Blenderized Enteral Nutrition Diet Study: Feasibility, Clinical, and Microbiome Outcomes of Providing Blenderized Feeds Through a Gastric Tube in a Medically Complex Pediatric Population

Gallagher, Kelsey; Flint, Annika; Mouzaki, Marialena; Carpenter, Andrea J.; Haliburton, Beth; Bannister, Louise; Norgrove, Holly; Hoffman, Lisa; Mack, David R.; Stintzi, Alain; Marcon, Margaret

doi:10.1002/jpen.1049

Cited by 92 publications

(309 citation statements)

References 33 publications

(36 reference statements)

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“…It is noteworthy to mention that in 53% of our patients, caregivers reported an increase in oral intake once the blended diet was initiated, and 2 children were able to be transitioned exclusively to oral feeds. Although not formally assessed, these observations were noted in previous studies …”

Section: Discussionmentioning

confidence: 78%

“…Standard enteral formulas (eg, whole protein, hydrolysate, or amino acid–based) have been primarily used for gastrostomy feedings since the 1970s and are easily quantifiable, convenient, portable, and safe. However, in recent years caregivers have been increasingly requesting blended diets, as they perceive these diets to be more “natural” and possibly better tolerated by their children compared with standard enteral formulas …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported positive clinical outcomes with the use of blended diets, including reduced gagging and retching in gastrostomy‐fed children with fundoplication, and decreased stool output in patients with intestinal failure and chronic diarrhea . Additionally, a recent study reported that pediatric patients previously fed standard enteral formulas acquired a more diverse microbiome when switched to blended diets . Regardless of this emerging data, there is still hesitancy on the part of some medical providers who consider blended diets substandard and unsafe because of inadequate strong evidence for potential benefit, nutrient variability, and potential risk of foodborne illnesses …”

Section: Introductionmentioning

confidence: 99%

“…However, in recent years caregivers have been increasingly requesting blended diets, as they perceive these diets to be more "natural" and possibly better tolerated by their children compared with standard enteral formulas. [1][2][3] Previous studies have reported positive clinical outcomes with the use of blended diets, including reduced gagging and retching in gastrostomy-fed children with fundoplication, and decreased stool output in patients with intestinal failure and chronic diarrhea. 4,5 Additionally, a recent study reported that pediatric patients previously fed standard enteral formulas acquired a more diverse microbiome when switched to blended diets.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Additionally, a recent study reported that pediatric patients previously fed standard enteral formulas acquired a more diverse microbiome when switched to blended diets. 2 Regardless of this emerging data, there is still hesitancy on the part of some medical providers who consider blended diets substandard and unsafe because of inadequate strong evidence for potential benefit, nutrient variability, and potential risk of foodborne illnesses. 4 Given the increasing requests for blended diets in our clinic population and the paucity of available literature, we reviewed our clinical experience with gastrostomy-fed children who had been receiving standard enteral formulas and were subsequently switched to a blended diet.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds

et al. 2019

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Background To determine the prevalence of gastrointestinal (GI) symptoms in children receiving a blended diet via a gastrostomy tube. Methods This is a single‐center, retrospective study of children ages 1–18 years that received a blended diet. We reviewed demographics, anthropometrics, clinical characteristics, and rationale for switching to blended diet. Fixed‐effects logistic regression analysis was used to evaluate the changes in patient symptoms over the 12‐month follow‐up period, and fixed‐effects regression was employed to test for changes in anthropometrics. Results Twenty‐three patients (8 female, 15 male) were identified, and data from 89 outpatient visits were analyzed. The most common underlying diagnosis was neurological disorder. Thirty‐five percent of patients received commercial whole cow milk formulas, 30% received hydrolysate formulas, and 35% received amino acid−based formulas. After formula switches were made, 65% received homemade blended diets, 17.5% received commercial blended diets, and 17.5% received a combination of both. Median duration of time on a blended diet was 17 months. Ninety‐five percent of patients who were previously experiencing upper GI symptoms improved within the first 3 months after blended diet initiation. Twenty‐one percent of patients developed mild constipation on the diet, which was managed with increased water intake and/or polyethylene glycol. Only 2 patients discontinued the blended diet, because of inadequate weight gain and worsening of upper GI symptoms. Conclusions In our study population, blended diets were well tolerated in gastrostomy‐fed children and were associated with clinical improvement of upper GI symptoms.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds

et al. 2019

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Children and Young People's Continuing Care

Price¹,

Thomas²

2020

Nursing Care of Children and Young People With Long‐Term Conditions

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Pilot Study of the Effect of Plant‐Based Enteral Nutrition on the Gut Microbiota in Chronically Ill Tube‐Fed Children

McClanahan

Yeh

Firek

et al. 2019

J Parenter Enteral Nutr

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BackgroundDietary intake sharply impacts the structure and function of the gut microbiota, which is important for childhood health. However, little is known about the microbiota of children who cannot eat by mouth. Standard enteral formulas for supplemental nutrition are low in fiber and high in processed sugars and are commonly associated with gastrointestinal side effects. In this pilot study, we examined the effects of plant‐based enteral nutrition (PBEN) upon the gut bacteria of chronically ill children.MethodsTen children (median age 3.5 years, age range 2–8 years) dependent upon conventional enteral formula were transitioned to PBEN for 2 months. Microbial diversity within fecal samples collected before and after PBEN was assessed by 16S ribosomal RNA gene sequence analysis and was compared with rectal swabs from healthy children. Fecal short‐chain fatty acids and bile acids were measured in parallel.ResultsRelative to control samples, fecal samples from study subjects were depleted of commensals (eg, Faecalibacterium) and enriched with pathogens (eg, Enterococcus). Postintervention samples from study subjects were more similar to healthy controls. Most subjects experienced PBEN‐induced alterations in the gut microbiota, but these changes varied significantly across individuals. Clinical diaries indicated that PBEN was well tolerated, with improvement in symptoms noted in several subjects.ConclusionResults from this pilot study suggest that PBEN is well tolerated and could improve the health of the microbiota in chronically ill children. This trial provides a rationale for systematic evaluation of PBEN in clinical trials of children who require supplemental nutrition.

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Blenderized Enteral Nutrition Diet Study: Feasibility, Clinical, and Microbiome Outcomes of Providing Blenderized Feeds Through a Gastric Tube in a Medically Complex Pediatric Population

Abstract: Initiation and maintenance of BTFs is not only feasible in a medically complex pediatric population but can also be associated with improved clinical outcomes and increased intestinal bacterial diversity.

Cited by 92 publications

References 33 publications

Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds

Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds

Children and Young People's Continuing Care

Pilot Study of the Effect of Plant‐Based Enteral Nutrition on the Gut Microbiota in Chronically Ill Tube‐Fed Children

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