Nutrient Profiles of Enteral Feeds in Two Selected Hospitals in Accra, Ghana.

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Rosa Adom, Daniel Mensah, Eunice Nortey, Matilda Asante, Laurene Boateng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5319046/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hospital-prepared enteral feeds have demonstrated significant benefits for critically ill patients, primarily by maintaining gut integrity, reducing stress, and supporting immunity. These feeds are often preferred over commercial formulas due to their cost-effectiveness and patient tolerability. However, despite these advantages, hospital-prepared enteral feeds can exhibit inconsistent energy and nutrient values, which may impact their effectiveness. In Africa, and specifically in Ghana, there is a notable gap in documented research regarding the nutrient profiles of these feeds. This lack of data makes it challenging to standardize and optimize enteral nutrition practices across hospitals. Recognizing this gap, our study aims to assess the nutrient profiles of hospital-prepared enteral feeds in two selected hospitals in Accra Methods Twenty-one (21) dietitians and six (6) diet cooks were interviewed. Three (3) hospital-prepared enteral feed samples were collected from the two hospitals on three different days and their energy and nutrient values were analysed. The recipes used in the preparation of the feeds were collected through interviews with diet cooks. Energy and nutrient values obtained from chemical analyses of hospital-prepared enteral feeds, were compared to a commercial formula using one sample t-test. Results Most dietitians in both hospitals (90% in Hospital A and 73% in Hospital B) utilized hospital-prepared enteral feeds, such as fortified porridges and soups. However, the energy and nutrient values of these feeds were significantly lower compared to a commercial formula ( Ensure original). When enteral feeds from the 2 hospitals were compared, statistically significant differences were found for all nutrients except energy, carbohydrate, vitamin C, and sodium. Conclusions The study highlighted differences in the nutritional profiles of hospital-prepared enteral feeds between the 2 hospitals, and significantly lower energy and nutrient content compared to a commercial formula, Ensure Original . Low energy and nutrient content in hospital-prepared feeds could lead to suboptimal patient outcomes, including slower recovery times and increased susceptibility to infections. Further research is needed to explore ways to improve the nutrient profiles of hospital-prepared feeds and develop enteral feeding protocols in hospitals in Ghana. Enteral feeding hospital-prepared feeds standardized recipe Figures Figure 1 Figure 2 INTRODUCTION Enteral nutrition is provided to patients with a functional gut, but who are unable to eat to meet the nutritional requirements and is the preferred choice of feeding the critically ill because of its nutritional benefits, safety and cost effectiveness [ 1 , 2 ]. Critically ill patients have unique metabolic or immune responses to illness which may be modulated by appropriately focused nutrition support [ 1 ]. Kopp and colleagues [ 3 ] in their review noted that inadequate oral intake, preexisting nutritional deprivation and significant multi organ system disease are indications for nutrition support. The degree to which patients derive benefits from nutrition support depends on the content of the nutrient substrate, severity of the disease, route, dosing, and timing. Enteral formula is defined as liquid nutrition that is delivered to patients through enteral route in the form of powder or liquid commercial products and blenderized [ 4 ]. It is important for clinicians to consider the efficacy, nutritional status, gastrointestinal function patients’ tolerance and cost when selecting enteral formulas [ 5 , 6 ]. Before commercial enteral formulas were available, hospital foods were blended into thin consistencies and fed to patients through tubes [ 5 ]. These feeds had several disadvantages including varying degrees of bacterial contamination and blockage of feeding tubes as well as inadequate supply of nutrients to the critically ill [ 7 ]. Despite these disadvantages, Hron et al [ 8 ], have also reported that hospital-prepared enteral feeds supply the nutrients needed by the body and leads to better patient outcomes. In developing countries, the provision of hospital-prepared enteral feeds to critically ill patients is a common practice [ 9 ]. Documented literature in Ghana have focused on the routes of enteral nutrition and named nasogastric as the common route of enteral access [ 10 ], however there is limited research documenting the types and nutrient profiles of formulas provided to the critically ill. Thus, the purpose of this study was to investigate the types of formulas, as well as the nutrient profiles of hospital-prepared enteral feeds given to critically ill patients, in two selected hospitals in Accra. METHODS Study Aim To investigate the types of formulas and the nutrient profiles of hospital-prepared enteral feeds given to critically ill patients, in two selected hospitals in Accra. Study Design A cross-sectional study was designed and carried out in two hospitals in Accra. A purposive sampling method to was used to recruit dietitians and diet cooks who had been involved in providing enteral nutrition support to critically ill patients for more than one year. Study Procedures The study was carried out in two phases. In phase one, structured closed-ended questionnaires were administered to dietitians and diet cooks number to collect background information such as number of years of practice, frequency of prescribing enteral feeds, types of enteral feeds prescribed (for dietitians); and years of cooking, educational level, and training on enteral feed preparation (for diet cooks). In-depth interviews were then conducted with the diet cooks to collect information on recipes used in the preparation of hospital-prepared enteral feeds. The recipes collected represented the “basic feed” which refers to the hospital-prepared enteral feed provided to patients who did not require modified feeds for special conditions. The diet cooks described food ingredients used in the feed preparation by the aid of household handy measures. In the second phase, researchers observed the preparation of the feeds in the diet kitchens and a sample (500ml) of the hospital-prepared enteral feeds was collected in labelled airtight plastic containers on three different days from each hospital, giving a total of six (6) food samples from the two hospitals. Food samples were kept in tightly covered plastic containers and transported to the University of Ghana, Department of Nutrition and Food Science laboratory within two (2) hours of collection for analyses. Moisture was determined on all six (6) food samples before they were stored in the cold room. The nutritional parameters analysed were protein, fat, crude fibre, calcium, sodium, potassium, iron, phosphorus, vitamin c [ 11 , 12 ]. Energy and carbohydrates were calculated by computation. The commercial formula ( Ensure Original ) selected for this study was based on the commonly used commercial formula in the two selected hospitals. Energy and nutrient values for the commercial formula was obtained from the manufacturer’s website [ 13 ], with moisture alone being determined in the laboratory. Data Analysis Statistical analysis was performed using IBM SPSS Statistics version 23 (2015). Means and standard deviations were used to summarize results obtained from the questionnaires, chemical, and nutrient analyses, and presented in charts, figures and tables where appropriate. To compare nutrient