Formulation of Enteral Foods

This chapter describes the formulation of enteral foods based on malted cereals. Malted cereals are rich sources of easily digestible carbohydrates but are poor sources of dietary proteins. The proteins of malted cereals are deficient in lysine and tryptophan contents. To overcome this deficiency, the malted cereals are generally blended with grain legumes, or protein of animal origin for the preparation of nutritious foods (Chandrasekhara et al., 1957; Deshikachar, 1980; Malleshi and Deshikachar, 1986; Mareo et al., 1988; Onilude et al., 2004; Rao and Muralikrishna, 2006). Grain legumes, milk, and eggs are rich sources of dietary protein and contain favorable profile of essential amino acids (EAA). As discussed earlier, malting or sprouting also improves the overall nutritional quality of cereals and legumes (Bilgiçli and Elgün, 2005). Hence, the blend of malted cereals and legumes will be nutritious foods of enhanced bioavailability of nutrients. Incorporation of milk and egg to the blend further improves the protein quality as well as palatability of the food.

While formulating enteral foods, besides the overall nutritional quality, other factors such as the nutrient density, electrolytes concentrations, content of specific nutrients such as branched chain amino acids (Bower et al., 1986; Ferrando et al., 1995; Kato and Suzuki, 2004), aromatic amino acids (Ferenci, 1996), arginine (Barbul, 1986; Farreras et al., 2005), glutamine (Souba et al., 1990; Gianotti et al., 1995; Van den Berg et al., 2005), nucleotides (Van Buren et al., 1983; Farreras et al., 2005), and shadow nutrients (Menon and Natraj, 1984) among others require considerations, depending on the requirement of patients. Similarly, the composition of lipid, namely the proportion of polyunsaturated fatty acids (PUFA) with special reference to the ratio between n-6 and n-3 fatty acids (Narshimha Rao, 1993; Turley and Strain, 1993; Grester, 1995; Roy et al., 2004; Farreras et al., 2005), structured glycerides (Sandstorm et al., 1995; Roy et al., 2004), and medium-chain triglycerides (Ledeboer et al., 1995) is required to be incorporated in appropriate proportion. The beneficial effects of dietary fiber in normal nutrition are being extended to enteral nutrition (Cummings et al., 1980; Rushdi et al., 2004). The soy polysaccharides (Scheppach et al., 1990; Kapadia et al., 1995; Lien et al., 1996) are being used as sources of dietary fiber in most of the enteral foods. The breakdown fraction of the dietary fiber of the enteral foods serves as a major fuel to the intestinal villi in the form of short-chain fatty acids (mainly butyrates), besides contributing to the other well-known physiological benefits of the dietary fiber (Heymsfield et al., 1988; Frankenfield and Bayer, 1989; Rays et al., 2005). Several investigators have reported the beneficial effects of probiotics especially of lactic acid bacteria (LAB) in terms of colonization of intestinal microflora, reduction in lactose intolerance, minimization of bacterial translocation, and enhancement of immune status among others (Gilliland and Speck, 1977; Puhan and Zambrini, 1992; Schiffrin et al., 1995; Helander et al., 1997; Patider and Prajapati, 1997; Klaenhammer et al., 2005; Rays et al., 2005; Xiao et al., 2006).