Enteral feeding (10)

Primary difference between enteral formulas:

• The protein and fat content

• The structure and size of proteins

Classification of enteral formulation:

1. Standard or polymeric formulas

2. Semi-elemental

3. Elemental

4. Disease specific

5. Modular products

6. Blendirized formulas

Advantages of standard polymeric formulas:

1. Inexpensive

2. Provide macro and micronutrients in amounts suitable for most patients

3. Used for long periods (6+ weeks)

4. Low osmolality

5. Suitable for most patients (including paediatrics)

Give examples of:

• Standard polymeric formula

• Semi-elemental formula

• Elemental formula

• Disease specific formula

• Ensure

• Peptamen AF

• Neocate

• Magnacal renal

Partially hydrolyzed and hydrolyzed formulas are……………and………………….respectively.

semi-elemental and elemental formulas.

A suitable option formula for patients with:

• Decreased GIT surface area

• GIT dysfunction

• Pancreatic diseases

Elemental formula.

Elemental formulas are not for oral use because they’re………………..

less palatable

Disease specific formulas include:

• Renal formulas

• Respiratory formulas

• Hepatic formulas

• Trauma or stress formulas

• Immune-enhancing ingredients

Modular products include…………

protein powders, carbohydrate powders, MCT oil, amino acids.

Modular products are commonly given to………………………..

fortify tube feedings or meals.

Composition of ONS:

• Carbohydrates (simple sugars or sucrose; improves taste)

• Fibers may be included

• Vitamins and minerals may be provided through oral supplements

• Approximately 40% to 60% of total energy from carbohydrates, 15% to 25% from protein, and 15% to 35% from fat.

EN formulas with a high caloric density, have a…………………………..free water content.

low

With the osmolarity of EN formulas in mind, a fluid overloaded patient (with renal disease, heart disease, respiratory edema, etc) will benefit from a……………………….EN formula.

calorie dense.

Caloric (energy) density according to standard/ISO and dense:

• Standard/ISO: 1-1.3 Kcal/ml

• Dense: 1.5-2 Kcal/ml

Protein content in enteral formulations:

1. In normal levels of pancreatic enzymes, full or whole proteins or protein isolates can be provided

2. In GIT dysfunction, hydrolysed proteins in semi-elemental or elemental formulas

3. Some formulas may have specific aa’ at pharmacological levels (including arginine and glutamine) for wound and muscle.

A protein restricted patient will use a…………………………with…………………..of total calories as proteins.

low nitrogen formula; =<10%

(Standard; 20%. High protein formula; => 25%)

Primary macronutrient and energy source in enteral formulations.

Carbohydrate (40 to 70% of calories in enteral formulas)

Fat content in EN formulations include:

Long chain TG (LCT): Corn, soybean oil, safflower oil, canola oil Fish oil: provide DHA & EPA (ω-3 PUFA)

Medium chain TG (MCT): Palm kernel, coconut oil

Considerations of vitamins and minerals content in EN formulation.

Must meet requirements of dietary reference intakes (DRIs). Most do, if not, external supplements are given.

Care is taken to avoid the clinical complications of inadequate or excessive micronutrient intake.

Osmolality of enteral formulations ranges from………………………………..

270-875 mOsm/kg

Higher osmolality is seen with additions of……………………..

Sucrose or/and single aa’ or high amounts of di- or tri-peptides.

Enteral feeding complications:

• Mechanical

• Metabolic

• Gastrointestinal

• Infection complications