Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition.

Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022-2023 Board of Directors.

Home enteral nutrition: A descriptive study.

BACKGROUND: With data demonstrating benefit, the prevalence of home enteral nutrition (HEN) has increased significantly over the last few decades. Despite this increase, there remains a paucity of data regarding real-world use of HEN including clinical outcomes and complications. METHODS: Descriptive analysis of prospectively maintained database of our specialized HEN program was undertaken. Patients who received care in our program with HEN initiation date between January 1, 2018, and December 31, 2020, were included in the analysis. Data regarding demographic information, anthropometrics, enteral nutrition (EN) regimen, electrolytes, and nutrition therapy history were included and tracked until July 31, 2021. RESULTS: During the study period, 1600 patients initiated HEN treatment under our care. Majority of the study population needed EN therapy due to malignancy and its complications, including malignant dysphagia or mechanical obstruction (60.6%) followed by neurodegenerative diseases (7.5%). By the end of the study period, a majority of the patients (82%) stopped HEN treatment. Of these, 44.2% achieved EN goals and/or oral autonomy. Patients continued HEN treatment for a median of 100 (interquartile range, 32-301) days. Overall, 53.2% of patients experienced/reported at least one HEN-related complication that was clinically managed by the HEN team. Complications included tube-related, enteral feeding intolerance (EFI), and electrolyte shifts. CONCLUSION: In our study population, HEN was most utilized to manage malignancy-related complications, including dysphagia. Unfortunately, complications, including EFI and tube-related complications, remained quite prevalent. Further evaluation regarding risk factors for complications and preventive mechanisms, such as increased education, is indicated.

When is enteral nutrition indicated?

Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.

Blenderized food tube feeding in patients with head and neck cancer.

BACKGROUND: Patients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions. METHODS: In this open-label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement. RESULTS: Of the 16 patients who completed the 6-week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6-week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC. CONCLUSION: BTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

Transition to peptide-based diet improved enteral nutrition tolerance and decreased healthcare utilization in pediatric home enteral nutrition.

BACKGROUND: Home enteral nutrition (HEN) use continues to increase in children unable to meet nutritional needs through oral intake. Some patients do not tolerate standard polymeric formula (SPF), which may lead to malnutrition. Use of peptide-based diet (PBD) has demonstrated benefits in adults, however there remains a paucity of data in pediatric population. METHODS: Retrospective review of medical records of children receiving HEN between October 2015 and October 2019 was conducted. Nutrition, tolerance, and healthcare utilization was tracked through May 2020. Children receiving PBD as initial formula or transitioned to PBD from SPF were included. Our objective was to assess gastrointestinal tolerance and impact on healthcare utilization in children receiving PBD. RESULTS: During study period, 30 children (mean age, 9 ± 5.44 years; 20 of 30 [66.7%] male) utilized PBDs. Twenty-one patients started PBD directly with malnutrition as primary indication. Nine patients transitioned from SPF to PBD, most often due to intolerance of SPF (66%). After transition to PBD, no symptoms were reported in 6 of 9 (66.7%) patients, and symptoms of SPF intolerance resolved in 4 of 9 (44.5%) patients. Healthcare utilization declined significantly after transition to PBD, including mean numbers of emergency room visits (0.78 ± 1.09 to 0.11 ± 0.33; P = .025), provider visits (1.67 ± 1.32 to 0.56 ± 0.73; P = .007), and phone calls (1.22 ± 1.39 to 0.33 ± 0.50; P = .026). CONCLUSIONS: PBD is well tolerated and can result in significant reduction in healthcare utilization in children intolerant to SPF.

Accepted Safe Food-Handling Procedures Minimizes Microbial Contamination of Home-Prepared Blenderized Tube-Feeding.