contents of hospital-prepared enteral feeds obtained from chemical analyses between the two hospitals an independent samples t-test was used. Nutrient values of hospital-prepared enteral feeds from each hospital were compared with Ensure Original using a one sample t-test, with nutrient values for 100 ml of Ensure Original as the standard. Tests were performed based on means of duplicate samples (for the hospital-prepared enteral feeds) and statistical significance was set at p ≤ 0.05. RESULTS Sociodemographic Characteristics of Respondents in the Study Twenty-one (21) dietitians and six (6) diet cooks from the two hospitals participated in the study. All diet cooks interviewed from the two hospitals had received training in preparing hospital-prepared enteral feeds. The mean practice period for dietitians in Hospital A was 7.9 ± 4.630 years and 3.8 ± 2.422 years for Hospital B. Tables 1 and 2 present the sociodemographic characteristics of participating dietitians and diet cooks. Table 1 Sociodemographic characteristics of participating dietitians Variable Hospital A Frequency (%) Hospital B Frequency (%) Total Frequency (%) Gender Male Female Total 3 (30) 7 (70) 10 (100) 6 (54.5) 5 (45.5) 11(100) 9 (42.8) 12 (57.1) 21(100) Period of practice 1-4years 5-8years 9-12years >12years Total 2 (20) 5 (50) 0 (0) 3 (30) 10 (100) 9 (81.8) 1 (9.1) 1 (9.1) 0 (0) 11 (100) 11 (52.4) 6 (28.6) 1 (4.8) 3 (14.3) 21 (100) Table 2 Sociodemographic characteristics of participating diet cooks Variable Hospital A Frequency (%) Hospital B Frequency (%) Total Frequency (%) Gender Male Female Total 0 (0) 4 (100) 4 (100) 0 (0) 2 (100) 2 (100) 0 (0) 6 (100) 6 (100) Number of years worked 1-5years 6-10years 11-15years 16-20years >20years Total 2 (50) 1 (25) 0 (0) 0 (0) 1 (25) 4 (100) 0 (0) 0 (0) 0 (0) 1 (50) 1 (50) 2 (100) 2 (33.3) 1 (16.7) 0 (0) 1 (16.7) 2 (33.3) 6 (100) Types of enteral feeds Figure 1 presents the types of enteral feeds used in Hospitals A and B. Dietitians in the two hospitals used both commercial formulas and hospital-prepared enteral feeds to feed patients. More than two- thirds of the dietitians in Hospital A (90%) and Hospital B (73%) used hospital-prepared enteral feeds. Fortified porridges and soups were the types of hospital-prepared enteral feeds used in both hospitals with fortified soup being commonly used (100%). The various brands of commercial enteral formulas used in Hospitals A and B are shown in Figure 2. Dietitians in both hospitals use more than one brand of commercial enteral formula. Ensure , Complan , Casilan were the three commonly used brands of commercial enteral formulas in both hospitals. All other brands were collectively categorized under other . Food ingredients used in preparing hospital-prepared enteral feeds In this study, food ingredients used in the preparation of the investigated sample “fortified soup” in Hospital A were fresh tomatoes, onions, fish powder, soya bean flour and rice flour. In Hospital B, rice, fresh tomatoes, onions and fish (tuna) were used. A description of food ingredients, quantities used, and recipes will be made available from the corresponding author on reasonable request. Energy and nutrient values for hospital-prepared enteral feeds (fortified soup) Table 3 presents the energy and nutrient values of the hospital-prepared enteral feeds obtained by chemical analyses for the 2 hospitals. Statistically significant differences were observed in all nutrients except for energy, carbohydrate, vitamin C and sodium between the two hospitals. Table 3 Energy and nutrient values of hospital- prepared enteral feeds for Hospitals A and B Nutritional Parameter HPEF_A (N=6) (Mean ± SD) HPEF_B (N=6) (Mean ± SD) p-value Moisture (%) 93.932 ± 0.593 94.827 ± 0.128 0.005* Energy (kcal/100g) 23.190 ± 2.013 21.625 ± 1.640 0.171 Fibre (g/100g) 0.492 ± 0.067 0.120 ± 0.059 0.000* Fat (g/100g) 0.284 ± 0.081 0.495± 0.118 0.005* Protein (g/100g) 0.498 ± 0.276 0.002 ± 0.002 0.001* Carbohydrate (g/100g) 4.661 ± 0.392 4.290 ± 0.176 0.061 Vitamin C (mg/100g) 24.437 ± 9.845 30.242 ± 4.265 0.215 Calcium (mg/100g) 24.74 ± 7.884 4.745 ± 0.546 0.000* Iron (mg/100g) 1.677 ± 0.654 0.205 ± 0.268 0.000* Potassium (mg/100g) 72.383 ± 4.601 28.75 ± 5.334 0.000* Sodium(mg/100g) 71.953 ± 4.519 175.552 ± 145.413 0.112 Phosphorus (mg/100g) 159.917 ± 60.158 20.115 ± 26.338 0.000* HPEF_A - Hospital-prepared enteral feed for Hospital A, HPEF_A - Hospital-prepared enteral feed for Hospital A, *significant at p ≤ 0.05 Comparison of energy and nutrient values of hospital-prepared enteral feeds to a commercial formula ( Ensure ) The energy and nutrient values of hospital-prepared enteral feeds (HPEF_A AND HPEF_B) were compared to “Ensure ” commercial formula. These results are presented in Tables 4 and 5. Table 4 highlights the energy and nutrient values of Hospital-prepared enteral feed for Hospital A (HPEF_A) compared to 100 ml of “ Ensure ” commercial formula. Significant differences (p ≤ 0.05) were observed in all the nutritional parameters, except for fibre, which was not reported for Ensure . Table 4 Comparison of energy and nutrient values of hospital-prepared enteral feed for Hospital A compared to “ Ensure ” commercial formula Nutritional Parameter HPEF_A Ensure P-value Moisture (%) 93.93 ± 0.59 84 0.024* Energy (kcal/100g) 23.19 ± 2.01 92.8 0.002* Fibre (g/100g) 0.49 ± 0.07 - - Fat (g/100g) 0.28 ± 0.08 2.53 0.006* Protein (g/100g) 0.50 ± 0.28 3.8 0.004* Carbohydrate (g/100g) 4.66 ± 0.39 13.5 0.004* Vitamin C (mg/100g) 24.44 ± 9.85 33.8 0.003* Calcium (mg/100g) 24.74 ± 7.88 139.2 <0.001* Iron (mg/100g) 1.68 ± 0.65 1.9 0.029* Potassium (mg/100g) 72.38 ± 4.60 168.8 <0.001* Sodium(mg/100g) 71.95 ± 4.52 88.6 0.002* Phosphorus (mg/100g) 159.92 ± 60.16 105.5 <0.001* HPEF_A - Hospital-prepared enteral feed for Hospital A, *significant at p ≤ 0.05 The results for the energy and nutrient values for hospital-prepared enteral feed for Hospital B (HPEF_B) and “ Ensure ” commercial formula are shown in Table 5. Significant differences (p ≤ 0.05) were observed in all nutrients. It is noteworthy that Ensure product manufacturer reported a non-specific fibre content value of less than 1 [13]. Hence, we chose not to report on fibre for the commercial enteral formula. Table 5 Comparison of energy and nutrient values of hospital-prepared enteral feed for Hospital B compared to “ Ensure ” commercial formula Nutritional Parameter HPEF_B Ensure P-value Moisture (%) 94.83 ± 0.13 84 0.002* Energy (kcal) 21.63 ± 1.64 92.8 <0.001* Fibre (g/100g) 0.12 ± 0.06 - - Fat (g/100g) 0.50± 0.12 2.53 0.013* Protein (g/100g) 0.002 ± 0.002 3.8 <0.001* Carbohydrate (g/100g) 4.29 ± 0.18 13.5 0.001* Vitamin C (mg/100g) 30.24 ± 4.26 33.8 0.007* Calcium (mg/100g) 4.75 ± 0.55 139.2 <0.001* Iron (mg/100g) 0.20 ± 0.27 1.9 0.004* Potassium (mg/100g) 28.75 ± 5.33 168.8 <0.001* Sodium(mg/100g) 175.55 ± 145.41 88.6 <0.001* Phosphorus (mg/100g) 20.12 ± 26.34 105.5 <0.001* HPEF_B - Hospital-prepared enteral feed for Hospital B, one sample t-test, *significant at p ≤ 0.05 DISCUSSION This study explored the nutrient profiles of enteral feeds prepared in two selected hospitals in Accra, Ghana, revealing several key findings with significant implications for both research and practice. Dietitians in the two hospitals predominantly used hospital-prepared enteral feeds over commercial formulas. This preference may be attributed to the availability and lower cost of local ingredients used in hospital-prepared feeds, as highlighted by Ojo and colleagues [ 14 ], who noted the high usage of such feeds in developing countries due to their cost-effectiveness. The commercial formulas used included brands like Ensure , Complan , and Casilan , with Ensure being the most common due to its widespread availability in urban pharmacies. The