L Koretz
- Olive View-UCLA Medical Center, David Geffen-UCLA School of Medicine, Sylmar and Los Angeles, California, USA
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16
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Rathe M, De Pietri S, Wehner PS, Frandsen TL, Grell K, Schmiegelow K, Sangild PT, Husby S, Müller K. Bovine Colostrum Against Chemotherapy-Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double-Blind, Placebo-Controlled Trial. JPEN J Parenter Enteral Nutr 2019; 44:337-347. [PMID: 30861163 DOI: 10.1002/jpen.1528] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/28/2019] [Accepted: 02/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The toxic effect of chemotherapy on the gastrointestinal tract may lead to mucositis and is associated with the pathogenesis of other treatment-related complications. We hypothesized that nutrition supplementation with bovine colostrum, rich in bioactive factors, would ameliorate gastrointestinal toxicity and reduce the incidence of fever and infectious complications during induction treatment for childhood acute lymphoblastic leukemia (ALL). METHODS Children with newly diagnosed ALL were included in a 2-center, randomized, double-blind, placebo-controlled clinical trial. Patients were randomized to receive a daily colostrum or placebo supplement during 4 weeks of induction treatment. Data on fever, bacteremia, need for antibiotics, and mucosal toxicity were prospectively collected. (Trial registration: www.clinicaltrials.gov NCT01766804). RESULTS Sixty-two patients were included. No differences were found for the primary outcome (number of days with fever). No difference was observed for neutropenic fever, intravenous antibiotics, or incidence of bacteremia. Peak severity of oral mucositis was significantly reduced by colostrum (7/29 patients, 24% mild; 6/29, 21% moderate; 1/29, 3% severe) compared with placebo (12/31, 39% mild; 1/31, 3% moderate; 7/31, 23% severe) (P = 0.02). Among patients receiving at least 1 dose of supplement (colostrum: n = 22; placebo: n = 30), the peak weekly self-reported oral mucositis score was overall significantly less severe in the colostrum group (P = 0.009). CONCLUSION The use of prophylactic bovine colostrum showed no effect on fever, infectious morbidity, or inflammatory responses. Nevertheless, these data may suggest protective effects on the oral mucosa during induction therapy in childhood ALL, encouraging additional studies confirming these findings.
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Affiliation(s)
- Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Silvia De Pietri
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peder Skov Wehner
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Thomas Leth Frandsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kathrine Grell
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Torp Sangild
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Section of Comparative Pediatrics and Nutrition, Department of Clinical Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Klaus Müller
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Inflammation Research, Rigshospitalet, Copenhagen, Denmark
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17
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Affiliation(s)
- Ronald L Koretz
- Emeritus Professor of Clinical Medicine, Olive View-UCLA Medical Center, David Geffen-UCLA School of Medicine, Sylmar and Los Angeles, California
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18
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Abstract
Tube feeding (TF) is the most common form of nutrition support. In recent years, TF administration has increased among patient populations within and outside hospital settings, in part due to greater insurance coverage, reduced use of parenteral nutrition, and improved formularies suitable for sole source nutrition. With increasing life expectancy and improved access to TFs, the number of adults dependent on enteral nutrition is expected to grow. However, enteral TF intolerance (ETFI) is the most common complication of TFs, typically presenting with at least 1 adverse gastrointestinal event, including nausea, diarrhea, and constipation. ETFI often leads to reductions in TF volume with associated energy and protein deficits. Potentially ensuing malnutrition is a major public health concern due its effects on increased risk of morbidity and mortality, infections, prolonged hospital length of stay, and higher healthcare costs. As such, there is a need for intervention strategies to prevent and reduce ETFI. Incorporating whole foods with bioactive properties is a promising strategy. Emerging research has elucidated bioactive properties of whole foods with specific benefits for the prevention and management of adverse gastrointestinal events commonly associated with TFs. However, lack of evidence-based recommendations and technological challenges have limited the use of such foods in commercial TF formulas. This review addresses research gaps by discussing 5 whole foods (rhubarb, banana, curcumin, peppermint oil, and ginger) with bioactive attributes identified through literature searches and clinical experience as having substantial scientific rationale to consider their application for ETFI in adult populations.
