Viscosity Thickened Enteral Formula

Reference work entry

Abstract

Thickened enteral formula (TEF) is a formula in which viscosity is intentionally increased by adding thickener to prevent enteral nutrition-related complications, such as diarrhea, nausea, vomiting, and gastroesophageal reflux (GER). Three types of TEFs are available at present: intragastric TEF, TEF prepared by mixing liquid enteral formula and thickener, and ready-to-use type. The positive effects of TEF are considered to be based on its high viscosity, which reduces the outflow rate of gastric contents and thereby helps to prevent diarrhea and GER. While several studies have been conducted on TEF with viscosity ranging from 900 to 20,000 mPa · s, the mechanisms of TEF have not been fully demonstrated. TEF efficacy with regard to reducing complications of EN should not be determined based solely on quantitative viscosity data, as modalities for measuring viscosity and assessing complications subsequent to administration have not been standardized. Potential advantages of TEF include prevention of GER, diarrhea, skin trouble around the percutaneous endoscopic gastrostomy puncture site, and improvement of blood glucose levels and quality of life for both patients and caregivers. However, most previous studies of TEF have been empirical in nature, with little scientific evidence available supporting the efficacy of TEF in preventing complications of EN. TEF administration is only successful when functions of gastric motility, enterokinesis, digestion, and absorption are all normal. When applying TEF, bacterial contamination, feeding tube shape, timing and volume of administered water, and nutrient interactions should be considered. Given the present findings, TEF appears more suitable for use in patients in long-term care hospitals, nursing homes, or home medical care settings than acute care hospitals. Establishing a solid base of evidence supporting the usage of TEF will require more large-scale randomized controlled trials.

