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Background: Among the anthropometric measurements, calf circumference has been widely used as a simple and practical method to diagnose low muscle mass and sarcopenia. However, the association between this measurement and clinical outcomes in people receiving home enteral nutrition is still unknown. Therefore, this study aimed to investigate the association of calf circumference with mortality, discharge from home enteral nutrition, continuity in home enteral nutrition, and new hospitalizations in adult and older adult people. Methods: This retrospective cohort study used secondary data, including people aged ≥18 years receiving home enteral nutrition. The association between calf circumference and the outcomes of mortality, discharge from home enteral nutrition, and continuity in home enteral nutrition was analyzed using multinomial logistic regression. The association between calf circumference and the occurrence of new hospitalizations was investigated using binary logistic regression. Results: Among the 899 people included in the study, 470 were men (52.3%), the median age was 72 years (interquartile range, 56.5–82), and 850 had inadequate calf circumference (94.5%). As calf circumference increased, the odds of mortality decreased and the probability of discharge from home enteral nutrition and continuity in home enteral nutrition increased. Furthermore, in people with oncologic diagnoses, the odds of new hospitalizations were reduced by 71.9% for each additional centimeter in calf circumference. Conclusion: These findings underline the importance of using calf circumference as part of the nutrition assessment because it is a simple, easy, and cost‐effective method that can also be used as a tool to predict clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: With data demonstrating benefit, the prevalence of home enteral nutrition (HEN) has increased significantly over the last few decades. Despite this increase, there remains a paucity of data regarding real‐world use of HEN including clinical outcomes and complications. Methods: Descriptive analysis of prospectively maintained database of our specialized HEN program was undertaken. Patients who received care in our program with HEN initiation date between January 1, 2018, and December 31, 2020, were included in the analysis. Data regarding demographic information, anthropometrics, enteral nutrition (EN) regimen, electrolytes, and nutrition therapy history were included and tracked until July 31, 2021. Results: During the study period, 1600 patients initiated HEN treatment under our care. Majority of the study population needed EN therapy due to malignancy and its complications, including malignant dysphagia or mechanical obstruction (60.6%) followed by neurodegenerative diseases (7.5%). By the end of the study period, a majority of the patients (82%) stopped HEN treatment. Of these, 44.2% achieved EN goals and/or oral autonomy. Patients continued HEN treatment for a median of 100 (interquartile range, 32–301) days. Overall, 53.2% of patients experienced/reported at least one HEN‐related complication that was clinically managed by the HEN team. Complications included tube‐related, enteral feeding intolerance (EFI), and electrolyte shifts. Conclusion: In our study population, HEN was most utilized to manage malignancy‐related complications, including dysphagia. Unfortunately, complications, including EFI and tube‐related complications, remained quite prevalent. Further evaluation regarding risk factors for complications and preventive mechanisms, such as increased education, is indicated. [ABSTRACT FROM AUTHOR]

Background: The emerging field of chrononutrition investigates the effects of the timing of nutritional intake on human physiology and disease pathology. It remains largely unknown when patients receiving home nutrition support routinely administer home parenteral nutrition (HPN) and/or home enteral nutrition (HEN). Methods: The present descriptive study included data collected from a patient‐oriented survey designed to assess the timing of infusions and sleep habits of patients receiving HPN and HEN in the United States. Results: A total of 100 patients were included. Patients had a mean age of 44.1 years and 81% were female. Among 73 patients supported with HPN and 27 patients supported with HEN, 86% and 44% reported overnight infusions, respectively. The median start and end times of overnight infusions were 2100 (interquartile range [IQR] = 1900–2200) and 0800 (IQR = 0700–1000), respectively, for HPN and 2000 (IQR = 1845–2137) and 0845 (IQR = 0723–1000), respectively, for HEN. Overnight infusions started 2.0 h (IQR = 1.1–3.0) and 2.0 h (IQR = 0.6–3.3) before bedtime for HPN and HEN, respectively, and stopped 12.9 min (IQR = −21.3 to 29.1) and 30.0 min (IQR = −17.1 to 79.3) after wake time for HPN and HEN, respectively. Sleep disruption because of nutrition support or urination was most common among patients receiving infusions overnight compared with those receiving infusions continuously or during the daytime. Conclusions: Our survey study focusing on a novel and medically relevant dimension of nutrition found that most HPN‐dependent and HEN‐dependent patients receive infusions overnight while asleep. Our findings suggest that overnight infusions coinciding with sleep may result in sleep and circadian disruption. [ABSTRACT FROM AUTHOR]

