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Fange Gjelstad IM, Lyckander C, Høidalen A, Bratland Å, Blomhoff R, Paur I, Henriksen C. Impact of radiotherapy on body weight in head and neck cancer patients: A prospective study. Clin Nutr ESPEN 2025; 65:390-399. [PMID: 39710169 DOI: 10.1016/j.clnesp.2024.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 11/22/2024] [Accepted: 12/17/2024] [Indexed: 12/24/2024]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet. METHODS In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record. RESULTS Critical weight loss (defined as >5 % from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8 % during radiotherapy, and an additional 2.1 % at follow-up (n = 48). A nasogastric feeding tube was used by 42 % at the end of radiotherapy, and 29 % at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27 kcal/kg body weight, 7.8 vs 4.4 % weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92 % of the patients were malnourished at the end of treatment and 71 % at follow-up (p < 0.001). CONCLUSION Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.
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Affiliation(s)
- Ingrid M Fange Gjelstad
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Christian Lyckander
- Department of Nutrition, Institute of Basic Medical Science, University of Oslo, Oslo, Norway
| | - Anne Høidalen
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Åse Bratland
- Section for Head and Neck Oncology, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Rune Blomhoff
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway; Department of Nutrition, Institute of Basic Medical Science, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Science, University of Oslo, Oslo, Norway.
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Zaher S, Alhindi R, Alturki L, Alsobhi E, Alahmadi L, Aldhowayan HA. Enteral Nutrition Practices and Complications in ICU Settings: A Cross-Sectional Study of Healthcare Professionals' Perspectives in Saudi Arabia. J Multidiscip Healthc 2025; 18:289-304. [PMID: 39866349 PMCID: PMC11761842 DOI: 10.2147/jmdh.s506732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 01/09/2025] [Indexed: 01/28/2025] Open
Abstract
Background Enteral Nutrition (EN) is the preferred method for providing nutritional support in intensive care units (ICUs) compared to parenteral nutrition (PN) due to its physiological advantages, safety profile, and cost-effectiveness compared to parenteral nutrition (PN). However, evidence suggests that EN might be associated with some complications. In this study, we aimed to identify the most common EN complications, as reported by healthcare professionals (HCPs) working in adult and paediatric ICUs (PICUs) in Saudi Arabia. We also investigated the factors influenced the HCPs' perception in reporting these EN complications. Methods In this cross-sectional pilot study, data was collected through an online survey from 25 December 2022 to the end of February 2023. All dietitians, physicians and nurses working in adult and PICUs in Saudi-Arabia were eligible to participate. The survey collected information about the demographic data of the participants, some of the EN related practice in intensive care settings as well as the frequency of the reported EN complications. Results A total of 173 respondents were included in the study. The most frequently reported complications were diarrhoea [3.06 ±1.197], aspiration [2.88 ±1.261], and constipation [2.85 ±1.11]. A statistical difference was recorded in the frequency of some of the reported EN complications between HCPs working in adults and paediatric ICUs (p<0.05). The participant's profession (r=-2.84, p<0.05) and years of experience (r=-0.5, p<0.05) appeared to statistically influence the perception of HCPs regarding EN complications. Conclusion This study highlighted the commonly reported complications associated with EN, with differences observed between adult and paediatric settings. The variation in reported complications may be attributed to differences in practitioner characteristics. These findings may emphasize the importance of targeted training, standardized reporting, and evidence-based practices to optimize EN management and improve patient outcomes in ICU settings.