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Affiliation(s)
- Adam J Kuchnia
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Beth Conlon
- Nestlé Nutrition R&D Centers Inc, Bridgewater, New Jersey, USA
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Pastoriza S, Rufián-Henares JÁ, García-Villanova B, Guerra-Hernández E. Evolution of the Maillard Reaction in Glutamine or Arginine-Dextrinomaltose Model Systems. Foods 2016; 5:E86. [PMID: 28231180 PMCID: PMC5302425 DOI: 10.3390/foods5040086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/26/2016] [Accepted: 12/02/2016] [Indexed: 11/30/2022] Open
Abstract
Enteral formulas are foods designed for medical uses to feed patients who are unable to eat normally. They are prepared by mixing proteins, amino acids, carbohydrates and fats and submitted to sterilization. During thermal treatment, the Maillard reaction takes place through the reaction of animo acids with reducing sugars. Thus, although glutamine and arginine are usually added to improve the nutritional value of enteral formulas, their final concentration may vary. Thus, in the present paper the early, intermediate, and advanced states of the Maillard reaction were studied in model systems by measuring loss of free amino acids through the decrease of fluorescence intensity with o-phtaldialdehyde (OPA), 5-Hydroximethylfurfural (HMF), furfural, glucosylisomaltol, fluorescence, and absorbance at 420 nm. The systems were prepared by mixing glutamine or arginine with dextrinomaltose (similar ingredients to those used in special enteral formula), and heated at 100 °C, 120 °C and 140 °C for 0 to 30 min. The recorded changes in the concentration of furanic compounds was only useful for longer heating times of high temperatures, while absorbance and fluorescence measurements were useful in all the assayed conditions. In addition, easiness and sensitivity of absorbance and fluorescence make them useful techniques that could be implemented as indicators for monitoring the manufacture of special enteral formulas. Glucosylisomaltol is a useful indicator to monitor the manufacture of glutamine-enriched enteral formulas.
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Affiliation(s)
- Silvia Pastoriza
- Departamento de Nutrición y Bromatología, Facultad de Farmacia, Universidad de Granada, Campus Universitario de Cartuja, 18071 Granada, Spain.
| | - José Ángel Rufián-Henares
- Departamento de Nutrición y Bromatología, Instituto de Investigación Biosanitariaibs.GRANADA, Universidad de Granada, 18071 Granada, Spain.
| | - Belén García-Villanova
- Departamento de Nutrición y Bromatología, Facultad de Farmacia, Universidad de Granada, Campus Universitario de Cartuja, 18071 Granada, Spain.
| | - Eduardo Guerra-Hernández
- Departamento de Nutrición y Bromatología, Facultad de Farmacia, Universidad de Granada, Campus Universitario de Cartuja, 18071 Granada, Spain.
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20
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Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P. ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]. JPEN J Parenter Enteral Nutr 2016; 41:15-103. [PMID: 27815525 DOI: 10.1177/0148607116673053] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.
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Affiliation(s)
- Joseph I Boullata
- 1 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania and Department of Nutrition, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Lillian Harvey
- 3 Northshore University Hospital, Manhasset, New York, and Hofstra University NorthWell School of Medicine, Garden City, New York, USA
| | - Arlene A Escuro
- 4 Digestive Disease Institute Cleveland Clinic Cleveland, Ohio, USA
| | - Lauren Hudson
- 5 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Mays
- 6 Baptist Health Systems and University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Carol McGinnis
- 7 Sanford University of South Dakota Medical Center, Sioux Falls, South Dakota, USA
| | | | - Sarita Bajpai
- 9 Indiana University Health, Indianapolis, Indiana, USA
| | | | - Tamara J Kinn
- 11 Loyola University Medical Center, Maywood, Illinois, USA
| | - Mark G Klang
- 12 Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Linda Lord
- 13 University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Martin
- 14 University of Texas Center for Health Sciences at San Antonio, San Antonio, Texas, USA
| | - Cecelia Pompeii-Wolfe
- 15 University of Chicago, Medicine Comer Children's Hospital, Chicago, Illinois, USA
| | | | - Abby Wood
- 17 Baylor University Medical Center, Dallas, Texas, USA
| | - Ainsley Malone
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
| | - Peggi Guenter