Background: Home enteral nutrition (HEN) use continues to increase in children unable to meet nutritional needs through oral intake. Some patients do not tolerate standard polymeric formula (SPF), which may lead to malnutrition. Use of peptide‐based diet (PBD) has demonstrated benefits in adults, however there remains a paucity of data in pediatric population. Methods: Retrospective review of medical records of children receiving HEN between October 2015 and October 2019 was conducted. Nutrition, tolerance, and healthcare utilization was tracked through May 2020. Children receiving PBD as initial formula or transitioned to PBD from SPF were included. Our objective was to assess gastrointestinal tolerance and impact on healthcare utilization in children receiving PBD. Results: During study period, 30 children (mean age, 9 ± 5.44 years; 20 of 30 [66.7%] male) utilized PBDs. Twenty‐one patients started PBD directly with malnutrition as primary indication. Nine patients transitioned from SPF to PBD, most often due to intolerance of SPF (66%). After transition to PBD, no symptoms were reported in 6 of 9 (66.7%) patients, and symptoms of SPF intolerance resolved in 4 of 9 (44.5%) patients. Healthcare utilization declined significantly after transition to PBD, including mean numbers of emergency room visits (0.78 ± 1.09 to 0.11 ± 0.33; P =.025), provider visits (1.67 ± 1.32 to 0.56 ± 0.73; P =.007), and phone calls (1.22 ± 1.39 to 0.33 ± 0.50; P =.026). Conclusions: PBD is well tolerated and can result in significant reduction in healthcare utilization in children intolerant to SPF. [ABSTRACT FROM AUTHOR]

Objective: Peptide ‐based (PB) enteral tube feeding (ETF) formulas have been shown to reduce gastrointestinal (GI) intolerance in patients receiving enteral nutrition. However, limited data exist in relation to their use in the postacute/home care setting. We sought to assess the real‐world GI tolerance, healthcare utilization, and resource use costs of 100% whey‐protein PB ETF in adults in a postacute care setting and describe their demographic, clinical, and treatment characteristics. Method: Using medical claims data from the United States, we analyzed GI intolerance events occurring in adults receiving 100% whey‐protein PB ETF (Peptamen® adult formulas) for one year before and after initiation of ETF. Resource use costs were subsequently estimated using a multivariate general linearized model and adjusted for age, gender, and Charlson Comorbidity Index score. Results: The proportion of adults experiencing no GI intolerance events increased from 41% (418/1022) to 59% (601/1022) in the one‐year period after initiation of 100% whey PB ETF (P <.001). The proportion of patients with at least one hospital inpatient visit also decreased from 100% (1022/1022) to 72% (737/1022) over the same period, and the mean number of inpatient visits per patient decreased from 15.6 to 13.0. Cost modeling revealed that outpatient visits accounted for 42% ($1174/$2820) of total estimated healthcare resource costs in the first 30 days after 100% whey PB ETF initiation, with only 9% ($255/$2820) due to emergency room visits. Conclusion: These 100% whey‐protein PB ETF formulas are a valuable nutrition treatment option for patients with or at risk of malnutrition who show intolerance to standard ETF formulas and may reduce hospital inpatient visits and associated costs. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is by far the most effective treatment option available for successfully achieving and maintaining weight loss in the obese population, but it can also be associated with complications that lead to malnutrition. There is limited data on how enteral nutrition (EN) can be used to provide nutrition support in such cases. Methods: Retrospective review of our Home Enteral Nutrition (HEN) database was conducted from February 2013 to April 2018 to identify patients who received HEN because of bariatric surgery–related complication. Results: During the study period, 72 patients (86% female, mean age 50.3 ± 11.6 years) initiated HEN because of bariatric surgical complication. Most common bariatric surgery was Roux‐en‐Y (74%) and most common indication for HEN was malnutrition/failure to thrive (33%). HEN was most commonly provided through nasojejunal feeds and resulted in an average increase in body weight and body mass index from 74.8 kg and 26.5, respectively, before HEN to 76.9 kg and 27.2, respectively, at the end of the HEN period. Through HEN, patients received 22.2 ± 7.9 kcal/kg/d and 1.0 ± 0.3 g/kg/d protein, meeting 94% ± 17% of their energy goals and 95% ± 29% of their protein goals. Vitamin deficiencies were noted in 69% of patients at the time of HEN initiation, which improved to 10% after enteral feeds and appropriate vitamin supplementation. Conclusion: HEN is safe and effective in treating malnutrition and vitamin deficiencies that might occur as a complication of bariatric surgery, leading to avoidance of parenteral nutrition support in most cases. [ABSTRACT FROM AUTHOR]

Purpose: The increased prevalence of home enteral nutrition (HEN), reemergence of blenderized tube feeding (BTF), and conversion of enteral connectors to the ISO 80369-3 standard are creating a significant need to better understand the practices of the HEN population. A cross-sectional survey of current HEN consumers was conducted to evaluate the demographics of HEN consumers, including formulas and feeding tubes being used.Methods: In order to disseminate the survey to a wide range of HEN consumers, we partnered with private infusion companies (Coram and Pediatric Home Services) along with the Oley and Tube Feeding Awareness Foundations. A validated survey focusing on patient demographics, tube types, formula used, and tube clogging complications was placed online from September 1, 2016, to October 15, 2016.Results: During the study period, 1519 surveys were completed, with 1062 respondents in the pediatric group (<18 years old) and 457 in the adult group (≥18 years old). The most popular formulas were standard polymeric and specialized formulas in both the pediatric and adult groups. However, a significant number in the pediatric (31.2%) and adult (18.6%) groups used BTF either alone or in combination with other formulas. Clogging was also quite prevalent and correlated with tube size.Conclusions: The present study highlights the significant diversity of the HEN practice in terms of types and sizes of tubes as well as formulas used, including confirmation of the widespread use of BTF. These data are key to ensure HEN providers are able to appropriately support and educate their patients. [ABSTRACT FROM AUTHOR]