nutrient analysis revealed that the energy and nutrient values of hospital-prepared feeds were significantly lower compared to commercial formulas and those reported in other studies. For instance, the energy content of the feeds in this study was 23.19 kcal/100g in Hospital A and 21.63 kcal/100g in Hospital B, which is considerably lower than the 40.5 kcal/100g reported by Vieira and colleagues [ 15 ] and the 84 kcal/100ml found in commercial formulas like Ensure [ 16 ]. This low energy content could potentially put patients at risk for malnutrition. Similarly, the protein content in the feeds was found to be inadequate, with values of 0.498 g and 0.002 g per 100g in Hospitals A and B, respectively. This is much lower than the 2.10 g reported by Vieira and colleagues [ 15 ] and the 3.7 g per 100 ml found in Ensure . Given the critical role of protein in promoting healing and managing metabolic stress [ 17 ], the low protein content is concerning. The primary protein source, fish, is relatively expensive in the study setting, which might limit its use, thus contributing to the low protein content, especially since neither hospital had a standardized recipe or protocol for feed formulation. The study also found significantly lower fat and fibre values in the hospital-prepared feeds compared to other studies. For instance, fat and fibre values in this study were 0.28g and 0.49g in Hospital A, and 0.50g and 0.12g in Hospital B, respectively, whereas Vieira and colleagues [ 15 ] reported values of 1.90 g and 0.80 g for fat and fibre respectively. The low values observed may be due to nutrient loss during preparation, such as sieving or diluting feeds with water to reduce viscosity, making them easier to pass through feeding tubes [ 15 , 18 ]. Mineral and vitamin values were also lower than reported in previous studies. Potassium, calcium, sodium, and phosphorus values were lower than those reported by previous studies [ 19 , 20 ]. However, iron and vitamin C levels in Hospital A (1.68 mg and 24.44 mg, respectively) were higher than those reported by Mokhalalati et al [ 19 ]. The discrepancies in nutrient content between the two hospitals, coupled with the lack of standardized recipes, suggest inconsistencies in ingredient usage and preparation methods. To the best of our knowledge, this study is the first to describe and compare nutrient profiles of hospital prepared enteral feeds in Ghana. It has significant implications for practice and has contributed new data to aid the planning and provision of enteral nutrition support in hospitals in Ghana. These strengths notwithstanding, the study had some limitations. The study was conducted in 2 public hospitals in Accra, the results thus reflect the unique enteral feed preparation practices and nutrient profiles of hospital prepared enteral feeds of these two hospitals. Consequently, the study's conclusions are based on a narrow scope, which might overlook important factors or trends that could have been identified with a broader dataset from multiple hospitals. This limitation underscores the need for future research to include a more extensive range of hospitals to validate the findings and ensure broader applicability. CONCLUSIONS The low energy and nutrient content of hospital-prepared feeds highlight the need for standardized recipes and protocols to ensure adequate nutrition for patients. Dietitians and healthcare providers should whenever possible, consider supplementing hospital-prepared feeds with commercial formulas or other nutrient-dense options to meet patient needs. Future research should focus on understanding the impact of preparation techniques, such as sieving and dilution, on nutrient retention. Additionally, exploring cost-effective, nutrient-dense recipes using locally available ingredients could improve the nutritional quality of hospital-prepared feeds. To help address these issues, hospitals should adopt standardized recipes and protocols for enteral feed preparation, consider fortifying feeds with commercially available nutrient powders or supplements, and provide training for dietitians and kitchen staff on nutrient preservation. Future studies should investigate nutrient losses associated with different preparation methods and explore alternative, locally sourced ingredients to enhance feed quality. By addressing these gaps, there is potential to improve the nutritional care of patients receiving enteral feeds and reduce the risk of malnutrition in hospital settings. Abbreviations HPEF_A - Hospital-prepared enteral feed for Hospital A HPEF_B - Hospital-prepared enteral feed for Hospital B Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki, and approval was sought from the University of Ghana College of Health Sciences Ethical and Protocol Review Committee (Protocol number – CHS-Et/M.7-4.8/2018-2019), and the Institutional Review Boards of the two participating hospitals. Participation in the study was purely voluntary and a written informed consent was obtained from participants. Consent for publication: Not applicable Availability of data and materials: The data supporting this study will be made available upon reasonable request from corresponding author. Competing interests: The authors declare that they have no competing interests. Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Authors’ contributions: L.B. and R.A. conceived, designed, and carried out the study, analysed data, and wrote the manuscript. D.M. and M.A. contributed to the study’s design, provided critical revisions, and approved the final version. E.N. assisted with data collection and analysis and contributed to manuscript preparation. All authors have reviewed and approved the final manuscript. Acknowledgements: The authors extend their gratitude to all the dietitians and diet cooks at the study hospitals for their invaluable support. References McClave SA, Martindale RG, Rice TW, Heyland DK. Feeding the critically ill patient. Critical care medicine. 2014 Dec 1;42(12):2600-10. Ojo O, Keaveney E, Wang XH, Feng P. The effect of enteral tube feeding on patients’ health-related quality of life: a systematic review. Nutrients. 2019 May 10;11(5):1046. Kopp Lugli A, de Watteville A, Hollinger A, Goetz N, Heidegger C. 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Carter H, Johnson K, Johnson TW, Spurlock A. Blended tube feeding prevalence, efficacy, and safety: what does the literature say?. Journal of the American Association of Nurse Practitioners. 2018 Mar 1;30(3):150-7. Mokhalalati JK, Druyan ME, Shott SB, Comer GM. Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia. Saudi medical journal. 2004 Mar 1;25(3):331-41. Sullivan MM, Sorreda-Esguerra P, Platon MB, Castro CG, Chou NR, Shott S, Corner GM, Alarcon P. Nutritional analysis of blenderized enteral diets in the Philippines. Asia Pacific journal of clinical nutrition. 2004 Dec 1;13(4). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5319046","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":370151288,"identity":"3e54f21d-eea3-404a-96cc-2da1c6c629c4","order_by":0,"name":"Rosa Adom","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Rosa","middleName":"","lastName":"Adom","suffix":""},{"id":370151290,"identity":"a89bfc49-8a64-4088-a015-b5f21c4fd5e2","order_by":1,"name":"Daniel Mensah","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Mensah","suffix":""},{"id":370151291,"identity":"24a20174-3123-4561-bf01-d53ef77f500e","order_by":2,"name":"Eunice Nortey","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Eunice","middleName":"","lastName":"Nortey","suffix":""},{"id":370151292,"identity":"15a01227-aa65-4f00-a320-64446257c765","order_by":3,"name":"Matilda Asante","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Matilda","middleName":"","lastName":"Asante","suffix":""},{"id":370151294,"identity":"a38cadd7-8f6c-4064-a6b1-30e3be1c7493","order_by":4,"name":"Laurene Boateng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACPgkogx9MsgGxBE7FEMAGUnAAiCUbSNZicIBoLdLNBz9/qLhjt/lG+gWGD2WHGeSjGwhokTmWLHHgzLPkbTdyChhnnDvMYHjnACGH5RhIHGw7nGx2IyeBmbcNqGVGAkEtxj8O/jucbDwDqOUvkVrMJA42HLYzkEg/wMwI1CIvQUiLzLE0izPHDidInHnDcLDnXDqPASEt/NLNh29U1By2529Pf/jgR5m1nDwhh8FAYgMDDzhqICQxwJ6Bgf0BmCXfQKSWUTAKRsEoGDEAAJhTSJFJDmN2AAAAAElFTkSuQmCC","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"Laurene","middleName":"","lastName":"Boateng","suffix":""}],"badges":[],"createdAt":"2024-10-23 12:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5319046/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5319046/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69418972,"identity":"1df48f06-f330-4514-89d9-560251046dd9","added_by":"auto","created_at":"2024-11-20 07:34:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33689,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTypes of enteral feeds used in Hospitals A and B\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5319046/v1/9854b05e8813534cafe79ff0.png"},{"id":69418973,"identity":"6a938554-3a21-4935-8e58-c38fef27f3e0","added_by":"auto","created_at":"2024-11-20 07:34:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35119,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBrands of commercial formulas used in Hospitals A and B\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5319046/v1/a15410fa0ab708c31099a70a.png"},{"id":69422462,"identity":"2df75179-e19f-45a0-815e-bcbb7fbb60ff","added_by":"auto","created_at":"2024-11-20 07:59:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":830955,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5319046/v1/835e3ff3-c535-44b9-99c8-c5a6ff378634.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNutrient Profiles of Enteral Feeds in Two Selected Hospitals in Accra, Ghana.\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEnteral nutrition is provided to patients with a functional gut, but who are unable to eat to meet the nutritional requirements and is the preferred choice of feeding the critically ill because of its nutritional benefits, safety and cost effectiveness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Critically ill patients have unique metabolic or immune responses to illness which may be modulated by appropriately focused nutrition support [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Kopp and colleagues [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] in their review noted that inadequate oral intake, preexisting nutritional deprivation and significant multi organ system disease are indications for nutrition support. The degree to which patients derive benefits from nutrition support depends on the content of the nutrient substrate, severity of the disease, route, dosing, and timing.\u003c/p\u003e \u003cp\u003eEnteral formula is defined as liquid nutrition that is delivered to patients through enteral route in the form of powder or liquid commercial products and blenderized [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is important for clinicians to consider the efficacy, nutritional status, gastrointestinal function patients\u0026rsquo; tolerance and cost when selecting enteral formulas [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Before commercial enteral formulas were available, hospital foods were blended into thin consistencies and fed to patients through tubes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These feeds had several disadvantages including varying degrees of bacterial contamination and blockage of feeding tubes as well as inadequate supply of nutrients to the critically ill [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite these disadvantages, Hron \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], have also reported that hospital-prepared enteral feeds supply the nutrients needed by the body and leads to better patient outcomes.\u003c/p\u003e \u003cp\u003eIn developing countries, the provision of hospital-prepared enteral feeds to critically ill patients is a common practice [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Documented literature in Ghana have focused on the routes of enteral nutrition and named nasogastric as the common route of enteral access [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], however there is limited research documenting the types and nutrient profiles of formulas provided to the critically ill. Thus, the purpose of this study was to investigate the types of formulas, as well as the nutrient profiles of hospital-prepared enteral feeds given to critically ill patients, in two selected hospitals in Accra.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e \u003cstrong\u003eStudy Aim\u003c/strong\u003e \u003cp\u003eTo investigate the types of formulas and the nutrient profiles of hospital-prepared enteral feeds given to critically ill patients, in two selected hospitals in Accra.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Design\u003c/strong\u003e \u003cp\u003eA cross-sectional study was designed and carried out in two hospitals in Accra. A purposive sampling method to was used to recruit dietitians and diet cooks who had been involved in providing enteral nutrition support to critically ill patients for more than one year.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Procedures\u003c/strong\u003e \u003cp\u003eThe study was carried out in two phases. In phase one, structured closed-ended questionnaires were administered to dietitians and diet cooks number to collect background information such as number of years of practice, frequency of prescribing enteral feeds, types of enteral feeds prescribed (for dietitians); and years of cooking, educational level, and training on enteral feed preparation (for diet cooks).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIn-depth interviews were then conducted with the diet cooks to collect information on recipes used in the preparation of hospital-prepared enteral feeds. The recipes collected represented the \u0026ldquo;basic feed\u0026rdquo; which refers to the hospital-prepared enteral feed provided to patients who did not require modified feeds for special conditions. The diet cooks described food ingredients used in the feed preparation by the aid of household handy measures.\u003c/p\u003e \u003cp\u003eIn the second phase, researchers observed the preparation of the feeds in the diet kitchens and a sample (500ml) of the hospital-prepared enteral feeds was collected in labelled airtight plastic containers on three different days from each hospital, giving a total of six (6) food samples from the two hospitals. Food samples were kept in tightly covered plastic containers and transported to the University of Ghana, Department of Nutrition and Food Science laboratory within two (2) hours of collection for analyses. Moisture was determined on all six (6) food samples before they were stored in the cold room. The nutritional parameters analysed were protein, fat, crude fibre, calcium, sodium, potassium, iron, phosphorus, vitamin c [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Energy and carbohydrates were calculated by computation. The commercial formula (\u003cem\u003eEnsure Original\u003c/em\u003e) selected for this study was based on the commonly used commercial formula in the two selected hospitals. Energy and nutrient values for the commercial formula was obtained from the manufacturer\u0026rsquo;s website [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], with moisture alone being determined in the laboratory.