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
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Kar P, Plummer MP, Chapman MJ, Cousins CE, Lange K, Horowitz M, Jones KL, Deane AM. Energy-Dense Formulae May Slow Gastric Emptying in the Critically Ill. JPEN J Parenter Enteral Nutr 2016; 40:1050-6. [PMID: 26038421 DOI: 10.1177/0148607115588333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/11/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Enteral feed intolerance occurs frequently in critically ill patients and can be associated with adverse outcomes. "Energy-dense formulae" (ie, >1 kcal/mL) are often prescribed to critically ill patients to reduce administered volume and are presumed to maintain or increase calorie delivery. The aim of this study was to compare gastric emptying of standard and energy-dense formulae in critically ill patients. METHODS In a retrospective comparison of 2 studies, data were analyzed from 2 groups of patients that received a radiolabeled 100-mL "meal" containing either standard calories (1 kcal/mL) or concentrated calories (energy-dense formulae; 2 kcal/mL). Gastric emptying was measured using a scintigraphic technique. Radioisotope data were collected for 4 hours and gastric emptying quantified. Data are presented as mean ± SE or median [interquartile range] as appropriate. RESULTS Forty patients were studied (n = 18, energy-dense formulae; n = 22, standard). Groups were well matched in terms of demographics. However, patients in the energy-dense formula group were studied earlier in their intensive care unit admission (P = .02) and had a greater proportion requiring inotropes (P = .002). A similar amount of calories emptied out of the stomach per unit time (P = .57), but in patients receiving energy-dense formulae, a greater volume of meal was retained in the stomach (P = .045), consistent with slower gastric emptying. CONCLUSIONS In critically ill patients, the administration of the same volume of a concentrated enteral nutrition formula may not result in the delivery of more calories to the small intestine over time because gastric emptying is slowed.
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Affiliation(s)
- Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Mark P Plummer
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | | | - Kylie Lange
- National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Karen L Jones
- National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia National Health and Medical Research Council, Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
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Halmos EP, Bogatyrev A, Ly E, Liels KL, Muir JG, Gibson PR. Challenges of Quantifying FODMAPs in Enteral Nutrition Formulas: Evaluation of Artifacts and Solutions. JPEN J Parenter Enteral Nutr 2016; 41:1262-1271. [PMID: 27406943 DOI: 10.1177/0148607116658763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diarrhea associated with enteral nutrition has been attributed to excessive FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) content of formulas. This study aimed to readdress their FODMAP content by measuring fermentation-specific effects after a formula load in healthy participants and by defining issues with analytical methods. METHODS Breath hydrogen production expressed as mean area under the curve (AUC) for 12 hours after ingestion of 15 g lactulose or 500 mL of 1 of 2 formulas of seemingly different FODMAP content was evaluated in a double crossover design. Quantification of specified FODMAPs via enzymatic and liquid chromatographic assays was assessed with additional controls to investigate the influence of maltodextrin and sucrose present in the formulas, and alternative assays were applied. RESULTS In 15 hydrogen-producing participants, AUC following both formulas was minimal (≤21 ppm/12 h) compared with 15 g lactulose ( P < .001). Elevated breath hydrogen was detectable when >2.5 g fructo-oligosaccharide was consumed. Maltodextrin showed dose-dependent interference with enzymatic measurement of fructans and coeluted with raffinose with liquid chromatography. Application of an alternative fructan assay that includes additional enzymes to hydrolyze maltodextrins indicated that fructan content was <15% of that previous reported. Galacto-oligosaccharide (GOS) content could not be estimated by chromatography due to maltodextrins. An enzymatic assay, while overestimating GOS content, showed it to be very low. CONCLUSION FODMAPs were not detected in enteral formulas in human bioassays, and their content may be grossly overestimated mainly due to high formula concentrations of maltodextrin. Better estimates of FODMAP content in enteral formulas can be made by alternative assay approaches.
