The impact of homemade formula on nutritional status of long-term tube fed nursing home residents-a study in Ever New Hospital nursing home in Sinying City

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The elderly population and prevalence of chronic diseases in Taiwan are rising rapidly, which contribute to the growing rate of tube-fed residences in nursing home. The elderly people and tube-fed patients are at high risk of malnutrition. Hence, there is an urgent need to develop strategies to improve nutritional status of institutionalized tube-fed elderly. A variety of commercial tube-feeding formulas (CTF) are available in the market, which most contain complete and balanced nutrition regiments designed for specific requirement. CTF is usually easily to prepare and serve, and is preferred type in institute. In contrast, Homemade Blended Formula (HBF) made freshly from nature “real” foods is often less variety and time consuming to prepare. However, HBF is less cost, and, most important, it provides non-nutrient functional components, such as dietary fiber and phytochemicals, that have beneficial effects on health promotion. Accordingly, the combination of CTF and HBF may be a better approach for tube-feeding. The main purpose of this study is to investigate the effect of HBF intervention on the nutritional status of long-term tube-fed nursing home residents receiving CTF. Thirty-five tube-fed residents of Ever New Hospital Nursing Home in Sinying City, 14 male and 21 female, average age 79 years old, were recruited for the study. The participants were provided HBF to replace two of five meals of CTF for 3 months. The nutritional statuses of residents were assayed before and after the intervention. The results showed that more than 50% of participants had been in the nursing home for more than 12 months before the study. Each resident had been diagnosed with at least one type of chronic disease, and the most prevalent diseases were hypertension (60%) and stroke (60%). The average daily medication intake was 9 types of drug. The most commonly used drugs were laxative (74.29%) and acid-suppressive (68.57%) agents. Almost all of the participants were disability and bedbound evaluated by Barthel’s Index and Karnofsky Scale, respectively. The average scores obtained from the Mini Nutritional Assessment (MNA) were 16.57 + 1.57 and 17.97 + 2.93 for male and female, respectively, suggesting malnutrition or at high risk of malnutrition. The nutritional statuses were further evaluated by biochemical parameters, and the average levels were 4.1 + 0.6 (x 106 /l), 11.9 + 1.9 g/dl, 35.4 + 5.7%, 89.9 + 9.2%, 29.3 + 5.1 %, 8.4 + 2.4 (x 103/l) and 3.3 + 0.3 g/dl for RBC, Hb, Hct, MCV, MCHC, WBC and albumin, respectively. The levels were all at borderline low, implying the risk of anemia and protein deficiency. The daily intake of calories, carbohydrate, fat and protein, the MNA scores and nutritional status-related biochemical parameters did not changed by HBF. However, the blood levels of total cholesterol, urea nitrogen (BUN) and glutamic pyruvic transaminase (GTP) decreased, and sodium ion concentration was increased significantly (p < 0.05) after intervention, but all of values were still at normal range. In conclusion, the results from this study indicate that long-term tube-fed elderly are at risk of malnutrition, and especially at risk of anemia and protein deficiency. The HBF provided in this may be used for the replacement of CTF without affecting nutritional status of residents. However, the statuses of the nutrients related to anemia, such as protein, iron, vitamin B6 and vitamin B12, should be monitored closely, and HBF should contain these nutrients sufficiently for preventing anemia and maintaining nutritional status of institutionalized tube-fed elderly. Key words: Homemade formula. Mini Nutritional Assessment scale (MNA). Malnourished