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Analysis\u003c/strong\u003e \u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics version 23 (2015). Means and standard deviations were used to summarize results obtained from the questionnaires, chemical, and nutrient analyses, and presented in charts, figures and tables where appropriate. To compare nutrient contents of hospital-prepared enteral feeds obtained from chemical analyses between the two hospitals an independent samples t-test was used. Nutrient values of hospital-prepared enteral feeds from each hospital were compared with \u003cem\u003eEnsure Original\u003c/em\u003e using a one sample t-test, with nutrient values for 100 ml of \u003cem\u003eEnsure Original\u003c/em\u003e as the standard. Tests were performed based on means of duplicate samples (for the hospital-prepared enteral feeds) and statistical significance was set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics of Respondents in the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwenty-one (21) dietitians and six (6) diet cooks from the two hospitals participated in the study. All diet cooks interviewed from the two hospitals had received training in preparing hospital-prepared enteral feeds. The mean practice period for dietitians in Hospital A was 7.9 \u0026plusmn; 4.630 years and 3.8 \u0026plusmn; 2.422 years for Hospital B. Tables 1 and 2 present the sociodemographic characteristics of participating dietitians and diet cooks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Sociodemographic characteristics of participating dietitians\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (30)\u003c/p\u003e\n \u003cp\u003e7 (70)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e10 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (54.5)\u003c/p\u003e\n \u003cp\u003e5 (45.5)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e11(100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (42.8)\u003c/p\u003e\n \u003cp\u003e12 (57.1)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e21(100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriod of practice\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1-4years\u003c/p\u003e\n \u003cp\u003e5-8years\u003c/p\u003e\n \u003cp\u003e9-12years\u003c/p\u003e\n \u003cp\u003e\u0026gt;12years\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e3 (30)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e10 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (81.8)\u003c/p\u003e\n \u003cp\u003e1 (9.1)\u003c/p\u003e\n \u003cp\u003e1 (9.1)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e11 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (52.4)\u003c/p\u003e\n \u003cp\u003e6 (28.6)\u003c/p\u003e\n \u003cp\u003e1 (4.8)\u003c/p\u003e\n \u003cp\u003e3 (14.3)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e21 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Sociodemographic characteristics of participating diet cooks\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.7133%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3072%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.7133%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3072%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e4 (100)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e2 (100)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e6 (100)\u003c/p\u003e\n \u003cp\u003e6 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.7133%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of years worked\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1-5years\u003c/p\u003e\n \u003cp\u003e6-10years\u003c/p\u003e\n \u003cp\u003e11-15years\u003c/p\u003e\n \u003cp\u003e16-20years\u003c/p\u003e\n \u003cp\u003e\u0026gt;20years\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3072%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003cp\u003e1 (25)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e1 (25)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e1 (50)\u003c/p\u003e\n \u003cp\u003e1 (50)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.9898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003cp\u003e6 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTypes of enteral feeds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 presents the types of enteral feeds used in Hospitals A and B. Dietitians in the two hospitals used both commercial formulas and hospital-prepared enteral feeds to feed patients. More than two- thirds of the dietitians in Hospital A (90%) and Hospital B (73%) used hospital-prepared enteral feeds. Fortified porridges and soups were the types of hospital-prepared enteral feeds used in both hospitals with fortified soup being commonly used (100%). The various brands of commercial enteral formulas used in Hospitals A and B are shown in Figure 2. Dietitians in both hospitals use more than one brand of commercial enteral formula. \u0026nbsp;\u003cem\u003eEnsure\u003c/em\u003e, \u003cem\u003eComplan\u003c/em\u003e, \u003cem\u003eCasilan\u003c/em\u003e were the three commonly used brands of commercial enteral formulas in both hospitals. All other brands were collectively categorized under \u003cem\u003eother\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFood ingredients used in preparing hospital-prepared enteral feeds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, food ingredients used in the preparation of the investigated sample \u0026ldquo;fortified soup\u0026rdquo; in Hospital A were fresh tomatoes, onions, fish powder, soya bean flour and rice flour. In Hospital B, rice, fresh tomatoes, onions and fish (tuna) were used. A description of food ingredients, quantities used, and recipes will be made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnergy and nutrient values for hospital-prepared enteral feeds (fortified soup)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents the energy and nutrient values of the hospital-prepared enteral feeds obtained by chemical analyses for the 2 hospitals. Statistically significant differences were observed in all nutrients except for energy, carbohydrate, vitamin C and sodium between the two hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Energy and nutrient values of hospital- prepared enteral feeds for Hospitals A and B\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional Parameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPEF_A\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=6)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPEF_B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=6)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eMoisture (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e93.932 \u0026plusmn; 0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e94.827 \u0026plusmn; 0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eEnergy (kcal/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e23.190 \u0026plusmn; 2.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e21.625 \u0026plusmn; 1.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eFibre (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e0.492 \u0026plusmn; 0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e0.120 \u0026plusmn; 0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eFat (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e0.284 \u0026plusmn; 0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e0.495\u0026plusmn; 0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eProtein (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e0.498 \u0026plusmn; 0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e0.002 \u0026plusmn; 0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eCarbohydrate (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e4.661 \u0026plusmn; 0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e4.290 \u0026plusmn; 0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eVitamin C (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e24.437 \u0026plusmn; 9.845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e30.242 \u0026plusmn; 4.