Enteral nutrition (EN) provides critical macro and micronutrients to individuals who cannot maintain sufficient oral intake to meet their nutritional needs. EN is most commonly required for neurological conditions that impair swallow function, such as stroke, amytrophic lateral sclerosis, and Parkinson’s disease. An inability to swallow due to mechanical ventilation and altered mental status are also common conditions that necessitate the use of EN. EN can be short or long term and delivered gastrically or post-pylorically. The expected duration and site of feeding determine the type of feeding tube used. Many commercial EN formulas are available. In addition to standard formulations, disease specific, peptide-based, and blenderized formulas are also available. Several other factors should be considered when providing EN, including timing and rate of initiation, advancement regimen, feeding modality, and risk of complications. Careful and comprehensive assessment of the patient will help to ensure that nutritionally complete and clinically appropriate EN is delivered safely.

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Enteral Nutrition Overview

Objective: To analyze scientific evidence on the use of blenderized tube feeding in children regarding nutritional composition, family satisfaction, and health outcomes. Data source: Survey was conducted in the PubMed, Scopus, Embase, and Virtual Health Library (VHL) databases using the following search terms: blenderized tube feeding OR blended tube feeding OR homemade OR pureed AND enteral nutrition AND enteral tube. The methodological quality of the selected articles was evaluated using the Critical Appraisal Skill Programme and Hierarchical Classification of Evidence. Data synthesis: After analysis, 11 articles were included in the present review. Most studies demonstrated improvements in health outcomes and greater family satisfaction after replacing the commercial enteral feeding with blenderized tube feeding. Conclusions: When guided and monitored by the healthcare team, a blenderized tube feeding ensures an adequate nutritional composition. The use of this method is also associated with positive health outcomes such as reductions in gastrointestinal symptoms and hospitalizations. Moreover, a high frequency of family satisfaction was verified.%

Blenderized tube feeding for children: an integrative review.

When oral nutrition is not feasible, enteral nutrition (EN) therapy is often considered the preferred route of nutrition support to meet the nutrient needs of individuals with a functional gastrointestinal tract across multiple levels of care (critical care, acute care, and home care). Enteral formulations have progressively evolved over the last 50 years from the simple blending of hospital food thin enough to run through a feeding tube, to the development of commercial standard formulas, followed by specialized formulas with immune-modulating and disease-specific qualities, to the most recent shift to food-based or blenderized EN composed of natural, whole foods with perceived health benefits. With the vast number of enteral formulations on the market, clinicians may be overwhelmed trying to determine proven vs theoretical benefits. This review is intended to explore differences in enteral formulations, identify implications for clinical practice, and review evidenced-based clinical guidelines to assist clinicians in enteral formula selection.

Enteral nutrition product formulations: A review of available products and indications for use.

BACKGROUND
Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised, and synthesised the available evidence on the benefits and complications of BD versus commercial feeds.


METHODS
A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022.


INCLUSION CRITERIA
English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations, or attitudes and (3) comparing commercial blends only. Data was synthesised using the narrative synthesis approach established by Popay et al, using the Mixed Methods Appraisal Tool.


RESULTS
806 database results were identified and 61 were sought for retrieval. Full text article review revealed 7 eligible, involving 267 participants (age range 9 months - 26 years). Studies reported differences in GI symptoms (n=222), medication use (n=119), growth (n=189), complications or adverse events (n=91). The results indicate towards positive outcomes, particularly in gastrointestinal symptom control with few reports of mild adverse events in the included studies.


CONCLUSION
There is a paucity of data in this area and much heterogeneity in included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic and more primary research, ideally using standardised reporting, is required to answer the key questions. This article is protected by copyright. All rights reserved.

Blended diet for enteral tube feeding in young people - a systematic review of the benefits and complications.

Nearly half a million individuals in the United States are dependent on enteral nutrition to meet their nutrition needs. Public interest in blenderized tube feeding (BTF) has increased over the past decade; however, medical professionals indicate a lack of knowledge about these products and their effects. The purpose of this review is to analyze clinical outcomes in adults who use a BTF formula as their primary nutrition source. A literature search was conducted in PubMed, Scopus, and CINAHL using search terms "adult," "enteral nutrition," "tube feeding," "BTF," blenderized," "blended," "homemade," and "pureed." Nine studies met the inclusion criteria and were analyzed in the review. Under close monitoring, BTF does not pose a higher risk for deterioration in anthropometric measurements. Furthermore, BTF use is consistently associated with improvements in diarrhea. As such, clinicians should consider the use of these formulas in the acute care or rehabilitation settings. Additional research is needed in patients with diverse clinical backgrounds in free-living communities. Larger populations sizes and longer intervention time frames are crucial to providing statistically significant results needed to strengthen the quality of evidence on this topic.

Clinical outcomes associated with blenderized tube feedings in adults: A systematic review.

There is emerging evidence in the pediatric population that blenderized tube feeding (BTF) may improve gastrointestinal intolerance; however, not much is known about the impact of BTF on clinical outcomes in adults. This article presents a review of the literature published in the past 10 years that explored the impact of BTF on nutrition status (ie, weight status, body mass index, and upper-arm circumference) and nutrition adequacy in adults. The results indicate that BTF, compared with commercial enteral formula (CEF), may be inadequate in calories, macronutrients, and some micronutrients, given variability in BTF formula composition. As a result, BTF may result in significantly more weight loss than CEF. Thus, BTF may not be appropriate for adult patients who are malnourished or are at risk for malnutrition due to the potential worsening of clinical outcomes.

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

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