BACKGROUND: The number of patients requiring home enteral nutrition (HEN) continues to increase. Many of these patients are interested in using blended food instead of, or in addition to, commercial enteral formula (CEF). Increased risk of food-borne illness is a concern of blenderized tube-feeding (BTF). This project assessed a standard procedure for minimizing bacterial growth of BTF prepared in the home setting. METHODS: Fifty participants prepared BTF in their kitchens using a standard preparation procedure to minimize bacterial contamination. BTF was assessed for growth of aerobic microorganisms, Escherichia coli, Staphylococcus aureus, and coliforms at baseline, 24-hour, and 48-hour intervals after preparation for a total of 150 colony forming units (CFU) counts performed. RESULTS: No sample had zero aerobic microbial counts; yet no substantial increase in microbial counts was observed during the 48 hours. At baseline and 24 hours, 5/50 (10%) had a CFU count of >104 , and at 48 hours, 6/50 (12%) exceeded 104 CFUs. Out of 150 CFU counts, 2 (1.3%) were just over 105 CFU/mL. Samples exceeding 104 CFU/mL were likely contaminated by common endospore-forming bacteria found in soil or by bacteria in milk that was close to its expiration date. CONCLUSION: In this study, 88% of the samples met the US Food Code criteria for safe food consumption; 10.7% met guidelines for marginal safety by other standards; and 1.3% slightly exceeded 105 CFUs. Established safe food-handling procedures can minimize bacterial contamination of BTF and consequently reduce risk of food-borne infection in HEN patients.

Cross-sectional Evaluation of Home Enteral Nutrition Practice in the United States in the Context of the New Enteral Connectors.

PURPOSE: The increased prevalence of home enteral nutrition (HEN), reemergence of blenderized tube feeding (BTF), and conversion of enteral connectors to the ISO 80369-3 standard are creating a significant need to better understand the practices of the HEN population. A cross-sectional survey of current HEN consumers was conducted to evaluate the demographics of HEN consumers, including formulas and feeding tubes being used. METHODS: In order to disseminate the survey to a wide range of HEN consumers, we partnered with private infusion companies (Coram and Pediatric Home Services) along with the Oley and Tube Feeding Awareness Foundations. A validated survey focusing on patient demographics, tube types, formula used, and tube clogging complications was placed online from September 1, 2016, to October 15, 2016. RESULTS: During the study period, 1519 surveys were completed, with 1062 respondents in the pediatric group (<18 years old) and 457 in the adult group (≥18 years old). The most popular formulas were standard polymeric and specialized formulas in both the pediatric and adult groups. However, a significant number in the pediatric (31.2%) and adult (18.6%) groups used BTF either alone or in combination with other formulas. Clogging was also quite prevalent and correlated with tube size. CONCLUSIONS: The present study highlights the significant diversity of the HEN practice in terms of types and sizes of tubes as well as formulas used, including confirmation of the widespread use of BTF. These data are key to ensure HEN providers are able to appropriately support and educate their patients.

Addressing Frequent Issues of Home Enteral Nutrition Patients.

The home enteral nutrition (HEN) population is a medically diverse group whose number has increased substantially in recent decades. Although medically stable compared with acute care patients requiring nutrition support, HEN population needs are unique and require a team approach to manage nutrition. Frequently encountered issues by the HEN team include mechanical issues of the tube site, gastrointestinal and metabolic problems, and patient preferences regarding tube weaning, formula selection, and compliance. A thorough search of the published literature on how to manage these issues was conducted using scientific healthcare databases with the following inclusion criteria: English only, last 10 years, and reviews and clinical trials. Where appropriate, references from the retrieved articles were hand-searched for relevant articles older than 10 years and cited in this review. The purpose of this review is to provide the HEN team with strategies to address the top issues of home enteral feeding.

Blenderized Tube Feedings for Adult Patients on Home Enteral Nutrition: A Pilot Study.