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eCalcium (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e24.74 \u0026plusmn; 7.884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e4.745 \u0026plusmn; 0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eIron (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e1.677 \u0026plusmn; 0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e0.205 \u0026plusmn; 0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003ePotassium (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e72.383 \u0026plusmn; 4.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e28.75 \u0026plusmn; 5.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003eSodium(mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e71.953 \u0026plusmn; 4.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e175.552 \u0026plusmn; 145.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003ePhosphorus (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2436%;\"\u003e\n \u003cp\u003e159.917 \u0026plusmn; 60.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1987%;\"\u003e\n \u003cp\u003e20.115 \u0026plusmn; 26.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3141%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHPEF_A - Hospital-prepared enteral feed for Hospital A, HPEF_A - Hospital-prepared enteral feed for Hospital A, *significant at p \u0026le; 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of energy and nutrient values of hospital-prepared enteral feeds to a commercial formula (\u003cem\u003eEnsure\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe energy and nutrient values of hospital-prepared enteral feeds (HPEF_A AND HPEF_B) were compared to \u003cem\u003e\u0026ldquo;Ensure\u003c/em\u003e\u0026rdquo; commercial formula. These results are presented in Tables 4 and 5.\u003c/p\u003e\n\u003cp\u003eTable 4 highlights the energy and nutrient values of Hospital-prepared enteral feed for Hospital A (HPEF_A) compared to 100 ml of \u0026ldquo;\u003cem\u003eEnsure\u003c/em\u003e\u0026rdquo; commercial formula. Significant differences (p \u0026le; 0.05) were observed in all the nutritional parameters, except for fibre, which was not reported for \u003cem\u003eEnsure\u003c/em\u003e. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Comparison of energy and nutrient values of hospital-prepared enteral feed for Hospital A compared to \u0026ldquo;\u003cem\u003eEnsure\u003c/em\u003e\u0026rdquo; commercial formula\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional Parameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;HPEF_A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEnsure\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eMoisture (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e93.93 \u0026plusmn; 0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eEnergy (kcal/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e23.19 \u0026plusmn; 2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e92.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eFibre (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e0.49 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eFat (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e0.28 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eProtein (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e0.50 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eCarbohydrate (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e4.66 \u0026plusmn; 0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eVitamin C (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e24.44 \u0026plusmn; 9.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eCalcium (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e24.74 \u0026plusmn; 7.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e139.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eIron (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e1.68 \u0026plusmn; 0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.029*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003ePotassium (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e72.38 \u0026plusmn; 4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e168.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003eSodium(mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e71.95 \u0026plusmn; 4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e88.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.3951%;\"\u003e\n \u003cp\u003ePhosphorus (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.0441%;\"\u003e\n \u003cp\u003e159.92 \u0026plusmn; 60.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e105.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2804%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHPEF_A - Hospital-prepared enteral feed for Hospital A, *significant at p \u0026le; 0.05\u003c/p\u003e\n\u003cp\u003eThe results for the energy and nutrient values for hospital-prepared enteral feed for Hospital B (HPEF_B) and \u0026ldquo;\u003cem\u003eEnsure\u003c/em\u003e\u0026rdquo; commercial formula are shown in Table 5. Significant differences (p \u0026le; 0.05) were observed in all nutrients. \u0026nbsp;It is noteworthy that \u003cem\u003eEnsure\u003c/em\u003e product manufacturer reported a non-specific fibre content value of less than 1 [13]. Hence, we chose not to report on fibre for the commercial enteral formula.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Comparison of energy and nutrient values of hospital-prepared enteral feed for Hospital B compared to \u0026ldquo;\u003cem\u003eEnsure\u003c/em\u003e\u0026rdquo; commercial formula\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional Parameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPEF_B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEnsure\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eMoisture (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e94.83 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eEnergy (kcal)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e21.63 \u0026plusmn; 1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e92.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eFibre (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e0.12 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eFat (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e0.50\u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eProtein (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e0.002 \u0026plusmn; 0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eCarbohydrate (g/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e4.29 \u0026plusmn; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eVitamin C (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e30.24 \u0026plusmn; 4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eCalcium (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e4.75 \u0026plusmn; 0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e139.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eIron (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e0.20 \u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003ePotassium (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e28.75 \u0026plusmn; 5.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e168.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003eSodium(mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e175.55 \u0026plusmn; 145.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e88.