Regional survey of neurodisabled clients in the community on long-term tube feeding as a main source of nutrition

Abstract

Background: It is well recognised that some people with cerebral palsy and other conditions have low energy requirements because they lack mobility and have a low resting energy expenditure (Dickerson et al., 1999). When tube fed, it may be necessary to give a reduced amount of an age appropriate feed to ensure an appropriate energy intake and avoid excessive weight gain, although this may compromise the intake of other nutrients (Skelton et al., 2006). The aim of the survey was to compare prescribed nutrient intake of tube fed clients, who have enteral feeding as their major source of nutrition, with dietary reference values. Methods: Data on type and quantity of prescribed feeds was collected retrospectively from the case notes of 59 adults and 16 children aged >3 years with a learning disability who have tube feeds as their main source of nutrition. A nutritional analysis of the feed was completed using Microdiet dietary analysis programme, which was compared with the reference values for nutrient intake (Department of Health, 1991) for energy, protein potassium, vitamin D and chloride. Results: None of the prescribed feeds met the estimated average requirements (EAR) for energy. The level of compliance varied for the other nutrients as shown in Table 1. Table 1. Percentage (n) of clients compliant with dietary reference values (EAR/lower reference nutrient intake) Nutrient % Compliance Number compliant Energy 0 0/75 Protein 21 16/75 Potassium 56 42/75 Vitamin D 0 0/75 Chloride 80 60/75 Discussion: Because the energy requirement was often low in this group, and the feed prescribed accordingly, the intake of other nutrients was compromised. Commercial feeds are not always available to meet this client group's needs therefore prescribers must be aware of the potential for deficiencies to occur and it may be necessary to supplement feeds. It was possible that clients needing a very much reduced energy intake may not require as much as the reference nutrient intake for nutrients but there is no research to support this. Conclusions: The survey showed that the adults and children do not meet the EAR for energy and do not meet the reference nutrient intake/lower reference nutrient intake for some nutrients. Regular assessment, monitoring and follow-up with appropriate supplementation is necessary to ensure a nutritionally adequate intake.