Clinical and biochemical characteristics of patients with home enteral nutrition in an area of Spain

Abstract

Objective: The widespread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence, clinical and biochemical characteristics of a cohort of patients on home enteral nutrition (HEN). Design: Prospective observational study. Setting: Tertiary care. Subjects: Between January 1999 and December 2001, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. Interventions: Information for each patients was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. Results: In 1999, the incidence of HEN in our area was patients 15 per 100 000 inhabitants. This incidence rate rose to 21.3 in 2000 and decreased to 9.52 in 2001. The mean age of all patients was 58.7 AE 13 y. The distribution of patients by diseases was: 71 (69.6%) had a head and neck cancer; 14 (13.7%) had a neurological disorder affecting swallowing (cerebrovacular accident and/or dementia); 6 (5.9%) had tumors in different locations with anorexia; and 11 (10.8%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered orally in 81 patients (79.4%), via a nasogastric tube (NGT) in 15 patients (14.7%), via a percutaneous gastrostomy (PEG) in five patients (4.9%), and via a jejunostomy in one patient (1%). The mean duration of HEN was 101 AE 46.9 days. During the course of HEN, six patients had diarrhea (5.9%), and four (3.9%) constipation, and two vomiting (2%) that did not require cessation of HEN. Albumin, prealbumin, transferrin and lymphocytes improved in all the groups, when comparing the first review with the last. After the follow-up (3 y) with review, each 3 months, 10 of the 102 patients (9.8%) had died, and 92 (90.2%) were alive. Survival probability was influenced by the access route, with the worse outcome in patients with no oral nutrition (NGT, PEG and jejunonostomy; hazard ratio: 24.9; 95% CI: 4.1 -52), adjusted by age, sex and diagnosis. Conclusions: In conclusion, HEN is a valid and safe technique for nutrition support, with a good clinical outcome in our area.

Experience over 12 years with home enteral nutrition in a healthcare area of Spain

“…Home enteral nutrition is defined as the provision of enteral diets as the main source of daily intake at home. During recent years, the use of HEN has increased enormously, both because of its reliability and because of the need for National Health Services to discharge chronically ill patients (De Luis et al, 2006). This increase has triggered the development of specific legislation, guidelines and national registries in many countries.…”

Self‐Insertion of a Nasogastric Tube for Home Enteral Nutrition

“…Improving or maintaining nutrition status is the main aim of ETF 2 . Over the past 2 decades, numerous studies on home enteral nutrition (EN) demonstrated that it is a valid and safe technique for nutrition support 3 , 4 . Long‐term ETF can be a source of discomfort and esophagitis and predisposes to nasal and maxillary sinus inflammation 5 , 6 .…”

Home Enteral Nutrition

“…Among these patients who were considered to be on HEN, oral nutrition was the preferential route in 50.8%, followed by nasoenteral tube (30%), and in 17.4% ostomy tubes were placed. A prospective observational study was also performed in the Valladolid area in Spain between January 1999 and December 2001 showing that HEN was administered orally to 79% of the patients [10].…”