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5206%;\"\u003e\n \u003cp\u003ePhosphorus (mg/100g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1095%;\"\u003e\n \u003cp\u003e20.12 \u0026plusmn; 26.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.6715%;\"\u003e\n \u003cp\u003e105.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6984%;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHPEF_B - Hospital-prepared enteral feed for Hospital B, one sample t-test, *significant at p \u0026le; 0.05\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study explored the nutrient profiles of enteral feeds prepared in two selected hospitals in Accra, Ghana, revealing several key findings with significant implications for both research and practice. Dietitians in the two hospitals predominantly used hospital-prepared enteral feeds over commercial formulas. This preference may be attributed to the availability and lower cost of local ingredients used in hospital-prepared feeds, as highlighted by Ojo and colleagues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], who noted the high usage of such feeds in developing countries due to their cost-effectiveness. The commercial formulas used included brands like \u003cem\u003eEnsure\u003c/em\u003e, \u003cem\u003eComplan\u003c/em\u003e, and \u003cem\u003eCasilan\u003c/em\u003e, with \u003cem\u003eEnsure\u003c/em\u003e being the most common due to its widespread availability in urban pharmacies.\u003c/p\u003e \u003cp\u003eThe nutrient analysis revealed that the energy and nutrient values of hospital-prepared feeds were significantly lower compared to commercial formulas and those reported in other studies. For instance, the energy content of the feeds in this study was 23.19 kcal/100g in Hospital A and 21.63 kcal/100g in Hospital B, which is considerably lower than the 40.5 kcal/100g reported by Vieira and colleagues [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and the 84 kcal/100ml found in commercial formulas like Ensure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This low energy content could potentially put patients at risk for malnutrition.\u003c/p\u003e \u003cp\u003eSimilarly, the protein content in the feeds was found to be inadequate, with values of 0.498 g and 0.002 g per 100g in Hospitals A and B, respectively. This is much lower than the 2.10 g reported by Vieira and colleagues [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and the 3.7 g per 100 ml found in \u003cem\u003eEnsure\u003c/em\u003e. Given the critical role of protein in promoting healing and managing metabolic stress [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the low protein content is concerning. The primary protein source, fish, is relatively expensive in the study setting, which might limit its use, thus contributing to the low protein content, especially since neither hospital had a standardized recipe or protocol for feed formulation.\u003c/p\u003e \u003cp\u003eThe study also found significantly lower fat and fibre values in the hospital-prepared feeds compared to other studies. For instance, fat and fibre values in this study were 0.28g and 0.49g in Hospital A, and 0.50g and 0.12g in Hospital B, respectively, whereas Vieira and colleagues [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] reported values of 1.90 g and 0.80 g for fat and fibre respectively. The low values observed may be due to nutrient loss during preparation, such as sieving or diluting feeds with water to reduce viscosity, making them easier to pass through feeding tubes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMineral and vitamin values were also lower than reported in previous studies. Potassium, calcium, sodium, and phosphorus values were lower than those reported by previous studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, iron and vitamin C levels in Hospital A (1.68 mg and 24.44 mg, respectively) were higher than those reported by Mokhalalati \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The discrepancies in nutrient content between the two hospitals, coupled with the lack of standardized recipes, suggest inconsistencies in ingredient usage and preparation methods.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, this study is the first to describe and compare nutrient profiles of hospital prepared enteral feeds in Ghana. It has significant implications for practice and has contributed new data to aid the planning and provision of enteral nutrition support in hospitals in Ghana. These strengths notwithstanding, the study had some limitations. The study was conducted in 2 public hospitals in Accra, the results thus reflect the unique enteral feed preparation practices and nutrient profiles of hospital prepared enteral feeds of these two hospitals. Consequently, the study's conclusions are based on a narrow scope, which might overlook important factors or trends that could have been identified with a broader dataset from multiple hospitals. This limitation underscores the need for future research to include a more extensive range of hospitals to validate the findings and ensure broader applicability.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe low energy and nutrient content of hospital-prepared feeds highlight the need for standardized recipes and protocols to ensure adequate nutrition for patients. Dietitians and healthcare providers should whenever possible, consider supplementing hospital-prepared feeds with commercial formulas or other nutrient-dense options to meet patient needs. Future research should focus on understanding the impact of preparation techniques, such as sieving and dilution, on nutrient retention. Additionally, exploring cost-effective, nutrient-dense recipes using locally available ingredients could improve the nutritional quality of hospital-prepared feeds. To help address these issues, hospitals should adopt standardized recipes and protocols for enteral feed preparation, consider fortifying feeds with commercially available nutrient powders or supplements, and provide training for dietitians and kitchen staff on nutrient preservation. Future studies should investigate nutrient losses associated with different preparation methods and explore alternative, locally sourced ingredients to enhance feed quality. By addressing these gaps, there is potential to improve the nutritional care of patients receiving enteral feeds and reduce the risk of malnutrition in hospital settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHPEF_A - Hospital-prepared enteral feed for Hospital A\u003c/p\u003e\n\u003cp\u003eHPEF_B - Hospital-prepared enteral feed for Hospital B\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approval was sought from the University of Ghana College of Health Sciences Ethical and Protocol Review Committee (Protocol number – CHS-Et/M.7-4.8/2018-2019), and the Institutional Review Boards of the two participating hospitals. Participation in the study was purely voluntary and a written informed consent was obtained from participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe data supporting this study will be made available upon reasonable request from corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u0026nbsp;\u003c/strong\u003eL.B. and R.A. conceived, designed, and carried out the study, analysed data, and wrote the manuscript. D.M. and M.A. contributed to the study’s design, provided critical revisions, and approved the final version. E.N. assisted with data collection and analysis and contributed to manuscript preparation. All authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors extend their gratitude to all the dietitians and diet cooks at the study hospitals for their invaluable support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMcClave SA, Martindale RG, Rice TW, Heyland DK. Feeding the critically ill patient. Critical care medicine. 