OBJECTIVE: Despite surveys indicating a high prevalence of blenderized tube feeding (BTF) as an alternative to commercial enteral nutrition (EN), there remains a paucity of data regarding use in clinical practice. The objective of the present open-label pilot study was to assess the safety and effectiveness of BTF in adult patients being given home enteral nutrition (HEN). DESIGN: This is an open-label pilot study, in which all participants who had been on traditional EN formulas were changed to BTF for 6 weeks. SETTING/LOCATION: The Mayo Clinic in Rochester, Minnesota. PARTICIPANTS: Twenty individuals gave their consent to participate in the study, with nine completing the 6-week BTF protocol. OUTCOME MEASURES: Weight was measured at baseline and at 6 weeks of BTF use. Participants completed a survey regarding the frequency of BTF use and adverse effects, at baseline and then weekly for 6 weeks. RESULTS: Nine participants with a mean age of 60.6 ± 7.8 years completed the 6-week protocol. BTF use increased from 4.85 ± 2.44 to 6.45 ± 0.82 days per week from week 1 to week 6. The percentage of participants consuming >50% of their calorie intake from BTF increased from 23.1% (3 of 13 participants) at week 1 to 44.4% (4 of 9 participants) at week 6. Six of nine participants experienced weight gain, weight was maintained by one participant, and two participants lost weight (intentionally in one and due to an intolerance of commercial formula in the other). CONCLUSIONS: BTF was found to be safe and effective in promoting weight gain in adult participants who required HEN for at least 6 weeks.

Comparison of Syringe Compression Force Between ENFit and Legacy Feeding Tubes.

BACKGROUND: Since initial report in 1972, misconnections continue to be an issue, especially in hospitalized patients with multiple access devices. A new small-bore connector standard (ENFit) has been proposed in order to minimize misconnections. METHODS: Commercially available finalized ENFit tubes of a variety of sizes (14 French [Fr] size, 18Fr, 20Fr, 24Fr, and low-profile) were obtained for current testing. Variety of commercially available formulas including blenderized tube feeding (BTF) products (Jevity 1 Cal, Abbott Nutrition, Abbott Park, IL; Nourish, Functional Formularies, Centerville, OH; Real Food Blends, Chesterton, IN) were tested. RESULTS: Data from individual measurements were aggregated for ENFit and legacy tubes and revealed higher syringe compression force in legacy tubes compared with ENFit tubes for 20Fr size with Jevity formula. Our institution's BTF formula revealed that legacy tubes had lower syringe compression force than ENFit tubes for 14Fr tube size. Remaining measurements revealed no significant difference. Model 1 of regression analysis revealed that only formula and tube size were significant with R2 of 0.63. Model 2 evaluating the impact of tube size, blender, time of blending, and legacy vs ENFit revealed that tube size, blender used, and blending time were significant with legacy vs ENFit being nonsignificant (R2 of 0.72). CONCLUSIONS: Overall, only a small number of tube sizes (14Fr and 20Fr) with selected formulas revealed a significant difference between ENFit and Legacy tubes, with remaining studies finding no significant difference. Regression analysis revealed that variables such as formula, size of tube, blender used, and time of blending may have more impact on compression force.

Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding.

BACKGROUND: Many healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial loads of a standard ready-to-feed polymeric commercial formula (CF), a BTF made using baby food (BTF-BF), and a BTF prepared from blending whole food (BTF-WF), following food safety standards expected of U.S. hospitals. METHODS: Three tube-feeding formulas (CF, BTF-BF, BTF-WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart. RESULTS: No S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption. CONCLUSION: Judicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.

Effect of Home Enteral Nutrition on Diabetes and Its Management.

