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Kozow JFC, Rabito EI, Kruger JF, Medeiros CO, da Costa RL, Beux MR, Stangarlin-Fiori L. Microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home: a systematic review. Nutr Rev 2024; 82:1226-1238. [PMID: 37824326 DOI: 10.1093/nutrit/nuad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
CONTEXT The safety of enteral formulas is important to restore and maintain the health of patients. OBJECTIVE A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home. DATA SOURCES A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature. DATA EXTRACTION Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used. DATA ANALYSIS Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent. CONCLUSIONS A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022367573.
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Affiliation(s)
| | - Estela Iraci Rabito
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Jenifer Faria Kruger
- Complexo Hospital de Clínicas, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Caroline Opolski Medeiros
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Rayane Luizi da Costa
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Márcia Regina Beux
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Lize Stangarlin-Fiori
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
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da Silva ITF, Medeiros CO, Leobet J, Beux MR, Rabito EI, Etgeton SAP, Fiori LS. Assessment of the risk of contamination of enteral nutrition bottles based on the simulation of home use conditions and hygiene procedures. Nutr Clin Pract 2024; 39:873-880. [PMID: 38491970 DOI: 10.1002/ncp.11144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Home-prepared enteral formulations are supplied to patients through enteral nutrition bottles, via a gravity bag or other container, which may be inadequately sanitized and reused more times than recommended by the manufacturer. Such procedures increase the risk of contamination and can compromise the patient's clinical outcome. In light of this, the present study aimed to assess the risk of contamination of enteral nutrition bottles by simulating home use conditions and hygiene procedures. METHODS A simulation of bottle usage was conducted across the three categories of enteral nutrition (homemade enteral preparations, blended enteral preparations, and commercial enteral formulas) for 3 days, using three hygiene procedures reported by caregivers: use of detergent (DET); use of detergent and boiling water (DET+BW); and use of detergent and bleach (DET+BL). The microbiological contamination was determined by the analysis of aerobic mesophilic microorganisms. RESULTS The bottles that were used for 3 days, regardless of the enteral nutrition category, were within the acceptable limit for aerobic mesophilic microorganisms (between <4 and 8.0 colony-forming units [CFU]/cm2) when sanitized using the DET+BW and DET+BL procedures. The enteral nutrition bottles, when cleaned using the DET procedure during the 3 days of usage, showed low microbial contamination (between <4 and 3.0 CFU/cm2) in blended preparation and commercial formula only. CONCLUSION Thus, regardless of the enteral nutrition category, we found that the bottles can be used for 3 days, as long as the DET+BW or DET+BL hygiene procedure is applied and safe food handling measures are adopted.
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Affiliation(s)
| | - Caroline O Medeiros
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Jaqueline Leobet
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Márcia R Beux
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Estela I Rabito
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Schaina A P Etgeton
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
| | - Lize S Fiori
- Department of Nutrition, Federal University of Parana, Paraná, Brazil
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Paraná, Brazil
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3
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Doyle C, Louw J, Shovlin A, Dowd L, Kavanagh M. Blended feeding in gastrostomy-fed children-A scoping review. Child Care Health Dev 2024; 50:e13222. [PMID: 38265135 DOI: 10.1111/cch.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/08/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024]
Abstract
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.
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Affiliation(s)
- Carmel Doyle
- School of Nursing & Midwifery, Trinity College, Dublin, Ireland
| | - Julia Louw
- Trinity Centre for Practice and Healthcare Innovation, Trinity College, Dublin, Ireland
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da Costa RL, Medeiros CO, da Cunha DT, Stangarlin-Fiori L. Checklist to assess food safety when handling home enteral nutrition. Nutr Clin Pract 2023; 38:1309-1323. [PMID: 36822676 DOI: 10.1002/ncp.10962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Identifying food safety risks when handling enteral formulations at home is important to restore and maintain the health of patients. Therefore, this study developed and validated a food safety assessment checklist for handling home enteral nutrition (HEN). METHODS This methodological study developed a checklist based on a literature review and interviews with food safety professionals. The content validation, which was conducted by food safety and enteral feeding experts, assessed the relevance, clarity, and simplicity of the checklist using the content validity index of items (CVI-I), categories (CVI-C), and the entire instrument (CVI-EI). Each item was rated as either essential, necessary, or recommended according to the risk in relation to foodborne diseases. RESULTS The Food Safety for Handling Home Enteral Nutrition checklist (FSHEN checklist) that was developed includes 40 items and the following eight categories: physical structure; cleaning of facilities, equipment, furniture, and utensils; pests and waste; water supply; food handlers; ingredients and packaging; handling of enteral formulations; and the bottling and storage of enteral formulations. The CVI-EI was above the recommendation (≥0.93) for the three assessed criteria, as was the CVI-C in terms of clarity (≥0.95), relevance (≥0.98), and simplicity (≥0.84). A total of 52.5% of the items were rated as essential, 32.5% as necessary, and 15% as recommended. CONCLUSION The FSHEN checklist is relevant, clear, and easy to use. It can help health professionals and individuals working in the field to assess and prioritize items to improve food safety in the management of HEN.
