The nutritional status of long-term Home Enteral Nutrition (HEN) patients of Te Whatu Ora Counties Manukau : a focus on energy, macronutrients, vitamin D, and selenium : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
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Date
2024
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Massey University
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Background: Good nutritional status is important for well-being and reduced morbidity and mortality risk and pressure on healthcare systems. Despite being under the care of dietitians, home enteral nutrition (HEN) patients may be at risk of malnutrition and macro- and micronutrient deficiencies. It is important to understand the nutritional status of these patients to recommend appropriate feeding and nutrient monitoring practices. Aim: To investigate the nutritional status (energy, macronutrients, vitamin D, selenium) of long-term home enteral nutrition (HEN) patients in Counties Manukau, New Zealand to determine the prevalence of malnutrition. Methods: Data were collected from 42 long-term (≥4 weeks) HEN patients (18+ years) under the care of Te Whatu Ora Counties Manukau. Enteral and oral intake were collected through 5 x 24-hour recalls and compared against patients’ prescriptions and estimated requirements (energy, macronutrients, vitamin D, selenium). Clinical signs of deficiency were assessed with a physical assessment (n=40), and nutritional biomarkers from a blood sample (n=22). Body composition was measured with bioelectrical impedance analysis (BIA) (n=29). Malnutrition prevalence was determined by the Global Initiative on Malnutrition (GLIM) criteria. Data were described by mean ± SD, geometric mean (95% confidence intervals), median (interquartile range), and frequencies. Independent t-tests, Mann-Whitney, and Chi-square tests were used to compare data by feeding route and prescription adherence. Results: Malnutrition prevalence was 62.5% (n=25). Prevalence of low BMI and fat free mass index (FFMI) was 47.5% and 44.8% respectively. Mean body mass index (BMI) (21.1 ± 3.6 kg/m²) was low but normal. Fat and/or muscle wasting occurred in at least 35%. Energy and/or protein intake was inadequate in 20% (n=8). Mean plasma vitamin D (143.55 ± 55.35 nmol/L) and selenium (1.37 ± 0.19 µmol/L) were within range with no evidence of deficiency, serum/plasma concentrations were high in 40% and 38.1% respectively. Mean vitamin D intake (13.2 ± 5.3 µg) was low in 26.2% (n=11) but met requirements for all age groups except ≥70 years. Mean selenium intake (95.0 ± 28.1 µg) was low in 7.1% (n=3) but met requirements for all. There were significant differences in nutritional status measures by feeding route and/or prescription adherence. Conclusions: Many HEN patients had poor energy and protein status but maintained good vitamin D and selenium status. Adjustments to feeding practices regarding energy and protein, and more frequent monitoring of malnutrition may be beneficial for prevention of morbidity and mortality.
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Malnutrition, oral, prescription, feeding route