Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults

Vieira, Maricy Machado Cavalca; Santos, Valdirene Francisca Neves; Bottoni, Andrea; Morais, Tania Beninga

doi:10.1016/j.clnu.2016.11.020

Cited by 63 publications

(207 citation statements)

References 10 publications

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“…suggesting an overall poor hygiene status). Comparable microbial loads of blended feeds have been reported previously and are inevitable in blended feeds made from nonsterile ingredients and in nonsterile conditions. Carvalho et al .…”

Section: Discussionsupporting

confidence: 56%

A laboratory‐based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe

Madden

Baines

Bothwell

et al. 2019

J Human Nutrition Diet

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Background Concerns associated with blended enteral feeds include the risk of blocked tubes and microbial contamination, although the available evidence is limited. The present laboratory‐based investigation aimed to examine these risks in a blended feed providing a nutritionally adequate intake for a hypothetical patient. Methods A one‐blended feed recipe was made using three different methods (professional, jug and stick blenders) and three storage procedures. Feed samples were syringed via 10‐, 12‐ and 14‐French (Fr) enteral feeding tubes and both blockages and the time taken were recorded. Feed samples were diluted, plated on agars, incubated and bacterial colony‐forming units (CFU) counted. After storage at −80 °C, identification was undertaken using 16S rRNA polymerase chain reaction sequencing. Results Two blockages occurred during 27 administrations of feed made using a professional blender, although they were resolved with a water flush. No blockages occurred with the 14‐Fr tube and administration was quicker with wider tubes (P < 0.00001). There was no significant difference between the total bacterial CFU of feeds prepared using different methods (P = 0.771) or stored differently. The genus of bacteria identified included Enterococcus, Bacillus, lactose‐fermenting Enterobacteriaceae, Pseudomonas and Staphylococcus. Pathogens, such as Clostridium spp., Salmonella spp. and Vibrio spp., were not identified by phenotypic tests used. Sequencing identified Escherichia coli, Shigella spp., Streptococcus lutetiensis and Staphylococcus epidermidis. Conclusions The present study found no risk of tube blockages when one blended feed recipe made using three methods was delivered via a 14‐Fr tube. There is concern about bacterial contamination, although this was not influenced by the methods of preparation or storage used in the present study.

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Section: Discussionsupporting

confidence: 56%

A laboratory‐based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe

Madden

Baines

Bothwell

et al. 2019

J Human Nutrition Diet

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“…Vieira et al reported significantly higher CFUs in BTF preparations compared with CF in their study conducted in Brazil . However, Baniardalan et al reported higher than acceptable CFUs in CF and BTF in a study conducted in Iran .…”

Section: Discussionmentioning

confidence: 91%

“…For this study, 3 formulations were compared for growth of aerobic microorganisms, S. aureus , coliforms, and E. coli , at zero hour, 2 hours, and 4 hours after tube feed preparation. These microorganisms were assessed in similar published literature . CF consisted of a standard fiber‐containing polymeric formula (Jevity 1.0, Abbott Laboratories, Columbus, OH).…”

Section: Methodsmentioning

confidence: 99%

“…), 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 . Most of the current research on BTF safety has been conducted outside the U.S. where its use is more prevalent, and food handling practices, costs, and availability of CF vary widely.…”

Section: Introductionmentioning

confidence: 99%

“…Most of the current research on BTF safety has been conducted outside the U.S. where its use is more prevalent, and food handling practices, costs, and availability of CF vary widely. Microbial studies of BTF conducted in the Philippines, Saudi Arabia, Brazil, and Iran attributed higher than allowable aerobic plate counts in BTF formulations to time and temperature violations, improper food handling techniques, and poor personal hygiene practices . Conversely, Baniardalan et al found colony‐forming units (CFUs) were significantly higher in CF compared with BTF in the intensive care unit population of an Iranian teaching hospital .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Background Many healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial loads of a standard ready‐to‐feed polymeric commercial formula (CF), a BTF made using baby food (BTF‐BF), and a BTF prepared from blending whole food (BTF‐WF), following food safety standards expected of U.S. hospitals. Methods Three tube‐feeding formulas (CF, BTF‐BF, BTF‐WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart. Results No S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption. Conclusion Judicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.

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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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Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults

Cited by 63 publications

References 10 publications

A laboratory‐based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe

A laboratory‐based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe

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

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

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