Nutrition of patients with severe neurologic impairment

Abstract

BackgroundCommercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds.Patients and methodsA 6-month nutritional intervention was made with 37 malnourished children, adolescents and young adults (2–26 years old) with severe neurologic impairment (Gross Motor Function Classification system [GMFCS] grade V). The individual needs were calculated. Participants were fed by gastrostomy with either enteral formulas (n = 17) or pureed food (n = 20). Measurements to assess nutritional status were made at the beginning and at the end of intervention.ResultsThe Z scores for weight-for-age and for the body-mass index increased more in enteral formula than in pureed food group (2.07 vs. 0.70, p = 0.0012; and 3.75 vs. 0.63, p = 0.0014, respectively). Fat mass index increased more in enteral formula than in pureed food group (1.12 kg/m2 vs. 0.38 kg/m2; p = 0.0012). Patients in the enteral formula group showed increase in lean body mass expressed as fat-free mass index (0.70 kg/m2), while those in pureed food group did not (-0.06 kg/m2) (p = 0.0487).ConclusionsThe results suggest that even professionally planned pureed food diet is less effective than commercial enteral formula for nutritional rehabilitation of malnourished patients with severe neurologic impairment. However, larger and if possible randomised clinical studies should be made to confirm our findings.

Clinical Outcomes Associated With Commercial and Homemade Blenderized Tube Feedings: A Literature Review

“…Although 20 people agreed to participate in this study, only 9 completed the study, which equates to a 55% attrition rate 17 . Conversely, Orel et al found significant improvements in the weight‐for‐age z ‐scores for both the BTF intervention group by 0.7 ( P = .0114; 95% CI, 0.17–1.24) and the CEF control group by 2.07 ( P < .0001 with 95% CI, 1.49–2.65), but the control group had the greatest significant increase in weight for age ( P = .0012) 16 . Although the Hurt at al study does provide some evidence to suggest that BTF is effective in weight maintenance at least in the short term, it does not provide any statistical analysis of the data, and patients were allowed to utilize varying amounts of BTF during the study which could confound the results 17 .…”

“…Even though the diagnoses of the study participants varied in these studies, they all had some degree of malnutrition 15‐17 . Orel et al and Hurt et al both utilized a relatively small subset of patients compared with the study by Papakostas et al 15‐17 .…”

“…The studies included in this literature review investigated the impact of BTF on clinical outcomes in patient populations that are prone to malnutrition. A strength of the current research is that these studies 4,15‐17,20 measured and analyzed anthropometric data and/or assessed the nutrition composition of formulas in contrast to other studies that based their conclusions on self‐reported data 1,2 …”

“…Although there is a growing demand for BTF in lieu of CEF, there is currently a paucity of well‐designed studies and outcome data. The available research studies are primarily focused on the pediatric population, 1,2,11,12,23 with very few studies that assess the impact of BTF on clinical outcomes in adults 4,15‐17,20 . Future research in adults should focus on larger‐scale RCTs, preferably in developed countries such as the United States.…”

Severe neurological impairment: a review of the definition

“…. .expected to last at least 12 months (unless death intervenes) Involves either several different organ systems or one organ system severely enough to require specialty paediatric care Medically fragile children 51 Dependent on technology for survival Neuromuscular disorders 52 Disorders that involve injury or dysfunction of peripheral nerves or muscle Children with severe global developmental delay 47 Significant intellectual disability and severe motor impairment Extremely limited functional movement Dependent upon others for all activities of daily living Bakke et al 7 Neurological disorders but no significant mental deficiencies Buratti et al 10 Severe psychomotor and mental retardation Danielson and Emmens 13 Non-ambulatory Severe psychomotor and mental impairment Elliott 14 Profoundly, irreversibly neurologically damaged Will never be able to speak, walk, sit up, or feed themselves Intellectual abilities extremely limited Hauer 17 Non-verbal Severe impairment of the CNS Hauer and Solodiuk 18 Severe global impairment of the CNS Khoshoo et al 22 Profound developmental delay Neuromuscular impairment Non-verbal and wheelchair-bound Lind et al 24 GOS score III and IV Mahant et al 26 GMFCS level III-V McCrea et al 29 Profound developmental impairment Requires constant care Cannot mobilize Very limited possibilities for communication Mergler et al 31,32 Moderate or severe intellectual disability (IQ <55) GMFCS level IV or V Orel et al 35 GMFCS level V Pinnington and Hegarty 36,37 Quadriplegic distribution of athetosis and/or spasticity Associated impairments in visual perception and learning Roka et al, 38 Sun et al 44 from chronic disorders. Thirty-three of the articles referred to patients with CNS disorders only, while five included both patients with disorders of the CNS and PNS.…”