Hassan-Ghomi Majid, Nikooyeh Bahareh, Motamed Soudabeh, R Neyestani Tirang
Department of Technology Assessments, Standard and Tariff for Health, Deputy for Healthcare Affairs, Ministry of Health and Medical Education (MOHME), Tehran, Iran.
Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute (NNFTRI) and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Sep 5;31:55. doi: 10.14196/mjiri.31.55. eCollection 2017.
In several disease conditions, patients must inevitably be nourished by enteral feeding (EF). Though in many countries, commercial formulas are routinely used for EF, in Iran still home-made formulas are commonly employed as commercial formulas are not covered by insurance. This may pose patients to malnutrition and bring about further costs. The aim of this study was to evaluate the efficacy of EF commercial formulas in comparison with home-made formulas and thus to make further evidence for insurance policy-making Medline, Cochrane, Embass and Center for Review & Dissemination (CRD) as well as IranDoc and SID databases were searched. Keywords included formula, ICU, and enteral nutrition or tube feeding. No clinical trial study on the efficacy of EF formulas was found. Therefore, the compositions of available formulas and their cost-effectiveness were evaluated based on the clinical guidelines of scientific bodies such as American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and Enteral Nutrition (ESPEN) and relative articles available in PubMed. In addition, the expert opinions were also taken into consideration. Domestic commercial formulas seemed to less merit dietary recommended intakes, i.e. the amount of some nutrients were much higher, and some others were much lower than the recommended values. The amount of several micronutrients including vitamins B1, B6, C, D and K, as well as iron, calcium and magnesium were not sufficient to meet the body needs in most commercial formulas upon receiving 2000 kilocalories and less. Clinical studies on the efficacy of commercial formulas in comparison with home-made formulas are needed. Meanwhile, making suitable conditions for increasing the diversity of artificial nutrition products in the market would help clinical nutritionists to make better choices according to their patients conditions and to reduce the costs, as well.
在一些疾病情况下，患者不可避免地要通过肠内喂养（EF）来获取营养。尽管在许多国家，商业配方奶粉常用于肠内喂养，但在伊朗，由于商业配方奶粉不在保险覆盖范围内，仍普遍使用自制配方奶粉。这可能使患者面临营养不良的风险，并带来额外费用。本研究的目的是评估肠内喂养商业配方奶粉与自制配方奶粉相比的效果，从而为保险政策制定提供更多依据。检索了医学文献数据库（Medline）、考科蓝图书馆（Cochrane）、循证医学数据库（Embass）和综述与传播中心（CRD）以及伊朗文献数据库（IranDoc）和科学信息数据库（SID）。关键词包括配方奶粉、重症监护病房（ICU）和肠内营养或管饲。未找到关于肠内喂养配方奶粉效果的临床试验研究。因此，根据美国肠外与肠内营养学会（ASPEN）、欧洲肠外与肠内营养学会（ESPEN）等科学机构的临床指南以及PubMed上的相关文章，对现有配方奶粉的成分及其成本效益进行了评估。此外，还考虑了专家意见。国产商业配方奶粉似乎不太符合膳食推荐摄入量，即某些营养素的含量远高于推荐值，而另一些则远低于推荐值。在摄入2000千卡及以下热量时，大多数商业配方奶粉中包括维生素B1、B6、C、D和K以及铁、钙和镁在内的几种微量营养素的含量不足以满足身体需求。需要进行关于商业配方奶粉与自制配方奶粉效果比较的临床研究。同时，创造合适条件以增加市场上人工营养产品的多样性，将有助于临床营养学家根据患者情况做出更好的选择，并降低成本。
