Home enteral nutrition in adults: a five-year (2001-2005) epidemiological analysis.

BACKGROUND: In the last twenty years Home Enteral Nutrition (HEN) has undergone considerable development and has determined economic and organisational changes. The aim of this study is to evaluate the epidemiological data of 655 patients treated in the five-year period (2001-2005) in an area in the North-East of Italy. METHODS: The following data were analysed at the initiation of HEN: age, sex, pathology, Karnofsky index, type of enteral access device, presence of pressure ulcers, weight, body mass index, haematochemical tests, daily enteral intake. Length of therapy and patient survival were then considered. The outcome was based on patient mortality and the patient's ability to resume oral nutrition. RESULTS: HEN was prescribed for the following pathologies: 26.7% neurovascular, 40.9% neurodegenerative, 11.5% head-neck cancer, 9.8% abdominal cancer, 1.5% head injury, 2.6% congenital anomaly, 7.0% other pathologies. Before commencement of enteral feeding an average of 22.9% weight loss from past weight was observed across all indications for HEN. Mean incidence (cases/10(6) inhabitants/year) and prevalence (cases/10(6) inhabitants) were respectively 308.7 (range 80.7-355.6) and 379.8 (range 138.7-534.6). The median length of HEN was 196 days; only 7.9% of patients resumed oral nutrition. The median survival rate was 9.1 months and resulted influenced by age (Odds ratio: 1.80; 95% Confidence Interval: 1.19-2.72), sex (0.22; 0.08-0.59), and Karnofsky index (0.65; 0.43-0.97). Resumption of oral nutrition was influenced by age (0.50; 0.36-0.68), sex (2.50; 1.23-5.06), Karnofsky index (1.55; 1.15-2.10) and type of enteral access device (0.44; 0.26-0.76). CONCLUSIONS: Efficient organisation means being able to look after a greater number of patients undergoing HEN, raising awareness regarding the nutritional treatment.

Application criteria of enteral nutrition in patients with anorexia nervosa: correlation between clinical and psychological data in a "lifesaving" treatment.

BACKGROUND: Data and research increasingly point to multiple factors in the genesis of eating-behavior disorders, but the lack of a clear etiological definition prevents a unique therapeutic or prognostic approach from being defined. Therapeutic approaches, as well as scientific research, have separately analyzed the psychological aspects and the clinical-nutrition aspects without integrating the variables or correlating clinical and psychological data. This work has several goals because it aims at considering the problem from the 2 different perspectives. Psychological and clinical variables are analyzed both separately and together in order to assess (a) the minimal criteria to define a cure as "lifesaving" and submit a patient to artificial nutrition; (b) the kind of implementation artificial nutrition should follow; (c) which indicators of the efficacy of artificial nutrition must be taken into account; (d) the results in nutrition terms that may be obtained during the follow-up; (e) if artificial nutrition may be used as a therapeutic tool; (f) if there are any psychological effects after artificial nutrition; (g) if there are any effects due to the patients' age; and (h) the correlation between the psychological profile of a patient and the acceptance of the nutrition treatment. METHODS: Several psychological and pharmacologic variables, together with clinical and anthropometric data and blood chemical values, were all considered. CONCLUSIONS: Besides defining minimal criteria for a "lifesaving" cure and proposing 2 ad hoc scales for the assessment of patients' subjective willingness toward feeding and for the objective measurement of feeding itself, clinical data and correlations with psychological data evidenced the importance of artificial nutrition and specifically of enteral nutrition as a therapeutic tool, allowing us to define the modalities of implementation of enteral nutrition. Results show that, because enteral nutrition did not deteriorate the psychological state of the patients, and was found to be accepted more positively than feeding orally in the most critical initial phase, it should be included in the therapy.