Epidemiology of home enteral and parenteral nutrition in adults: Comprehensive national data.

BACKGROUND AND AIMS: Although HEN and HPN are important parts of home healthcare, lack of information about the number of patients concerned is surprising. This educational paper presents a review of literature concerning published national data on epidemiology of both HEN and HPN, for different countries. It compares these publications with an exhaustive retrospective observational study on our national adult population for the year 2019. METHODS: Our presented retrospective observational national study was carried out on patients aged 20 and over, divided by sex and into three age groups: 20-39, 40-59, 60 years old and over. Open data from the National Health Insurance obtained the number of patients who started a HEN or HPN during 2019 (incidence), as well as those followed in HEN or HPN during this year (prevalence). Results are compared with a literature review compiling all available publications presenting national data on epidemiology of both HEN and HPN for a same country. RESULTS: This work covered an entire national population of 50.881 948 adults. The incidence and prevalence of HEN were respectively 37.4/100 000 inhab/year and 74.0/100 000 inhab, with significant gender and age differences. The incidence and overall prevalence of HPN were respectively 22.0/100 000 inhab/year and 25.3/100 000 inhab. The prevalence of HPN during over 12 weeks was 6.2/100 000 inhab. The HEN/HPN ratio was 3:1. A total of 37 657 and 12 859 adults respectively required HEN and HPN among 50 881 948 people aged 20 and over. Published papers to compare, aggregating national data for both HEN and HPN, are only few. They do not have exhaustive data, they are often carried out on limited populations and often indiscriminately affect adults and children. CONCLUSIONS: Epidemiology of HEN and HPN remains poorly described in the literature. We present here the first results to accurately assess the incidence and prevalence of HAN on a complete national adult population and for a same year. The completeness of our data may explain these results of incidence and prevalence significantly higher than almost all available information in the existing literature, but as close as possible to real data.

Home enteral nutrition in children: an 11-year experience with 416 patients.

BACKGROUND & AIMS: We report our experience of paediatric home enteral nutrition, as there is little detailed evidence published. METHODS: All patients younger than 18 years commencing treatment between January 1990 and December 2000 were included in this retrospective study. RESULTS: The study covered 416 children and adolescents, corresponding to a total of 243,844 days of home enteral nutrition (HEN). The mean (+/-SD) age of patients commencing treatment was 5.4+/-5.3 years (range 0.1-17.8). Indications were digestive disorders in 35% of patients, neurological and muscular disorders in 35%, malignancy in 11%, failure to thrive in 8%, and miscellaneous ailments in 9%. Enteral feeding comprised commercially available paediatric industrial diets in 36%, adult-type diet in 35% and infant formulas in 29%. Children received enteral feeding by nasogastric tube (53%), or gastrostomy (41%). A mechanical pump was used in 98% of the patients. The mean duration of treatment was 595+/-719 days. CONCLUSIONS: HEN can be used while treating a large group of chronic diseases of children. It can be started very early in life and is often prolonged over several years.

Dramatic changes in home-based enteral nutrition practices in children during an 11-year period.

OBJECTIVES: Experience with pediatric home-based enteral nutrition (HEN), in particular series including children only, has been reported only rarely. We investigated the evolution of pediatric HEN activity during an 11-year period. METHODS: All patients aged 17 years or younger who started HEN between January 1990 and December 2000 were included in this retrospective study. RESULTS: The annual number of patients treated with HEN increased dramatically from 16 in 1990 to 200 in 2000, with more than 65 new patients every year since 1999 (P < 0.0001). The mean age at the commencement of HEN decreased from 6.2 +/- 1.4 (SEM) to 4.8 +/- 0.7 years (P = 0.006). The use of nasogastric tubes decreased from 63% in 1990 to 35% in 1998 (P = 0.009), and the use of gastrostomy increased from 50% to 60% from 1994 onward. The proportion of patients with digestive diseases commencing HEN in each year decreased from more than 40% before 1996 to less than 32% in 2000 (P = 0.009). Commercially manufactured pediatric diets were used increasingly (P = 0.0006). CONCLUSIONS: The evolution of HEN was marked by changes in the population treated and the modes of treatment after the emergence of gastrostomy and commercial diets. This justified the creation of a multidisciplinary, pediatric artificial nutrition unit.