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Affiliation(s)
- Sara Zaher
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Reham Alhindi
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Layan Alturki
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Elaf Alsobhi
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Lora Alahmadi
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Hadeel Abdulla Aldhowayan
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia
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Enteral Nutrition Practice and Associated Factors Among Intensive Care Unit Nurses in South Korea. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Bolgeo T, Di Matteo R, Gallione C, Gatti D, Bertolotti M, Betti M, Roveta A, Maconi A. Intragastric prepyloric enteral nutrition, bolus vs continuous in the adult patient: A systematic review and meta-analysis. Nutr Clin Pract 2022; 37:762-772. [PMID: 35174544 DOI: 10.1002/ncp.10836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bolus and continuous nutrition are commonly used enteral nutrition (EN) administration methodologies. Currently, there is insufficient evidence to establish which is the most effective method for reducing gastrointestinal complications in adult patients. The aim of this review is to evaluate the impact of bolus/intermittent EN compared with continuous EN for the following outcomes: diarrhea, constipation, emesis/vomiting, gastric residual volume, aspiration, and glycemic control in adult patients receiving intragastric prepyloric EN in the hospital setting. Bibliographical research was performed on the following databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. The review included all randomized and nonrandomized controlled trials of patients aged ≥18 years with preserved gastrointestinal function. Meta-analysis was performed by Review Manager V.5.3. Seven studies including 551 patients were included in the meta-analysis. Five of these studies reported that the diarrhea rate was higher in the bolus feeding group (risk ratio [RR] = 2.50; 95% CI, 1.17-5.34; P = 0.02), and another five of these studies indicated that the aspiration rate was higher in the continuous feeding group (RR = 0.55; 95% CI, 0.35-0.87; P = 0.01). There were no significant differences for the other outcomes. In conclusion, intermittent EN appears to reduce the incidence of aspiration in the hospital setting; however, it may increase the risk of diarrhea. For future research, we hypothesize the joint use of continuous nutrition until the patient reaches tolerance and then passing to bolus nutrition, thus reducing the incidence of aspiration and enabling a physiological nutrition intake.
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Affiliation(s)
- Tatiana Bolgeo
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Roberta Di Matteo
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Chiara Gallione
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Denise Gatti
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Marinella Bertolotti
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Marta Betti
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Annalisa Roveta
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
| | - Antonio Maconi
- Department of Integrated Activities Research Innovation 'SC Infrastructure Research Training Innovation', AO "SS.Antonio e Biagio e Cesare Arrigo", via Venezia n 16, Alessandria, 15122, Italy
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Hamdan M, Zidan S, Badrasawi M, Shweikeh H, Al-Masri R, Al-Khateeb R. Palestinian nurses' knowledge, attitudes, and practices regarding enteral nutrition: Cross-sectional study. Appl Nurs Res 2022; 63:151545. [PMID: 35034702 DOI: 10.1016/j.apnr.2021.151545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/31/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enteral nutrition support plays a key role in minimizing malnutrition in critically-ill patients, and its provision is originally a nurse's responsibility. Thus, nurses need to have a sufficient knowledge and a positive attitude with regard to enteral nutrition. In Palestine, literature regarding nurses' knowledge, practices, and attitudes of enteral nutrition is rare. OBJECTIVE This study aimed to investigate Palestinian nurses' knowledge, practices, and attitudes regarding enteral nutrition. METHOD Interview based pre-tested questionnaire was used during data collection procedure. Cronbach Alpha was also used to determine the reliability of knowledge, attitude and practice questionnaire. Descriptive statistics, independent t-test, and ANOVA were performed. RESULTS A total of 325 registered nurses were involved in the final analysis. The mean of the knowledge score is (9.6 ± 2.8) out of 20. It was confirmed that sociodemographic characteristics has no influence on nutrition knowledge score among nurses. The findings also reveal that certain aspects of enteral nutrition practices were consistent with the current guidelines such as flushing the tube and backrest elevation. On the other hand, certain practices showed inconsistency and differences with international guidelines such as checking gastric residual volume. Results also showed that nurses attitudes were positive towards enteral nutrition. CONCLUSION It was found that nurses' have inadequate knowledge regarding enteral nutrition. The findings also showed that enteral nutrition practices among nurses were somewhat incongruent with best current evidence. However, it was noted that they have positive attitudes towards enteral nutrition. Promoting research utilization is highly needed as well as establishing evidence-based guidelines.
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Affiliation(s)
- May Hamdan
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine.