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Affiliation(s)
- Rayane Luizi da Costa
- Postgraduate Program in Food and Nutrition, Federal University of Parana (UFPR), Curitiba, Brazil
| | - Caroline Opolski Medeiros
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana (UFPR), Curitiba, Brazil
| | - Diogo Thimoteo da Cunha
- Multidisciplinary Laboratory of Food and Health, School of Applied Sciences, State University of Campinas, Limeira, Brazil
| | - Lize Stangarlin-Fiori
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana (UFPR), Curitiba, Brazil
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5
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Phillips G, Coad J. Blended diets for tube-fed children and young people: a rapid review update. Arch Dis Child 2023; 108:1014-1018. [PMID: 37595987 DOI: 10.1136/archdischild-2023-325929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Many children and young people with complex health and care needs use enteral feeding tubes to optimise their nutritional intake in the UK and other countries. Blended diets as an alternative to the exclusive use of commercial formula are becoming more commonly used, and there is evidence to support the benefits of using a blended diet on the child or young person and their wider family.A rapid review was published in 2017 exploring blended diets as a valid alternative to commercial formula for enteral feeding for children and young people. An update was necessary to ensure that professional practice is informed by the latest evidence, which has expanded significantly since the publication of the original article. METHODS A rapid review method was used and the PRISMA checklist formed the basis of the protocol devised ahead of data collection. Key databases included: PubMed, MEDLINE, CINAHL, PsychINFO, Google Scholar. RESULTS 29 articles were included and four themes were identified from the collated data. (1) Symptom improvement and clinical outcomes, (2) nutritional content, (3) caregiver experiences and (4) blended diet practices. Findings showed that blended diets can have a positive impact on physical symptoms as well as social influences extending to families and carers. CONCLUSION Nutritional content, food hygiene and viscosity of food blends are important considerations for professionals and families to ensure safe practice when using blended diets for enteral feeding.
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Affiliation(s)
| | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
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6
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Sforza E, Limongelli D, Giorgio V, Margiotta G, Proli F, Kuczynska EM, Leoni C, Rigante D, Contaldo I, Veredice C, Rinninella E, Gasbarrini A, Zampino G, Onesimo R. The Impact of Blenderized Tube Feeding on Gastrointestinal Symptoms, a Scoping Review. APPLIED SCIENCES 2023; 13:2173. [DOI: 10.3390/app13042173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Severe gastrointestinal symptoms are one of the main reasons for switching from conventional artificial tube feeding to blenderized tube feeding (BTF). This study aimed to describe and quantify the impact of BTF on gastrointestinal symptoms in children and adults. We analyzed four databases (PubMed, Scopus, Cochrane Library, and Google Scholar). The review was performed following the PRISMA extension for Scoping Reviews checklist. The methodological quality of articles was assessed following the NIH quality assessment tools. The initial search yielded 535 articles and, after removing duplicates and off-topic articles, 12 met the inclusion criteria. All included papers unanimously converged in defining an improvement of gastrointestinal symptoms during blenderized feeding: the eight studies involving pediatric cohorts report a decrease from 30 to over 50% in gagging and retching after commencing BTF. Similar rates are reported for constipation and diarrhea improvement in most critically ill adults. Experimental studies and particularly randomized controlled trials are needed to develop robust evidence on the effectiveness of BTF in gastrointestinal symptom improvement with prolonged follow-up and adequate medical monitoring.
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Affiliation(s)
| | | | - Valentina Giorgio
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Francesco Proli
- Pediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Eliza Maria Kuczynska
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Donato Rigante
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Ilaria Contaldo
- Pediatric Neuropsychiatry, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Veredice
- Pediatric Neuropsychiatry, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Emanuele Rinninella
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Clinical Nutrition Unit, Department of Medical and Abdominal Surgery and Endocrine-Metabolic Scienze, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Zampino
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pediatric Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Rivero-Mendoza D, Caldwell CL, Cooper H, Goldberg J, Lamothe M, Logan S, Smith EB, Torna E, Zeldman JA, Dahl WJ. Recommending ultra-processed oral nutrition supplements for unintentional weight loss: Are there risks? Nutr Clin Pract 2023; 38:88-101. [PMID: 36286334 PMCID: PMC10092420 DOI: 10.1002/ncp.10921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/01/2022] [Accepted: 09/24/2022] [Indexed: 01/11/2023] Open
Abstract
Oral nutrition supplements (ONS) are widely recommended for the management of unintentional weight loss in patient populations, long-term care residents, and community-dwelling older adults. Most marketed ONS are ultra-processed, with precision nutrition and aseptic composition, as well as convenience and availability, driving their selection. However, therapeutic effectiveness is mixed and the potential health risks of consuming ultra-processed ONS long-term in lieu of less-processed foods have received little attention. A diverse and balanced microbiota supporting immunity and wellness is maintained by a diet rich in plant-sourced foods. The implications of ultra-processed ONS displacing plant-sourced foods, and specifically the potential for undesirable impacts on the gut microbiota, require consideration. Most ONS are either devoid of fiber or are supplemented with isolated or purified fibers that may contribute to adverse gastrointestinal symptoms and appetite suppression. In contrast, the diversity of microbial-available, nondigestible carbohydrates, together with the array of phytochemicals found in plant-sourced foods, support microbial diversity and its resiliency. This review outlines the clinical dilemma of recommending commercial ultra-processed ONS vs nutritionally adequate (eg, high-energy/high-protein) foods and beverages that contribute to diet quality, maintenance of a diverse and stable gut microbiota composition, and support nutrition status and health. Ultra-processed ONS may fall short of expected health benefits, and overreliance may potentially contribute to the risk for patient and older adult populations because of the displacement of a variety of healthful foods.