BACKGROUND: Diabetes mellitus (DM) is estimated to affect 9% of Americans and is associated with significant morbidity, mortality, and increased healthcare costs. METHODS: A retrospective review of a home enteral nutrition (HEN) database of patients seen between March 1, 2004, and April 31, 2014, at our institution was conducted to identify HEN patients who had a diagnosis of DM or were diagnosed within the acute period (4 months) of starting HEN therapy. RESULTS: 174 (3.7%) of 4682 patients in the HEN program had DM. HEN was provided through a gastrostomy tube in 82 patients and through a jejunostomy tube in 92 patients. At 3 months, data were available for 42 gastrostomy patients; 44% had a change in DM management, with 60% undergoing a change to insulin. Similarly, 34 patients with jejunostomy had data available, with 41% undergoing change in medication and 93% being changed to insulin therapy. For patients with available glycated hemogloblin values, at 3 months the gastrostomy patients noted a decrease of 0.5% (7.3% ± 1.1% to 6.8% ± 0.7%, not significant) and the jejunostomy patients noted a decrease of 0.4% (6.9% ± 0.9% to 6.5% ± 1.1%, P = .06). CONCLUSIONS: Overall, our results suggest that closer follow-up and laboratory assessment are necessary for management of HEN patients with DM. In those with data available, glycemic control can be maintained in patients receiving HEN with appropriate adjustment of DM management and focus on ensuring that patients are not overfed.

Prevalence of Metabolic Bone Disease in Tube-Fed Children Receiving Elemental Formula.

BACKGROUND: Previous studies suggest normal mineral status in children receiving elemental formula. However, a recent multicenter survey described 51 children who developed hypophosphatemia and bone disease while receiving elemental formula. Our aim is to determine the prevalence of metabolic bone disease in children receiving extensively hydrolyzed or amino acid-based formula. METHODS: We established a retrospective cohort using an institutional database of tube-fed children. We defined a "confirmed case" as a child with biochemical and radiographic evidence of bone disease (rickets and/or low-trauma fractures). We defined a "suspected case" as a child who had biochemical evidence and/or radiographic evidence of bone disease but with incomplete data during the review period. RESULTS: A total of 102 tube-fed children receiving elemental or semi-elemental formula were identified. The four elemental and semi-elemental formulas evaluated were Neocate®, EleCare®, Pregestimil®, and Alimentum®. Not all children had complete monitoring data performed during the review period. Of the children receiving Neocate who had monitoring data (46%), 23% developed hypophosphatemia and radiographic abnormalities (fractures or rickets), which resolved with phosphorus supplementation and/or change in the formula brand. CONCLUSIONS: We estimate that at least 11% and up to 23% of all tube-fed children receiving Neocate develop metabolic bone disease. Based upon the estimated prevalence, we recommend cautious use of this formula with monitoring for evolving bone disease in this population.

Comparison of Gravity Flow Rates Between ENFit and Legacy Feeding Tubes.

BACKGROUND: Misconnections between enteral supplies and other access devices have led to significant morbidity and mortality. To reduce misconnections, a standard small-bore connector has been developed (International Organization for Standards 80369-8; ENFit). The full impact of transition to this connector is not known, however. METHOD: Working with major manufacturers and Food and Drug Administration, we obtained ENFit and comparative legacy tubes of variable sizes (low-profile, 14F, 18F, 20F, and 24F balloon gastrostomies). Gravity enteral feeding was simulated with an empty bolus syringe attached to the feeding tube to be tested. The tube was clamped and filled to the 60-mL mark with liquid (water, Jevity 1 Cal, Isosource HN, Isosource 1.5 Cal, Two Cal HN, and Nourish). The clamp was released, and time for formula to leave the syringe was recorded. RESULTS: There was no difference in flow rate between the aggregate legacy and ENFit tubes for the low-profile, 18F, and 20F sizes. The ENFit 14F tubes had a lower flow rate vs the legacy tubes, largely due to the low flow rates seen with the 1 ENFit tube. Similarly, 24F ENFit tubes with some formulas yielded lower flow rates as opposed to legacy. CONCLUSION: Overall, for the low-profile, 18F, and 20F sizes, the ENFit tubes had similar flow rates when compared with the legacy tubes. For the 14F and 24F sizes, the flow rate of ENFit tubes was significantly lower, which could result in longer EN delivery for patients who are using these tubes to provide gravity feeding.

