Učinkovitost doma pripravljene pasirane hrane in enteralne formule pri zdravljenju podhranjenosti bolnikov s težko stopnjo prizadetosti osrednjega živčevja

Orel, Anija (author), Fidler Mis, Nataša (mentor), Homan, Matjaž (co-mentor)

Uvod: Bolniki s težko okvaro osrednjega živčevja so zaradi težav s hranjenjem pogosto podhranjeni. Če zadostna prehrana preko ust ni mogoča, je potrebno hranjenje preko hranilne gastrostome. Mednarodne smernice svetujejo uporabo enteralnih formul, vendar se veliko število skrbnikov odloča za uporabo pasirane hrane, ki prinaša tveganja. Do sedaj ni bilo raziskav, ki bi primerjale učinkovitost obeh načinov hranjenja pri zdravljenju podhranjenosti bolnikov s težko nevrološko okvaro. Material in metode: 45 zmerno ali hudo podhranjenih bolnikov s težko okvaro osrednjega živčevja hranjenih preko gastrostome smo razdelili v 2 skupini (hranjenih z enteralno formulo ali s pasirano hrano). Obema skupinama smo izračunali energijski in hranilni vnos, jim pripravili načrt hranjenja ter opravili svetovanje. Prehransko stanje (masa, ITM in višina za starost ter telesna sestava), prebavne težave, število in težo okužb ter zadovoljstvo, smo ponovno ovrednotili po 6 in 12 mesecih od pričetka zdravljenja. Rezultati: Bolniki obeh skupin so pridobili na Z vrednostih za telesno maso in ITM, vendar skupina na enteralni formuli bolj kot skupina na pasirani hrani (2,04 proti 0,31, p = 0.0000 ter 3,66 proti 0,38, p = 0,0002), ni pa bilo statistično pomembne razlike pri spremembi telesne višine. Obe skupini sta pridobili na mastni telesni masi izraženi kot indeks mastne telesne mase, vendar bolj skupina z enteralno formulo (1,48 kg/m2 proti 0,34 kg/m2, p= 0,0000), le skupina z enteralno formulo pa je pridobila tudi na pusti telesni masi izraženi kot indeks puste telesne mase, medtem ko pri skupini s pasirano hrano ni bilo statistično pomembne razlike (0,82 kg/m2 proti -0,17 kg/m2, p=0,0091). Pri številu in stopnji okužb ter prebavnih simptomih med skupinama ni bilo statističnih razlik. Zaključek: Rezultati kažejo, da je za zdravljenje podhranjenosti pri bolnikih s težko okvaro osrednjega živčevja primernejša uporaba enteralne formule kot pasirane hrane.

• Language: Slovenian
• Keywords: prehrana, podhranjenost, prizadetost osrednjega živčevja, pasirana hrana, enteralna formula, gastrostoma
• Work type: Doctoral dissertation
• Typology: 2.08 - Doctoral Dissertation
• Organization: BF - Biotechnical Faculty
• Publisher: [A. Orel]
• Year: 2019
• PID: 20.500.12556/RUL-109765
• UDC: 613.24:616.8
• COBISS.SI-ID: 5085560
• Publication date in RUL: 08.09.2019

Secondary language

• Language: English
• Title: Effectiveness of pureed food and enteral formula for treatment of malnutrition in patients with severe central nervous system impairment

Abstract

Background: Patients with severe impairment of central nervous system are often malnourished due to feeding difficulties. When adequate oral intake is not possible, gastrostomy placement is required. International guidelines recommend the use of enteral formula, however many caregivers prefer to use pureed food which has many risks. There has been no research so far to compare the efficiency of both feeding regimes when treating malnourishment of neurologically impaired patients. Methods: We allocated 45 moderately or severely malnourished patients with severe neurologic impairment to 2 groups (fed with enteral formula or pureed food). We calculated energy and nutritional needs using the same system for both groups, prepared a feeding plan and gave them counselling. We evaluated nutritional status (weight, BMI and height for age, body composition), gastrointestinal symptoms, number and severity of infections, and satisfaction after 6 and 12 months of treatment. Results: Patients of both groups gained weight and BMI, although the enteral formula group gained more (2.04 vs. 0.31, p = 0.0000 and 3.66 vs. 0.38, p = 0.0002, respectively). However, there was no significant difference in change of height. Both groups gained body fat expressed as fat mass index, although the enteral formula group gained more (1.48 kg/m2 vs. 0.34 kg/m2, p= 0.0000). Only the enteral formula group gained lean body mass expressed as fat-free mass index, while there was no significant change in the pureed food group (0.82 kg/m2 vs. -0.17 kg/m2, p = 0.0091). There was no statistical difference in number and severity of infections and gastrointestinal symptoms. Conclusion: The results show that enteral formula is more effective than pureed food in treatment of malnutrition in patients with severe impairment of central nervous system.

• Keywords: nutrition, malnutrition, impairment of central nervous system, pureed food, enteral formula, gastrostomy