Micronutrient intake from enteral nutrition in critically ill adult patients: A retrospective observational study.

OBJECTIVE: The objective of this study was to determine the intake of micronutrients including vitamins B12, D, C, and A; folate; thiamine; iron; zinc; and selenium that are delivered from enteral nutrition (EN) during routine clinical practice in critically ill adults, expressed as a percentage of the Australia and New Zealand nutrient reference values. METHODS: This single-center retrospective observational study was conducted in Melbourne, Australia during the first 7 d of intensive care unit admission. Mechanically ventilated patients prescribed exclusive EN were considered for inclusion. The primary and secondary outcomes were micronutrient intake expressed as a percentage of the recommended dietary intake (daily intake intended to meet the needs of 97% to 98% of a healthy population) and the upper level of intake (highest daily intake unlikely to pose adverse health effects), respectively. Data are presented as mean (SD) or median [interquartile range]. RESULTS: In total, 57 patients were included (62 (16) y, 67% male). EN was delivered for 5 [4-6] d, with 47% (20) energy adequacy achieved. EN delivery met the recommended dietary intake for vitamin B12, vitamin C, thiamine, and iron and did not meet the recommended dietary intake for vitamin D, vitamin A, folate, zinc, and selenium. No micronutrients exceeded the upper level of intake. CONCLUSION: EN delivery met the recommended intake for four micronutrients, did not meet the recommended intake for five micronutrients, and did not exceed the upper level of intake for any micronutrient when approximately 50% energy adequacy was achieved types.

Micronutrient intake from enteral nutrition in critically ill adults: A systematic review of randomised controlled trials.

OBJECTIVES: The primary objective was to compare the intake of important micronutrients provided from enteral nutrition to critically ill patients with the Australia and New Zealand recommended dietary intakes. A secondary objective was to compare the upper levels of intake and investigate prespecified subgroups. REVIEW METHOD USED: A systematic literature review was performed. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and CENTRAL were used. REVIEW METHODS: Databases were searched for randomised controlled trials that investigated an enteral nutrition intervention as the sole source of nutrition, were published in English between January 2000 and January 8th, 2021, and provided data to calculate micronutrient intake. The primary outcome was the % recommended dietary intake. The quality of individual trials was assessed using the Cochrane Risk of Bias Tool. Outcomes are presented as either mean ± standard deviation or median [interquartile range], with a p < 0.05 considered statistically significant. RESULTS: Thirteen trials were included (n = 1538 patients). Trials investigating hypocaloric nutrition were excluded from the primary outcome assessment (conducted in nine trials (n = 1220)). All nine trials delivered ≥104% of the recommended dietary intakes and <100% of the upper level of intakes of all micronutrients. In subgroup analyses, trials with ≥80% target energy delivered a higher % of the recommended dietary intake of vitamin B12, thiamine, zinc, and vitamin C. Acute Physiology and Chronic Health Evaluation scores ≥20 delivered a higher % of the recommended dietary intake of vitamin B12 and vitamin A. Antioxidant formulas compared with standard formulas delivered a higher % recommended dietary intake of vitamin C and thiamine. In the four trials that investigated hypocaloric feeding compared with control, there was no difference in micronutrient intake. The quality was low. CONCLUSIONS: Enteral nutrition delivery frequently met the recommended dietary intakes for all micronutrients investigated and did not exceed the upper levels of intake set for health. PROSPERO REGISTRATION: CRD42020178333.

A benchmarking study of home enteral nutrition services.

BACKGROUND & AIMS: Patients receiving home enteral nutrition (HEN) via an enteral feeding tube often have complex healthcare requirements. There is limited information regarding how HEN care is provided within Australia and New Zealand. This study aimed to investigate the characteristics of HEN services and the provision of nutrition care to individuals receiving HEN within Australia and New Zealand. METHODS: A cross-sectional study, surveying lead HEN dietitians for HEN services was conducted from the period 09 July 2019 to 20 September 2019 inclusive. An online survey was used to obtain data relating to the demographics, funding and clinical resources of respondents' HEN services. Services were benchmarked against a HEN service implementation checklist adapted from the Agency for Clinical Innovation (ACI). RESULTS: Responses were received from 107 HEN services, with an estimated combined population of 7122 HEN patients. Services were predominantly government-funded (n = 102, 95.3%) and operated from acute hospitals (n = 57, 53.3%). The reported combined cost of all HEN equipment to the patient ranged from $0-$77 per week or $0-$341 per month. Fifty-two services were reported to have a dedicated HEN dietitian/coordinator, which was positively associated with the undertaking of quality improvement activities (p = 0.019). Mean compliance to the ACI HEN implementation checklist was 70.4% (±15.7%) with a range of 13.0-98.2%. Mean compliance was significantly higher in services with a HEN dietitian/coordinator than services without one (75.5% (±12.0%) vs 64.3% (±16.6%); p < 0.001). CONCLUSIONS: This study provides detailed information regarding the characteristics of HEN services and nutrition care provided to enterally-fed patients across Australia and New Zealand. The majority of HEN services are not adhering to the ACI HEN service guidelines and there is considerable variation in cost burden for consumers indicating inequitable delivery of care to patients.