Foods for Special Medical Purposes in Home Enteral Nutrition-Clinical Practice Experience. Multicenter Study

Marcin Folwarski; Stanisław Kłęk; Agata Zoubek-Wójcik; Waldemar Szafrański; Lidia Bartoszewska; Krzysztof Figuła; Marlena Jakubczyk; Anna Jurczuk; Zbigniew Kamocki; Tomasz Kowalczyk; Bogna Kwella; Przemysław Matras; Joanna Sonsala-Wołczyk; Jacek Szopiński; Krystyna Urbanowicz; Anna Zmarzły

doi:10.3389/fnut.2022.906186

Foods for Special Medical Purposes in Home Enteral Nutrition-Clinical Practice Experience. Multicenter Study

Front Nutr. 2022 Jul 7:9:906186. doi: 10.3389/fnut.2022.906186. eCollection 2022.

Authors

Marcin Folwarski^{1

2}, Stanisław Kłęk³, Agata Zoubek-Wójcik⁴, Waldemar Szafrański², Lidia Bartoszewska⁵, Krzysztof Figuła⁶, Marlena Jakubczyk^{7

8}, Anna Jurczuk⁹, Zbigniew Kamocki¹⁰, Tomasz Kowalczyk⁶, Bogna Kwella¹¹, Przemysław Matras⁵, Joanna Sonsala-Wołczyk¹², Jacek Szopiński^{13

14}, Krystyna Urbanowicz¹², Anna Zmarzły¹²

Affiliations

¹ Department of Clinical Nutrition and Dietetics, Medical University of Gdańsk, Gdańsk, Poland.
² Home Enteral and Parenteral Nutrition Unit, Department of General Surgery, Nicolaus Copernicus Hospital, Gdańsk, Poland.
³ Surgical Oncology Clinic, Maria Skłodowska-Curie National Cancer Institute, Kraków, Poland.
⁴ Nutrimed Home Nutrition Center, Rzeszow, Poland.
⁵ First Department General and Transplant Surgery and Clinical Nutrition Medical University of Lublin, Home Enteral and Parental Nutrition Unit SPSK4, Lublin, Poland.
⁶ Nutricare Clinical Nutrition Center, Kraków, Poland.
⁷ Department of Anaesthesiology and Intensive Care Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.
⁸ Nutritional Team, Home Enteral and Parenteral Nutrition Clinic University Hospital No. 1 in Bydgoszcz, Toruń, Poland.
⁹ Outpatient Clinic of Nutritional Therapy Clinical Hospital of Białystok, Białystok, Poland.
¹⁰ 2nd Department of General, Gastroenterological and Oncological Surgery Medical University of Białystok, Białystok, Poland.
¹¹ Department of Clinical Nutrition, Provincial Specialist Hospital, Olsztyn, Poland.
¹² Gromkowski City Hospital Wrocław, Clinical Nutrition Unit, Wrocław, Poland.
¹³ Department of General Hepatobiliary and Transplant Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.
¹⁴ General Surgery and Clinical Nutrition Ward, Community Hospital Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.

Abstract

Background: Enteral nutrition (EN) with foods for special medical purposes (FSMP) is recommended for most patients on home enteral nutrition (HEN). Although there are disease-specific guidelines for energy, protein, and micronutrient provision, only a few studies are showing real-life experience in the long-term use of FSMP.

Methods: In a multicenter study, the influence of the FSMP composition and administration technique (bolus vs. continuous) on protein and energy provision in HEN was analyzed. Provision of vitamins and minerals was compared to recommended daily allowance (RDA) and upper tolerable limit (UL).

Results: Approximately, 772 patients on HEN, mostly (88.6%) with oncological and neurological diseases, were enrolled. The patients on standard FSMP received less protein and energy than those on hypercaloric and protein enriched despite receiving higher volumes of EN (p < 0.05). No differences were observed in jejunal feeding with oligomeric vs. polymeric FSMP in terms of energy, protein, and volume. Continuous gastric feeding provided more protein, energy, and volume vs. bolus feeding (p < 0.05). Significant number of patients received less than 100% RDA of vitamin D (50.5%), vitamin B3 (49%), vitamin K (21.8%), vitamin B5 (64.3%), vitamin B9 (60%). Majority of the patients received less than 100% RDA of sodium (80.2%), potassium (99%), chloride (98%), calcium (67%), magnesium (87%), fluoride (99%), and iodine (43%). Approximately, 43.63% of cancer and 49.9% of neurological patients received less than 1 g/kg/day of protein and 51.7% of cancer and 55.5% of neurological patients received less than 25 kcal/kg/day.

Conclusion: Awareness of the available compositions of FSMP and advantageous profiles of specific diets may lead to the implementation of recommendations for EN. HEN professionals need to analyze all the patient's needs and requirements to provide more tailored matching of nutritional support.

Keywords: FSMP; energy; enteral formulas; enteral nutrition; home enteral nutrition (HEN); micronutrients; protein provision; vitamin.