Blended foods for tube-fed children: a safe and realistic option? A rapid review of the evidence

Abstract

With the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain.

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

“…Although reasons why BTF ameliorates symptoms of tube feeding intolerance in some individuals have not been elucidated, at least part of the answer might be dietary diversity and subsequent microbiome response to whole food feeding. These early research associations are congruent with anecdotal reports from tube‐fed patients and/or caregivers of tube‐fed patients that BTF reduces gastrointestinal problems compared with CF feeding . Furthermore, BTF may be cost‐effective compared with CF by replacing more expensive elemental formulas and/or gastrointestinal medications.…”

“…In a review of clinical studies, Bobo noted a high variability of BTF composition in several studies, which can impact weight in adults and growth in children. Other studies demonstrated that BTF supports growth goals in children and weight maintenance in adults . Whole food blends are considerably more viscous than CF and may increase tube occlusion .…”

“…BTF has continued in areas where CF is not widely available, and in limited patient populations in developed countries . However, interest in and use of BTF have recently increased substantially in developed countries and are largely driven by patients and caregivers . This development creates conflict between the desire to provide patient‐centered care and adherence to established healthcare policies.…”

“…Some parents and healthcare providers (HCPs) report BTF supports growth in children, sustains weight in adults, alleviates tube feeding intolerance (constipation, retching, vomiting, gastric pain, etc. ), improves oral intake, and is less expensive than CF . Other research suggests BTF is not adequate to support the complete nutrient needs of patients and carries a high risk of bacterial infection .…”

Fortalecendo a Rede De Atenção Às Necessidades Alimentares Especiais: Uma Experiência Com Fórmulas Enterais Semiartesanais, Em Piraquara-Pr

“…Destaca-se que esses mesmos pesquisadores reforçam a necessidade da prescrição e do acompanhamento por nutricionista para a utilização de dietas enterais artesanais. 5,[8][9][10][11] Também é verdade que alguns estudos apontam como inseguro e ineficaz o uso das fórmulas artesanais, no entanto, alguns deles foram financiados por laboratórios que produzem fórmulas industrializadas. 12,13 Pesquisadores apontam que o lobby das indústrias de medicamentos e fórmulas nutricionais é o principal fator para a judicialização da saúde devido a sua influência junto às associações, entidades de classe e profissionais de saúde, que faz com que usuários e prescritores passem a considerar imprescindível o uso de determinada fórmula nutricional.…”