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Affiliation(s)
- Emma P Halmos
- 1 Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alex Bogatyrev
- 1 Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Ly
- 1 Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kelly L Liels
- 1 Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jane G Muir
- 1 Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter R Gibson
- 1 Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Affiliation(s)
- Ronald L Koretz
- Olive View-UCLA Medical Center, David Geffen-UCLA School of Medicine, Sylmar and Los Angeles, California
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24
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Abstract
Acute respiratory disease syndrome (ARDS) is a common complication of critical illness, associated with significant morbidity, prolonged intensive care unit (ICU) and hospital stay, and increased mortality. Inflammation plays a central role in ARDS, with inflammatory eicosanoid mediators produced from the ω-6 fatty acid arachidonic acid, such as leukotriene B4, being involved. The ω-3 fatty acids found in fish oil exert anti-inflammatory effects, including decreasing production of inflammatory eicosanoids from arachidonic acid. The ω-3 fatty acids are effective in models relevant to ARDS. Several randomized controlled trials of enteral formulas rich in ω-3 fatty acids, often in combination with other bioactive substances, have been conducted in patients with ARDS. Four of these trials reported marked clinical benefits, 2 reported no effect, and 1 reported a negative impact. A systematic review and meta-analysis of these 7 trials identified no overall effect on ventilator-free days or on ICU-free days. There was a small reduction in ICU length of stay and no overall effect on mortality. However, the authors formally identified that trials that used high fat in both treatment and control groups showed a significant reduction in mortality, while trials that used a high, or higher, fat treatment and a low-fat control group showed a trend toward an increase in mortality. It is concluded that differences in outcome reported among these studies largely relate to the relative fat contents of the treatment and control formulas. Further, it is concluded that high-fat enteral formulas should not be used in this patient group.
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Affiliation(s)
- Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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25
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Tsutsumi R, Horikawa YT, Kume K, Tanaka K, Kasai A, Kadota T, Tsutsumi YM. Whey Peptide-Based Formulas With ω-3 Fatty Acids Are Protective in Lipopolysaccharide-Mediated Sepsis. JPEN J Parenter Enteral Nutr 2014; 39:552-61. [PMID: 24492312 DOI: 10.1177/0148607114520993] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/02/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sepsis and septic shock syndrome are among the leading causes of death in critically ill patients. Lipopolysaccharide (LPS) released by bacteria within the colon may translocate across a compromised epithelium, leading to oxidative stress, inflammation, sepsis, and eventually death. METHODS We examined the effects of a whey-based enteral formula high in cysteine (antioxidant precursor) and the addition of ω-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), against a mouse model of LPS-induced sepsis. Mice were fed either a whey-based diet with EPA-DHA (PAF), a whey-based diet without EPA-DHA (PSTD), or a casein-based control diet (CONT). RESULTS Mice fed PAF or PSTD were protected against LPS-induced weight loss. Whey-based diets suppressed inflammatory cytokine release and oxidative stress damage. Furthermore, PAF and PSTD were able to inhibit autophagy, a mechanism in which the cell recycles damaged organelles. These anti-inflammatory and antioxidative effects of PSTD and PAF resulted in decreased liver inflammation and intestinal damage and promoted protective microbiota within the intestines. CONCLUSIONS These data suggest a clinical role for whey peptide-based diets in promoting healing and recovery in critically ill patients.
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Affiliation(s)
- Rie Tsutsumi
- Department of Nutrition, University of Tokushima Graduate School, Tokushima, Japan
| | - Yousuke T Horikawa
- Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Katsuyoshi Kume
- Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Asuka Kasai
- Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Takako Kadota
- Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
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Galán MG, Drago SR. Food matrix and cooking process affect mineral bioaccessibility of enteral nutrition formulas. J Sci Food Agric 2014; 94:515-521. [PMID: 23794294 DOI: 10.1002/jsfa.6280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/21/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND When enteral formulas (EF) are administered orally as a supplement to the normal diet, they are often mixed with conventional foods or included in recipes in order to seek new flavors and textures and avoid monotony. The aims of this work were to study the bioaccessibility of Fe, Zn and Ca from commercial EF and the impact upon their incorporation into sweet preparations. Twenty commercial EF, before and after inclusion in sweet food (rice pudding, RP; banana smoothie, BS; tea, T; chocolate dessert, CD) were evaluated regarding Fe, Zn and Ca dialyzability (%DFe , %DZn , %DCa ) as an estimator of mineral bioaccessibility. RESULTS Fe, Zn and Ca dialyzability from EF was variable and generally low. Heating during EF-sweet food preparation (T and CD) lowered values to 44.1 %DFe , possibly due to degradation of vitamin C, and 52.7 %DZn and 25.3 %DCa , due to the interaction with food components. CONCLUSION EF and EF-sweet foods did not represent a good supply of Fe, Zn and Ca as recommended. This study demonstrated how the bioaccessibility of these minerals is affected by the food matrix in which EF is included as well as heating during food preparation.
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Affiliation(s)
- María Gimena Galán
- Instituto de Tecnología de Alimentos, Facultad de Ingeniería Química, Universidad Nacional del Litoral, Santa Fe, Argentina; CONICET, Buenos Aires, Argentina
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