Caregivers' Perceptions of Real-Food Containing Tube Feeding: A Canadian Survey.

Caregivers of children requiring tube feeding show growing interest in real-food containing formula, including home-blenderized tube feeding (HBTF) and commercial real-food containing formulas (CRFCF). This study aimed to understand caregivers' perceptions of both. Caregivers using real-food containing tube feeding were recruited through the Feeding Tube Awareness Foundation Facebook group. A 13-question online survey asked about use of HBTF and CRFCF, beliefs about their choices, and what resources guided formula use. Forty-one completed the survey, with mean child age of 7 years. Overall, 54% (n = 22) used HBTF formulas, 34% (n = 14) CRFCF, and 12% (n = 5) used both. For 70% (n = 29), presence of whole foods, nutritional completeness, and natural ingredients were most important. Challenges with CRFCF use included lack of variety (n = 10, 53%) and cost (n = 9, 47%). HBTF challenges were difficulty preparing away from home (n = 19, 70%) and need for special blenders (n = 15, 56%). Participants believed CRFCF are convenient (n = 35, 85%) and nutritionally consistent (n = 25, 61%), but do not contain enough real-food ingredients (n = 26, 63%). Facebook or other social media was the most valued resource guiding formula use (n = 25, 61%). Caregivers desire formulas that are nutritionally complete and made of whole foods. CRFCF offers convenience and consistency, yet caregivers prefer more real-food ingredients.

Hospital Patients Are Not Eating Their Full Meal: Results of the Canadian 2010-2011 nutritionDay Survey.

nutritionDay is a 1-day cross-sectional survey identifying how nutrition care is provided. This paper provides results of the first 2 Canadian nutritionDay surveys. In November 2010 and 2011, data from standardized questionnaires were collected from 193 units in Canadian hospitals consisting of unit demographics and patient information including weight history, health status, nutrition assessment, nutrition therapy, food intake and 30-day outcomes. Results indicated that overall, 46% of the 1905 patients reported weight loss in the previous 3 months, and in half of these it was greater than 5 kg. Only 50% of the units had nutrition teams and nutrition therapy was provided to less than 14% of patients. More than 50% of patients ate less than normal in the previous week and 57% ate less than half of their meal on nutritionDay. Within the next 30 days the majority of patients went home, 10% remained in hospital, and 6% were readmitted. In this study, nutritionDay provided relevant information on nutrition assessment, weight history, food intake, nutrition therapy, length of stay, and outcomes in participating Canadian institutions. Data from 2010 and 2011 can help to both reflect on current practices and define continuous improvements through benchmarking with the overall goal of mitigating suboptimal nutrition intake during hospitalization.

Dietitian's approach to managing enteral nutrition intolerance when a formula change is indicated: A clinical practice survey.

BACKGROUND: Enteral nutrition intolerance (ENI) is often defined as one or more gastrointestinal (GI) symptoms related to enteral nutrition (EN) and may have significant impact on patient outcomes. There are multiple strategies to help manage ENI, such as changing the EN formula. The objective of this practice survey was to understand prevalence of ENI, management of ENI symptoms, and EN formula features considered when changing formulas to manage ENI. METHODS: Canadian clinical dietitians working across care settings (n = 4827) were invited to complete a 28-question online survey if involved in the management of adult and/or pediatric patients receiving EN. RESULTS: Five hundred seventeen surveys were analyzed. Significantly more dietitians in adult vs pediatric settings (83.4% and 59.1%, respectively; P = 0.0012), reported ENI in <40% of patients. Assessing medications, elevating the head of the bed, and changing EN infusion rate, volume, or feeding regimen were the highest-ranked strategies to manage ENI symptoms. Most (>90%) respondents change the EN formula <50% of the time to manage ENI. Dietitians consider caloric density and protein form as the most important EN features to manage upper-GI symptoms vs fiber source, osmolality, and form of protein to manage lower-GI symptoms. EN with real-food ingredients was ranked higher in importance for managing upper- and lower-GI symptoms by dietitians in pediatric vs adult settings. CONCLUSION: To manage ENI symptoms, dietitians consider multiple strategies before deciding to change the EN formula. When a formula change is indicated, dietitians consider different EN features for the management of upper- and lower-GI symptoms.

Understanding the use and tolerance of a pediatric and an adult commercial blenderized enteral formula through real-world data.

BACKGROUND: Home enteral nutrition (HEN) is frequently prescribed to individuals who cannot consume adequate food orally. Commercial blenderized enteral formulas (CBEF) containing real-food ingredients are becoming more popular and more widely available; however, the demographics of patients receiving these formulas have rarely been evaluated, and little data are available on patient tolerance in the community. METHODS: US claims data were obtained for children and adolescents/adults who used the CBEF of interest as the sole source of nutrition via enteral feeding tube in the community setting following discharge from acute care. Demographics, concomitant medications, clinical diagnoses, and Charlson Comorbidity Index scores were tabulated using descriptive statistics. Gastrointestinal (GI) symptoms before and after hospital discharge were compared using significance tests. RESULTS: The study included 231 participants (180 children, 51 adolescents/adults). CBEFs were prescribed to patients with a variety of diagnoses, of which the most common were digestive and respiratory disorders. Children experienced significantly lower rates of diarrhea, nausea, vomiting, constipation, and abdominal distension in the weeks following hospital discharge compared with the baseline (all P < 0.001). Adolescents/adults experienced significantly lower rates of constipation, nausea, and vomiting (all P < 0.05). Neither group increased their usage of GI medications following hospital discharge. CONCLUSION: These CBEFs, based on real-food ingredients, were prescribed to diverse patients in the community and were well tolerated. These formulas offer an alternative to standard polymeric formulas and an alternative or adjunct to homemade blenderized formulas.