Reemergence of Blended Tube Feeding and Parent's Reported Experiences in Their Tube Fed Children.

OBJECTIVE: Healthcare providers (HCPs) report increased interest in blenderized tube feeding (BTF) as an alternative to commercial formula (CF) feeding-particularly in families of tube fed children. The objective of this study was to explore parents' reported experiences of CF and BTF in their children. DESIGN: Prospective descriptive study utilizing a convenience sample. SETTING/SUBJECTS: Parents (n = 433) of tube fed children in an online tube feeding support group completed an electronic survey to compare experiences of CF and BTF in their tube fed children. RESULTS: The sample was evenly represented by parents using CF (50.5%) and BTF (49.5%). Reasons parents chose BTF included desire to provide whole foods (20.2%), decrease symptoms of tube feeding intolerance (19.7%), provide family meals (12.2%), increase oral intake (10.8%), address allergies (5.3%), or because they did not like formula (19.7%). Parents reported fewer symptoms of tube feeding intolerance on BTF and their children more frequently met growth goals compared to formula feeding. Only half (49.3%) of parents using BTF referred to HCPs for recipes and feeding oversight. The primary reasons parents did not use BTF included lack of knowledge (50.9%) or time constraints (20.0%). CONCLUSIONS: A significant number of parents in this sample successfully provide full or partial BTF to their children but only half rely on HCPs for guidance. There is wide variability in BTF preparation and delivery. Parents who use or have interest in BTF need knowledgeable and supportive HCPs for guidance and follow-up due to the unique nutritional needs of this patient population. HCPs need to be prepared to screen families of tube fed children who are using BTF or are interested in this feeding alternative to CF. Healthcare facilities need to evaluate their enteral feeding policies to accommodate patients on BTF.

Use of Blenderized Tube Feeding in Adult and Pediatric Home Enteral Nutrition Patients.

BACKGROUND: Long-term use of enteral nutrition (EN) continues to increase due to significant noted benefits. Patients also continue to express significant desire to pursue holistic and organic diets. Despite this, many nutrition providers are not well versed in assisting patients with blenderized tube feeding (BTF), and prevalence of its use is unknown. METHODS: A validated survey was administered to Oley Foundation members or individuals with access to the Oley website to assess the prevalence of BTF. RESULTS: A total of 216 participants took the survey, of whom 125 (57.8%) were pediatric patients with a mean age of 5.4 ± 3.5 years and 91 (42.2%) were adults with a mean age of 51.7 ± 19.5 years. Of pediatric patients, 112 (89.6%) used BTF for an average of 71% of their total daily nutrition intake; 93 (83%) reported that BTF comprised >50% of their daily EN, 12 (10.7%) reported it comprised 25%-50% of their daily enteral intake, and 7 (6.3%) reported BTF comprised < 25% of their daily intake. In the adult population, 60 (65.9%) used BTF for an average of 56% of total daily nutrition intake; 41 (68.4%) reported BTF comprised >50% of their daily nutrition intake, 11 (18.3%) reported it compromised 25%-50%, and 8 (13.3%) reported BTF comprised <25% of their daily intake. CONCLUSIONS: Most of the pediatric and adult patients surveyed use BTF as some portion of their enteral intake, making it essential that clinicians expand their knowledge related to BTF to appropriately care for this patient population.

Gravity Flow in Proposed Enteral Tube Small-Bore Connectors.

