Centre for Public Health Research, School of Health & Life Sciences, Teesside University, Middlesbrough, UK.
Fuse, The Centre for Translational Research in Public Health, Newcastle, UK.
J Hum Nutr Diet. 2023 Jun;36(3):673-686. doi: 10.1111/jhn.13090. Epub 2022 Oct 26.
Adults and children who are enterally tube-fed can experience adverse gastrointestinal symptoms (GIS). Observational data suggests that blended diets (BD) could mitigate such symptoms, with potential to improve quality of life and clinical outcomes. We present a novel systematic review examining the impact of BD, compared to commercial feeds, on GIS of adults and children who are tube-fed.
The protocol was registered with PROSPERO (CRD42021261147). Four electronic databases were searched from inception to August 2021. Search terms included 'tube-fed', 'blended diet' and 'formula'. Inclusion criteria were intervention studies comparing blended and commercial feeds using quantitative measures of GIS. Heterogeneity of outcome measures precluded meta-analysis; therefore, a narrative synthesis was conducted.
Six papers (n = 219), including two randomised control trials (RCT) and four single arm pre-post studies, were identified. Equal numbers studied in- and out-patients, adults and children. Risk of bias was notable for all studies. Equivocal and insufficient evidence prevented consensus on outcomes of vomiting, gagging, oral intake, bloating and constipation. However, one RCT and two single arm pre-post studies suggest that diarrhoea symptoms may be improved on BD.
Diarrhoea is prevalent in tube-fed populations and associated with adverse outcomes. Improvements in diarrhoea symptoms attributed to BD may be clinically important. Our findings are congruous with the wider observational evidence base, and support recommendations of the British Dietetic Association. BD may pose a viable alternative to commercial formula, and may mitigate symptoms of diarrhoea for adults and children who are tube-fed.
肠内喂养的成人和儿童可能会出现胃肠道不适（GIS）症状。观察性数据表明，混合饮食（BD）可能减轻此类症状，从而提高生活质量和临床结局。我们进行了一项新的系统评价，研究了与商业配方相比，BD 对肠内喂养的成人和儿童 GIS 的影响。
该方案在 PROSPERO（CRD42021261147）上进行了注册。从建库到 2021 年 8 月，我们在四个电子数据库中进行了搜索。检索词包括“肠内喂养”、“混合饮食”和“配方”。纳入标准是使用 GIS 的定量测量指标比较混合饮食和商业配方的干预研究。由于结局测量指标的异质性，无法进行荟萃分析；因此，进行了叙述性综合分析。
共确定了 6 篇论文（n=219），包括 2 项随机对照试验（RCT）和 4 项单臂前后研究，研究对象为门诊和住院患者、成人和儿童，数量相等。所有研究的偏倚风险均较高。由于证据不足，无法就呕吐、呛咳、口服摄入、腹胀和便秘等结局达成共识。但是，一项 RCT 和两项单臂前后研究表明，BD 可能改善腹泻症状。
腹泻在肠内喂养人群中很常见，且与不良结局相关。BD 改善腹泻症状可能具有临床意义。我们的发现与更广泛的观察性证据基础一致，并支持英国饮食协会的建议。BD 可能是商业配方的可行替代方案，并可能减轻肠内喂养的成人和儿童的腹泻症状。