| | - Souzan Zidan
- Department of Nutrition and Food Technology, Faculty of Agriculture, Hebron University, Hebron, West Bank, Palestine
| | - Manal Badrasawi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, West Bank, Palestine
| | - Hammam Shweikeh
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine
| | - Reem Al-Masri
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine
| | - Rana Al-Khateeb
- Department of Healthy and Therapeutic Nutrition, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, West Bank, Palestine
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Vargas-Mendoza N, García-Machorro J, Angeles-Valencia M, Martínez-Archundia M, Madrigal-Santillán EO, Morales-González Á, Anguiano-Robledo L, Morales-González JA. Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals. World J Gastroenterol 2021; 27:5630-5665. [PMID: 34629792 PMCID: PMC8473593 DOI: 10.3748/wjg.v27.i34.5630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has affected millions of people globally. It was declared a pandemic by the World Health Organization in March 2020. The hyperinflammatory response to the entry of SARS-CoV-2 into the host through angiotensin-converting enzyme 2 is the result of a "cytokine storm" and the high oxidative stress responsible for the associated symptomatology. Not only respiratory symptoms are reported, but gastrointestinal symptoms (diarrhea, vomiting, and nausea) and liver abnormalities (high levels of aspartate aminotransferase, alanine aminotransferase transaminases, and bilirubin) are observed in at least 30% of patients. Reduced food intake and a delay in medical services may lead to malnutrition, which increases mortality and poor outcomes. This review provides some strategies to identify malnutrition and establishes nutritional approaches for the management of COVID-19 and liver injury, taking energy and nutrient requirements and their impact on the immune response into account. The roles of certain phytochemicals in the prevention of the disease or as promising target drugs in the treatment of this disease are also considered.
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Affiliation(s)
- Nancy Vargas-Mendoza
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | - Jazmín García-Machorro
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | | | - Marlet Martínez-Archundia
- Laboratorio de Diseño y Desarrollo de Nuevos Fármacos e Innovación Biotécnológica, Instituto Politécnico Nacional, México 11340, Mexico
| | | | | | | | - José A Morales-González
- Laboratorio Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México 11340, Mexico
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ApSimon M, Johnston C, Winder B, Cohen SS, Hopkins B. Narrowing the Protein Deficit Gap in Critically Ill Patients Using a Very High-Protein Enteral Formula. Nutr Clin Pract 2020; 35:533-539. [PMID: 32083356 DOI: 10.1002/ncp.10472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Protein deficits have been associated with longer intensive care unit (ICU) stays and increased mortality. Current view suggests if protein goals are met, meeting full energy targets may be less important and prevent deleterious effects of overfeeding. We proposed a very-high protein (VHP) enteral nutrition (EN) formula could provide adequate protein, without overfeeding energy, in the first week of critical illness. METHODS This was a retrospective study of medical/surgical ICU patients receiving EN exclusively for ≥5 days during the first week of ICU admission. Twenty participants received standard EN; 20 participants received the VHP-EN formula (1 kcal/mL, 37% protein). Protein and energy prescribed/received, gastrointestinal tolerance, and feeding interruptions were examined. RESULTS Forty ICU patients [average Acute Physiology and Chronic Health Evaluation II score of 20.1] were included. Protein prescribed and received was significantly higher in the VHP group vs the standard EN group (135.5 g/d ± 22.9 vs 111.4 g/d ± 25; P = .003 and 112.2 g/d ± 27.8 vs 81.7 g/d ± 16.7, respectively; P = .002). Energy prescribed and received was similar between groups (1696 kcal/d ± 402 vs 1893 kcal/d ± 341, respectively; P = .101 and 1520 kcal/d ± 346 vs 1506 ± 380 kcal/d; P = .901). There were no differences in EN tolerance (P = .065) or feeding interruptions (P = .336). CONCLUSIONS Use of a VHP formula in ICU patients resulted in higher protein intakes without overfeeding energy or use of modular protein in the first 5 days of exclusive EN.