BACKGROUND: Enteral nutrition (EN) misconnections have been identified as a serious and potential deadly problem. An international effort led by EN industry leaders has developed a small-bore enteral connector (ENFit) that in theory will reduce the frequency of misconnections. Despite the potential benefit of preventing misconnections, the full impact of adoption of the ENFit connector is unknown. To assess the impact of transitioning to ENFit on our home EN (HEN) patients, the current study evaluated gravity feeding comparing 2 proposed small-bore connectors to the legacy (current connector) using various commercial formulas. METHODS: Six commonly used enteral formulas in our facility with varying density and viscosity were tested in triplicate. Forty milliliters of formula was poured into a syringe connected to an ENFit or legacy (current) feeding connector attached to varying French size tubes. The time it took formula to flow through the connectors was recorded, and the test was repeated in triplicate. RESULTS: All formulas took significantly longer to flow through the first ENFit connector compared with the legacy connector ( P < .05). The second ENFit connector demonstrated similar flow dynamics to the legacy connector. CONCLUSIONS: There is wide variability in the flow dynamics in ENFit connectors with significant potential impact on many facets of HEN, including medicine delivery, blenderized feeds, venting, and compliance with EN due to increased time to administer feeds. We highly recommend additional testing of flow dynamics, including gravity flow, as ENFit tubes are being developed and adopted.

Increased Force Required With Proposed Standardized Enteral Feed Connector in Blenderized Tube Feeding.

BACKGROUND: Enteral tube misconnections resulting in enteral nutrition being provided into the wrong port or tube has been increasingly reported, prompting the development of new international design standards for medical device tubing connectors. METHODS: Four sample enteral feeds with varying viscosity were placed into a syringe with either the current feeding connector or a prototype ENFit connector. The force (N) required to compress the syringe was gathered through a dynamic mechanical analyzer (RSA G2 Solids Analyzer; TA Instruments). RESULTS: The force needed to compress the syringe was lowest with a fiber-containing formula (Jevity 1 Cal, Abbott Nutrition, Columbus, OH), and a decline in force was detected with the ENFit compared with the current connector (8.61 ± 0.27 N vs 9.62 ± 0.23 N, P < .001). A commercial blenderized formula (Liquid Hope, Functional Formularies, Centerville, OH) required slightly higher force with the ENFit than the current connector (16.82 ± 1.23 N vs 14.5 ± 0.03 N, P < .001). Another commercial blenderized formula (Salmon, Oats, & Squash, Real Food Blends, Chesterton, IN) and a homemade blenderized recipe required significantly more force with the ENFit than the current tube (34.12 ± 0.95 N vs 22.91 ± 0.06 N, P < .001; 34.95 ± 0.06 N vs 27.72 ± 0.07 N, P < .001, respectively). CONCLUSION: ENFit adapter implementation is the largest change to home enteral nutrition in more than a decade. Additional rigorous testing is required to ensure that the needs of all patients receiving home enteral nutrition are met prior to widespread adoption.

Blenderized Tube Feeding Use in Adult Home Enteral Nutrition Patients: A Cross-Sectional Study.

BACKGROUND: Use of long-term enteral nutrition (EN) has increased dramatically in the United States. It has been the authors' experience that most home EN (HEN) patients use blenderized tube feeding (BTF) in addition to commercial EN. There are limited resources available for patients interested in BTF, and studies evaluating safety and effectiveness are limited. METHODS: The authors conducted a prospective cross-sectional study (n = 54). INCLUSION CRITERIA: age >18 years, follow-up in HEN clinic, prescribed commercial EN. Participants were provided the survey at HEN follow-up appointments after receiving HEN for at least 3 weeks. RESULTS: Median age (range) was 60.5 (22-87) years with 42.6% females (n = 23). BTF was used by 55.5% of patients (n = 30). Most (57%; n = 31) received HEN for >6 months. BTF use was a median of 4 (1-7) days per week. Most common reasons for using BTF were as follows: it is more natural (43%), like eating what their family does (33%), and tolerate BTF better (30%). In patients who use BTF, 80% reported maintaining goal body weight. BTF resulted in significantly less reported nausea, vomiting, bloating, diarrhea, and constipation compared with commercial EN. CONCLUSIONS: This is the first study to evaluate BTF use in an adult HEN population. More than 50% of our patients used and approximately 80% expressed a desire to use BTF if provided with adequate information. With new connection tube changes coming in the near future, adequate adapters for BTF need to be developed.