Blenderized feeding formulas with nutritious and inexpensive foods

BLENDERIZED FEEDING FORMULA 525 ORIGINAL ORIGINAL https://doi.org/10.1590/1678-98652017000400011 Blenderized feeding formulas with nutritious and inexpensive foods Dieta enteral manipulada com alimentos com qualidade nutricional e baixo custo Ana Paula Lança BENTO1 Rosa Wanda DIEZ GARCIA1 Alceu Afonso JORDÃO JÚNIOR1 ABSTRACT Objective To propose an inexpensive blenderized tube feeding formula consisting of foods with standard nutritional composition that meets the nutritional requirements of individuals aged more than 51 years. Methods The enteral diets were formulated mainly with fresh foods and tested for their physical (homogeneity, stability, osmolality, pH, and flow rate) and chemical (moisture, ash, protein, lipids, energy, crude fiber, vitamin C, calcium, iron, magnesium, and zinc) characteristics. The cost was determined by surveying item prices in supermarkets and stores that specialize in nutritional support. Results The blenderized tube feeding formula was stable and homogeneous, and had slightly acidic pH, hypertonic osmolality (603mOsm/kg), and flow rate comparable with gravity drip (21 minutes). Proximate composition analysis indicated appropriate levels of proteins, lipids, vitamin C, and zinc. The mean cost of 2000kcal of the standard blenderized tube feeding formula was R$ 12.3±1.4, which is 70% cheaper than the mean cost of similar commercial enteral formulas. Conclusion The planned diet can be an excellent choice for patients using blenderized tube feeding formulas as it consisted of habitual food items, had physical and nutritional quality, and was inexpensive. Keywords: Cost and cost analysis. Diet. Enteral nutrition. 1 Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica. Av. Bandeirantes, 3900, Monte Alegre, 14049-900, Ribeirão Preto, SP, Brasil. Correspondência para/Correspondence to: APL BENTO. E-mail: <>. Article based on the doctoral dissertation of APL BENTO, intitled “Elaboração de dietas enterais manipuladas, análise de sua composição nutricional e qualidade microbiológica”. Universidade de São Paulo; 2010. Support: Conselho Nacional de Desenvolvimento Científico e Tecnológico (Process nº 133579/2007-7). Rev. Nutri., Campinas, 30(4):525-534, jul./ago., 2017 Revista de Nutrição 526 APL BENTO et al. https://doi.org/10.1590/1678-98652017000400011 RESUMO Objetivo Propor uma formulação de dieta enteral manipulada com alimentos com composição nutricional padrão que atendam às necessidades nutricionais de pessoas com idade acima de 51 anos e que tenha baixo custo. Métodos As dietas enterais foram formuladas principalmente com alimentos in natura e testadas quanto às características físicas (homogeneidade, estabilidade, osmolalidade, pH e fluidez) e químicas (umidade, cinzas, proteína, lipídeos, energia, fibra bruta, vitamina C, cálcio, ferro, magnésio e zinco). O custo foi obtido por pesquisa de preço em supermercados e lojas especializadas em suporte nutricional. Resultados A dieta enteral manipulada apresentou-se estável, homogênea, pH levemente ácido, osmolalidade hipertônica (603mOsm/kg) e fluidez compatível com o gotejamento gravitacional (21 minutos). A avaliação centesimal demonstrou adequação para proteína, lipídeo, vitamina C, ferro e zinco. O custo médio de 2000kcal de dieta enteral padrão foi de R$ 12,3±1,4, o que representa um custo 70% menor, em relação ao custo médio de dietas enterais industrializadas semelhantes a estas disponíveis no mercado. Conclusão A dieta planejada pode ser uma excelente escolha para o paciente em uso de nutrição enteral domiciliar, foi elaborada com alimentos comuns ao hábito alimentar, apresentam qualidade física e nutricional e são de baixo custo. Palavras-chave: Custo e analise de custo. Dieta. Nutrição enteral. INTRODUCTION Indication of home enteral nutrition has been increasing in the last years secondary to many factors, such as the increasing prevalence of chronic diseases, especially in older adults, who compose most home enteral nutrition patients [1]. The drive to reduce costs and humanize healthcare allows patients to return home and receive treatment at a familiar, comfortable, and safe environment [2]. The prevalence of home enteral nutrition has been investigated in many countries throughout the world, and it is estimated to be 460 patients/one million inhabitants in the United States, 280 patients/one million inhabitants in England, and 74.6 patients/one million inhabitants in Spain [3]. In Brazil no nationwide study has been conducted to estimate this prevalence. However, some regional studies have been published in the scientific literature, such as one from the Federal District, which found a prevalence of 176 patients/one million inhabitants [4]. Revista de Nutrição Individuals who depend on this therapy use it for a long time, and for some, it is challenging to adhere to this therapy at home because of its cost as this therapy is not always fully covered by the healthcare system. In this sense, diets made of regular foods may be safely indicated. Blenderized Tube Feeding Formulas (BTFFs), defined herein as formulas mainly composed of fresh foods, should be considered important for the maintenance of home enteral nutrition because they can be prepared using the foods consumed by the family and be an alternative to Commercial Enteral Formulas (CEFs). Another advantage of BTFFs is the presence of bioactive compounds known as polyphenols, glucosinolates, and carotenoids, which may play many beneficial roles in human health, such as antioxidant activity, immune system stimulation, reduction of platelet aggregation, modulation of hormone metabolism, and reduction of blood pressure [5,6]. on The scientific literature has few studies BTFFs with adequate nutritional and Rev. Nutri., Campinas, 30(4):525-534, jul./ago., 2017 https://doi.org/10.1590/1678-98652017000400011 BLENDERIZED FEEDING FORMULA microbiological quality that can be safely recommended by health professionals [7-12]. For this reason, BTFFs have been disregarded because of a lack of scientific arguments in their favor. Although little suspicion has been raised on the microbiological quality of CEFs, studies had found high levels of contamination in them [13-16] and in BTFF, so both should be carefully prepared under rigorous hygienic conditions. Studies that attempt to find BTFF formulations with nutritional quality that meets the requirements of their users and that may be prescribed safely by professionals are necessary to guarantee home enteral nutrition. The objective of this study was to propose an inexpensive blenderized tube feeding formula made of foods with standard nutritional composition that meets the nutritional requirements of individuals aged more than 51 years. METHODS The Standard Blenderized Tube Feeding Formula was formulated with fresh and processed foods. The nutritional composition of these items was given by the Food Composition Table (TACO) (...truncated)