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Affiliation(s)
- Michele ApSimon
- Hamilton Health Sciences, Department of Critical Care, Hamilton General Hospital Site, Hamilton, Ontario, Canada
| | - Carrie Johnston
- Hamilton Health Sciences, Department of Critical Care, Hamilton General Hospital Site, Hamilton, Ontario, Canada
| | - Barb Winder
- Hamilton Health Sciences, Department of Critical Care, Hamilton General Hospital Site, Hamilton, Ontario, Canada
| | | | - Bethany Hopkins
- Medical Affairs, Nestlé Health Science Canada, North York, Ontario, Canada
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Differences in the incidence of postoperative pneumonia after percutaneous endoscopic gastrostomy between liquid and semi-solid nutrient administration. Eur J Clin Nutr 2019; 73:250-257. [PMID: 30610212 PMCID: PMC6368559 DOI: 10.1038/s41430-018-0380-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/05/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES This historical control study examined the differences in the incidence of postoperative pneumonia between patients administered liquid and semi-solid nutrients after percutaneous endoscopic gastrostomy (PEG). SUBJECTS/METHODS The medical records of adult patients who underwent PEG between March 1999 and March 2014 were investigated. The patients were administered either liquid or semi-solid nutrient and examined for gastroesophageal reflux via radiography after PEG. The study period was divided into periods I (liquid nutrient to all patients), II (semi-solid nutrient to patients with reflux and liquid nutrient to those without), and III (semi-solid nutrient to all patients). The patient characteristics and incidence of postoperative pneumonia were stratified by the periods. To assess the relationship between postoperative pneumonia and the periods, a logistic regression analysis was performed. RESULTS Of 370 patients enrolled, 149 were in period I, 64 in period II, and 157 in period III. Postoperative pneumonia was more frequently observed in period I (20.8%) than in periods II (7.8%) and III (10.2%). The odds ratios were higher in period I (period I vs. II: 3.10 [95% confidence intervals: 1.15-8.38]; period I vs. III: 2.32 [1.21-4.44]). The incidence of gastroesophageal reflux did not greatly differ between periods II (25.0%) and III (35.0%). CONCLUSIONS The incidence of postoperative pneumonia after PEG was lower in the patients administered semi-solid nutrient than in those administered liquid nutrient, suggesting that semi-solid nutrient administration to patients with PEG tubes is preferable to prevent postoperative pneumonia. Furthermore, it may be favored especially in those with gastroesophageal reflux.
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Abstract
In Jordan, there is a gap in literature regarding nurses' practices of enteral nutrition. Thus, the purpose of this study was to assess nurses' practices regarding enteral nutrition of critically ill adult patients. A descriptive, cross-sectional design was used to collect data through self-reported questionnaires and descriptive analyses were used to display the results of the study. The results revealed that some aspects of enteral nutrition practices were consistent with the current best evidences such as initiation time of enteral nutrition and backrest elevation. On the contrary, some aspects showed variations and inconsistency with current best evidences such as the amount of high gastric residual volume and its management. Nurses' practices regarding enteral nutrition were not consistent with international guidelines. This inconsistency can predispose patients to underfeeding. Enhancement of research utilization is highly recommended as well as establishing evidence-based guidelines.
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Santos VFND, Bottoni A, Morais TB. Qualidade nutricional e microbiológica de dietas enterais artesanais padronizadas preparadas nas residências de pacientes em terapia nutricional domiciliar. REV NUTR 2013. [DOI: 10.1590/s1415-52732013000200008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar as propriedades físico-químicas, microbiológicas e nutricionais de dietas enterais artesanais padronizadas preparadas nos domicílios de pacientes em terapia nutricional domiciliar. MÉTODOS: Foram desenvolvidas duas formulações de dietas enterais (F1=1,2kcal/mL e F2=1,5kcal/mL), elaboradas com maltodextrina (155/155g), concentrado proteico de soro de leite (30/15g) e óleos vegetais (30/60g) dissolvidos em água (q.s.p.1000mL). Os cuidadores receberam os ingredientes e as medidas padrão e foram orientados quanto ao preparo e às boas práticas de manipulação. O estudo teve duração de quatro meses, e amostras das dietas preparadas nos domicílios de 33 pacientes foram coletadas e analisadas no início e no final deste período. As amostras foram avaliadas quanto à sua adequação percentual em relação aos valores prescritos de macronutrientes e energia, bem como aos padrões microbiológicos estabelecidos pela legislação vigente. RESULTADOS: As dietas formuladas (Formulação 1/Formulação 2) apresentaram os seguintes teores de macronutrientes, energia e osmolalidade: água - 73,5/70,0%; proteína - 4,4/6,0%; lipídeo - 4,3/6,6%; carboidrato - 16,9/16,4%; energia - 120/150kcal/100mL; osmolalidade - 440/450mOsm/kg.H2O. As variações nas adequações percentuais das amostras domiciliares foram menores que 20,0% tanto na primeira quanto na última amostragem. As proporções de amostras em desacordo com os padrões legais foram significantemente menores nas amostras finais, 24,0% e 36,0% para bactérias mesófilas e coliformes, respectivamente. CONCLUSÃO: O preparo das dietas nos domicílios apresentou boa reprodutibilidade; no entanto, a qualidade microbiológica ainda permanece uma questão preocupante, exigindo uma atuação cuidadosa do profissional de saúde nos domicílios.
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