GLITEROS enteral formula based on tempeh flour and jicama flour for patients with hyperglycemia

V Sutikno,D.Y Fitranti,A Rahadiyanti,D.N Afifah,C Nissa

doi:10.26656/fr.2017.4(s3).s17

Abstract

Critically ill patients are susceptible to hyperglycemia during the treatment in the hospital. This condition could reduce immunity and increase the risk of mortality. The use of commercial diabetes-specific enteral reduces blood glucose level but increase the hospitalization cost due to the long-term period. Therefore, the homemade enteral formula developed using tempeh flour and jicama flour. GLITEROS comes from glycemia, tempeh and Pachyrhizus erosus. Arginine, glycine, and isoflavone contained in tempeh flour could improve insulin secretion. Moreover, inulin in jicama flour could control the increasing of blood glucose levels. The purpose of this study was to analyze the viscosity, macro-nutrient content, food fiber and protein digestibility of GLITEROS enteral formula. GLITEROS made from tempeh flour, jicama flour, soybean oil, skim milk, maltodextrin, and sugar. This study was an experimental design with three groups formula, A1 (1:1), A2 (5:3), A3 (2:3). Variables include viscosity, energy density, energy content, carbohydrates, protein, fat, dietary fiber and protein digestibility each with 3x repetitions in duplicate. The data were analyzed using Kruskal Wallis and One-way ANOVA. A1 formula had the highest carbohydrate (62%), dietary fiber (25.59%), and fat (10.49%) lower than A2 and A3 formula. A2 formula had 0.98 kcal/mL density energy and 984 kcal energy, 11,73 cP lower than A3 and A1 formula. A3 formula had the highest density energy (1.13 kcal/ mL), energy (1132.45 kcal), 36.10 cP viscosity, and protein (14.89%) lower than A1 and A2 formula. A1 formula is the most eligible in viscosity, energy density, energy content and protein of enteral formula for hyperglycemia patient according to American Diabetes Association (ADA), Canadian Diabetes Association (CDA), American Society of Parenteral and Enteral Nutrition (ASPEN) requirements.

Highlights

Hyperglycemia is a common complication in critically ill patients with a mortality rate 31% higher than patients with diabetes and normoglycaemia (Godinjak et al, 2015)
The hyperglycemia enteral formula in Indonesia is generally available in the form of commercial formulas, where the price is relatively more expensive resulting in an increase in hospitalization cost for patients
The requirements for enteral formulas for hyperglycemia patients must have hypoglycemic targets, osmolarity ranging from 300-450 mOsm/kg, and viscosity of 1-50 cP with energy densities of 1-1.2 kcal/ mL, energy content ranging from 15-25 kcal/kg/day, carbohydrates for 45-60% of total energy, 20-35% fat with 7-10% source of monounsaturated fatty acids (MUFA), 15-20% protein, 14 g/L soluble fiber and maximum use of 5% sugar (National Dysphagia Diet Task Force % American Dietetic Association, 2002; Cheng and Lau, 2013; Mc Mahon et al, 2013; Gosmanov and Umpierrez, 2013; American Diabetes Association, 2014; Sanz-Paris et al, 2017)

Summary

Introduction

Hyperglycemia is a common complication in critically ill patients with a mortality rate 31% higher than patients with diabetes and normoglycaemia (Godinjak et al, 2015). The increase in blood glucose levels in critical patients due to the release of counter regulatory hormones causes a decrease in insulin production, disrupts the glucose utilization by peripheral tissues and enhance the process of gluconeogenesis in the liver (Gosmanov and Umpierrez, 2013; Godinjak et al, 2015). The hyperglycemia enteral formula in Indonesia is generally available in the form of commercial formulas, where the price is relatively more expensive resulting in an increase in hospitalization cost for patients. Many hospitals developed enteral formulas (FERS) but have a relatively shorter shelf life because it is in liquid form. Innovations in the development of hospital enteral formula (FERS) using affordable local food ingredients in powder form becomes indispensable

Objectives

Methods

Results

Conclusion