2014 Dec 1;42(12):2600-10.\u003c/li\u003e\n\u003cli\u003eOjo O, Keaveney E, Wang XH, Feng P. The effect of enteral tube feeding on patients\u0026rsquo; health-related quality of life: a systematic review. Nutrients. 2019 May 10;11(5):1046.\u003c/li\u003e\n\u003cli\u003eKopp Lugli A, de Watteville A, Hollinger A, Goetz N, Heidegger C. Medical nutrition therapy in critically ill patients treated on intensive and intermediate care units: a literature review. Journal of clinical medicine. 2019 Sep 6;8(9):1395.\u003c/li\u003e\n\u003cli\u003eRobinson D, Walker R, Adams S. American Society for Parenteral and Enteral Nutrition (ASPEN) definition of terms, style, and conventions used in ASPEN Board of Directors\u0026ndash;Approved documents.\u003c/li\u003e\n\u003cli\u003eBrown B, Roehl K, Betz M. Enteral nutrition formula selection: current evidence and implications for practice. Nutrition in Clinical Practice. 2015 Feb;30(1):72-85.\u003c/li\u003e\n\u003cli\u003eBlaauw R, Du Toit AL. Case Study: Enteral formula: Selecting the right formula for your patient. South African Journal of Clinical Nutrition. 2017 Jun 23;30(2).\u003c/li\u003e\n\u003cli\u003eBowling TE. Enteral nutrition. Hospital Medicine. 2004 Dec;65(12):712-6.\u003c/li\u003e\n\u003cli\u003eHron B, Fishman E, Lurie M, Clarke T, Chin Z, Hester L, Burch E, Rosen R. Health outcomes and quality of life indices of children receiving blenderized feeds via enteral tube. The Journal of pediatrics. 2019 Aug 1;211:139-45.\u003c/li\u003e\n\u003cli\u003eNyati M, Ogada I, Nyirenda C. Adequacy of energy, zinc and selenium intakes among adult inpatients receiving total naso-gastric tube feeding admitted to a Copperbelt province Referral Hospital, in Ndola District, Zambia. BMC Nutrition. 2016 Dec;2:1-9.\u003c/li\u003e\n\u003cli\u003eAlhassan RK, Tsikata R, Tizaawaw RN, Tannor PA, Quaw PP, Awortwi CA, Ayanore MA, Afaya A, Salia SM, Milipaak J, Mwini-Nyaledzigbor PP. Adherence to standard nursing protocols on nasogastric tube feeding in a secondary referral hospital in Ghana: comparing self-ratings by professional and auxiliary nurses. BMC health services research. 2019 Dec;19:1-9.\u003c/li\u003e\n\u003cli\u003eAOAC. Official Methods of Analysis. Helrich K, editor. 15th ed. Washington DC: Association of Analytical Chemist, Inc.; 1990.\u003c/li\u003e\n\u003cli\u003eASEAN Network of Food Data Systems. ASEAN Manual of Food Analysis. First ed. Thailand; 2011\u003c/li\u003e\n\u003cli\u003eAbbott Nutrition Laboratories. Ensure\u0026reg; Original Shake: Complete, Balanced Nutrition. Abbott Nutrition. 2024. Available from: https://www.abbottnutrition.com/our-products/ensure-original-shake\u003c/li\u003e\n\u003cli\u003eOjo O, Adegboye AR, Ojo OO, Wang X, Brooke J. An evaluation of the nutritional value and physical properties of blenderised enteral nutrition formula: a systematic review and meta-analysis. Nutrients. 2020 Jun 20;12(6):1840.\u003c/li\u003e\n\u003cli\u003eVieira MM, Santos VF, Bottoni A, Morais TB. Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults. Clinical Nutrition. 2018 Feb 1;37(1):177-81.\u003c/li\u003e\n\u003cli\u003eHassan-Ghomi M, Nikooyeh B, Motamed S, Neyestani TR. Efficacy of commercial formulas in comparison with home-made formulas for enteral feeding: A critical review. Medical journal of the Islamic Republic of Iran. 2017;31:55.\u003c/li\u003e\n\u003cli\u003eMcClave SA, DiBaise JK, Mullin GE, Martindale RG. ACG clinical guideline: nutrition therapy in the adult hospitalized patient. Official journal of the American College of Gastroenterology| ACG. 2016 Mar 1;111(3):315-34.\u003c/li\u003e\n\u003cli\u003eCarter H, Johnson K, Johnson TW, Spurlock A. Blended tube feeding prevalence, efficacy, and safety: what does the literature say?. Journal of the American Association of Nurse Practitioners. 2018 Mar 1;30(3):150-7.\u003c/li\u003e\n\u003cli\u003eMokhalalati JK, Druyan ME, Shott SB, Comer GM. Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia. Saudi medical journal. 2004 Mar 1;25(3):331-41. \u003c/li\u003e\n\u003cli\u003eSullivan MM, Sorreda-Esguerra P, Platon MB, Castro CG, Chou NR, Shott S, Corner GM, Alarcon P. Nutritional analysis of blenderized enteral diets in the Philippines. Asia Pacific journal of clinical nutrition. 2004 Dec 1;13(4).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Enteral feeding, hospital-prepared feeds, standardized recipe","lastPublishedDoi":"10.21203/rs.3.rs-5319046/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5319046/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHospital-prepared enteral feeds have demonstrated significant benefits for critically ill patients, primarily by maintaining gut integrity, reducing stress, and supporting immunity. These feeds are often preferred over commercial formulas due to their cost-effectiveness and patient tolerability. However, despite these advantages, hospital-prepared enteral feeds can exhibit inconsistent energy and nutrient values, which may impact their effectiveness. In Africa, and specifically in Ghana, there is a notable gap in documented research regarding the nutrient profiles of these feeds. This lack of data makes it challenging to standardize and optimize enteral nutrition practices across hospitals. Recognizing this gap, our study aims to assess the nutrient profiles of hospital-prepared enteral feeds in two selected hospitals in Accra\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTwenty-one (21) dietitians and six (6) diet cooks were interviewed. Three (3) hospital-prepared enteral feed samples were collected from the two hospitals on three different days and their energy and nutrient values were analysed. The recipes used in the preparation of the feeds were collected through interviews with diet cooks. Energy and nutrient values obtained from chemical analyses of hospital-prepared enteral feeds, were compared to a commercial formula using one sample t-test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost dietitians in both hospitals (90% in Hospital A and 73% in Hospital B) utilized hospital-prepared enteral feeds, such as fortified porridges and soups. However, the energy and nutrient values of these feeds were significantly lower compared to a commercial formula (\u003cem\u003eEnsure\u003c/em\u003e original). When enteral feeds from the 2 hospitals were compared, statistically significant differences were found for all nutrients except energy, carbohydrate, vitamin C, and sodium.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study highlighted differences in the nutritional profiles of hospital-prepared enteral feeds between the 2 hospitals, and significantly lower energy and nutrient content compared to a commercial formula, \u003cem\u003eEnsure Original\u003c/em\u003e. Low energy and nutrient content in hospital-prepared feeds could lead to suboptimal patient outcomes, including slower recovery times and increased susceptibility to infections. Further research is needed to explore ways to improve the nutrient profiles of hospital-prepared feeds and develop enteral feeding protocols in hospitals in Ghana.\u003c/p\u003e","manuscriptTitle":"Nutrient Profiles of Enteral Feeds in Two Selected Hospitals in Accra, Ghana.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 07:34:50","doi":"10.21203/rs.3.rs-5319046/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d110470a-4506-402a-9695-842975fd4b9a","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-20T07:34:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-20 07:34:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5319046","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5319046","identity":"rs-5319046","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}