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Affiliation(s)
- Daniela Rivero-Mendoza
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| | - Cecelia L Caldwell
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Department of Food and Nutrition Services, Ascension Sacred Heart Pensacola Hospital, Pensacola, Florida, USA
| | - Hannah Cooper
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,MRM Nutrition, San Diego, California, USA
| | - Jessica Goldberg
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Veritas Collaborative, Atlanta, Georgia, USA
| | - Meagan Lamothe
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Department of Food and Nutrition Services, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Sarah Logan
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Lake Nona Performance Club, Orlando, Florida, USA
| | - Elena B Smith
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| | - Elena Torna
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| | - Jamie A Zeldman
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Wendy J Dahl
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
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8
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Uniat KC, Stangarlin-Fiori L, Krüger JF, Schieferdecker MEM, Rabito EI. MICROBIOLOGICAL QUALITY OF ENTERAL FORMULATIONS HANDLED AT HOME: A SYSTEMATIC REVIEW. JPEN J Parenter Enteral Nutr 2022; 46:1787-1796. [PMID: 35809193 DOI: 10.1002/jpen.2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/03/2022] [Accepted: 07/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have shown an increase in the number of patients who use enteral nutrition at home, and the benefits of this type of nutritional care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations. METHODS This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies which microbiologically analyzed homemade enteral preparations (HEP), blended enteral preparations (BEP), and commercial enteral formulas (CEF) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies. RESULTS Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n=73) of the HEP; 81.96% (n=50) of the BEP; and 44.87% (n=35) of the CEF. The presence of ten different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples. CONCLUSION The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kelly Cristina Uniat
- Department of Nutrition, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Lize Stangarlin-Fiori
- Department of Nutrition, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Jenifer Faria Krüger
- Department of Nutrition, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | | | - Estela Iraci Rabito
- Department of Nutrition, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
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9
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Dos Santos EF, Xavier de Melo V, Ávila S, de Araújo Marques Dengo V, Dall'igna ALA, Dziedicz DD, Stangarlin-Fiori L, Schieferdecker MEM, Mary Rodrigues Ferreira S. Macronutrients and energy in home-prepared enteral tube feeding: Comparison between food composition table estimates, nutrition labels, and laboratory analysis. Nutr Clin Pract 2021; 37:896-906. [PMID: 34897785 DOI: 10.1002/ncp.10795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The effectiveness of home enteral nutrition depends on the supply and delivery of the prescribed nutrients. This study compared the macronutrient and energy values of home-prepared enteral tube feeding analyzed in the laboratory with the same information calculated from labels and food composition tables. METHODS A total of 107 enteral formulations were analyzed: 66 commercial enteral formulas (CEFs), 19 homemade enteral preparations, and 22 blended enteral preparations (BEPs). The values of macronutrients and energy and the ratio between the values found in the laboratory and the calculated values were all evaluated. The tolerance limit of acceptable variation was 20%. The results were subjected to chemometric methods using principal component analysis (PCA) and hierarchical cluster analysis (HCA). RESULTS In the three categories of the enteral formulations, the calculated values for protein and fat were higher than those obtained in the laboratory. The calculated values for energy were higher than those obtained in the laboratory for the BEPs and CEFs. The CEFs had the highest percentage within the limit of acceptable variation for carbohydrate and protein, whereas the BEPs presented the lowest values for fat and energy. In the exploratory analysis of data using PCA and HCA, it was possible to verify similarities and discrepancies between the enteral formulations analyzed in the laboratory with those calculated from the labels and food composition tables. CONCLUSION The enteral formulations showed differences between the values of macronutrients and energy analyzed in the laboratory and those calculated from labels and/or food composition tables.
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Affiliation(s)
- Emilaine Ferreira Dos Santos
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná, Paraná, Curitiba, Brazil
| | - Vanessa Xavier de Melo
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná, Paraná, Curitiba, Brazil
| | - Suelen Ávila
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná, Paraná, Curitiba, Brazil
| | | | | | | | - Lize Stangarlin-Fiori
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná, Paraná, Curitiba, Brazil
| | | | - Sila Mary Rodrigues Ferreira
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná, Paraná, Curitiba, Brazil
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