Keywords

Zinc Hydrolysis Starch Magnesium Hydration 

List of Abbreviations

EN

Enteral nutrition

GER

Gastroesophageal reflux

IG

Intragastric

LT

Liquid and thickener

PEG

Percutaneous endoscopic gastrostomy

QOL

Quality of life

RTU

Ready to use

TEF

Thickened enteral formula

References

  1. Adachi K, Furuta K, Morita T, et al. Half-solidification of nutrient does not decrease gastro-esophageal reflux events in patients fed via percutaneous endoscopic gastrostomy. Clin Nutr. 2009;28:648–51.CrossRefPubMedGoogle Scholar
  2. Akatsu H, Yamamoto T, Suzuki Y, Kanie J. Better control of blood sugar with treatment using half-solid nutrients: a case report [in Japanese]. Nihon Ronen Igakkai Zasshi. 2005;42:564–6.CrossRefPubMedGoogle Scholar
  3. Goda F. The method of and evidence of short time gastrostomy tube feeding of semi-solid enteral nutrient. In: Goda F, editor. Guidebook for short time gastrostomy tube feeding of semi-solid enteral nutrient – towards the quality of good life for gastrostomy patients [in Japanese]. 1st ed. Tokyo: Ishiyaku Publishers; 2006a. p. 19–26.Google Scholar
  4. Goda F. The evidence for effectiveness of short time gastrostomy tube feeding of semi-solid enteral nutrient. In: Goda F, editor. Guidebook for short time gastrostomy tube feeding of semi-solid enteral nutrient – towards the quality of good life for gastrostomy patients [in Japanese]. 1st ed. Tokyo: Ishiyaku Publishers; 2006b. p. 27–34.Google Scholar
  5. Goda F. Short time gastrostomy tube feeding of semi-solid enteral nutrient [in Japanese]. In: PDN lectures. PEG doctors network; 2011. http://www.peg.or.jp/lecture/enteral_nutrition/05-02-01.html. Accessed 29 Apr 2013.
  6. Hallfrisch J, Behall KM. Mechanisms of the effects of grains on insulin and glucose responses. J Am Coll Nutr. 2000;19:320–25S.CrossRefGoogle Scholar
  7. Ichimasa A, Ichimaru S. Review of mechanism, current evidence and practice of enteral semi-solid formula use to prevent gastroesophageal reflux, diarrhea, and to improve patient care [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2010;25:1207–16.Google Scholar
  8. Ichimaru S, Amagai T, Wakita M, Shiro Y. Which is more effective to prevent enteral nutrition-related complications, high- or medium-viscosity thickened enteral formula in patients with percutaneous endoscopic gastrostomy?: a single-center retrospective chart review. Nutr Clin Pract. 2012;27:545–52.CrossRefPubMedGoogle Scholar
  9. Inada H, Kaneda K, Yamagata N. Prevention of aspiration pneumonia in patients with gastroesophageal reflux using REF-P1 (pectin gel) [in Japanese]. Jpn J Parenter Enteral Nutr. 1998;20:1031–6.Google Scholar
  10. Ito Y, Imataka T, Kobayashi K, et al. Comparison of the thickening agent and agar to use to prepare half solid enteral nutrition for the purpose of prevention of gastroesophageal reflux [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2006;21:77–83.Google Scholar
  11. Kanie J, Suzuki Y, Akatsu H, Kuzuya M, Iguchi A. Prevention of late complications by half-solid enteral nutrients in percutaneous endoscopic gastrostomy tube feeding. Gerontology. 2004a;50:417–9.CrossRefPubMedGoogle Scholar
  12. Kanie J, Suzuki Y, Iguchi A, Akatsu H, Yamamoto T, Shimokata H. Prevention of gastroesophageal reflux using an application of half-solid nutrients in patients with percutaneous endoscopic gastrostomy feeding. J Am Geriatr Soc. 2004b;52:466–7.CrossRefPubMedGoogle Scholar
  13. Kawasaki N, Urashima M, Odaira H, Noro T, Suzuki Y. Effects of gelatinization of enteral nutrients on human gastric emptying. Gastroenterol Res. 2010;3:106–11.Google Scholar
  14. Klosterbuer A, Roughead ZF, Slavin J. Benefits of dietary fiber in clinical nutrition. Nutr Clin Pract. 2011;26:625–35.CrossRefPubMedGoogle Scholar
  15. Maruyama M, Hiroi J, Matsumura A, Hashimoto N, Yokoshima Y. Intra-gastric change of the semi-solid formula with pectin liquid, “REF-P1” [in Japanese]. Jpn J Cancer Chemother. 2008;35:29–31s.Google Scholar
  16. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2009;33:277–316.CrossRefGoogle Scholar
  17. Miura Y, Endo R, Ikeda K, Sera K, Suwabe A. Comparison of absorption of trace elements on liquid and partially solidified enteral nutrition consist of the same elements – Examination about receipt and disbursement balance of trace elements after partially solidified enteral nutrition administration to rats. Nishina Mem Cyclotron Center Annu Report [in Japanese]. 2008;15:128–34.Google Scholar
  18. Miyamoto H. Application of nutrition support using half solid diet in the oldest patients with tube feeding [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2009;24:807–9.Google Scholar
  19. Miyazawa R, Tomomasa T, Kaneko H, Arakawa H, Shimizu N, Morikawa A. Effects of pectin liquid on gastroesophageal reflux disease in children with cerebral palsy. BMC Gastroenterol. 2008;8:11.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Murabayashi Y, Simizu A, Sakuma T, et al. Clinical experience with addition of polysaccharides thickening agent to liquid formula diets [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2006;21:85–9.Google Scholar
  21. Nagasawa K. Influence of semi-solid nutrient on gastric emptying in patients with gastrostomy. Jpn J Appl Physiol [in Japanese]. 2009;39:297–302.Google Scholar
  22. Nakayama T, Hayashi S, Okishio K, et al. Prompt improvement of a pressure ulcer by the administration of high viscosity semi-solid nutrition via a nasogastric tube in a man with tuberculosis: a case report. J Med Case Reports. 2010;4:24.CrossRefPubMedCentralGoogle Scholar
  23. Nishiwaki S, Araki H, Shirakami Y, et al. Inhibition of gastroesophageal reflux by semi-solid nutrients in patients with percutaneous endoscopic gastrostomy. J Parenter Enteral Nutr. 2009;33:513–9.CrossRefGoogle Scholar
  24. Okada S. Gel-forming properties of “EASYGEL”, the food for making various enteral nutrients into jelly [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2007;22:41–51.Google Scholar
  25. Okada S, Ogawa S. Influence of using semi-solid diet to the burden of nursing care for family- caregivers [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2011;26:1399–406.Google Scholar
  26. Shimoyama Y, Kusano M, Kawamura O, et al. High-viscosity liquid meal accelerates gastric emptying. Neurogastroenterol Motil. 2007;19:879–86.CrossRefPubMedGoogle Scholar
  27. Shizuku T, Adachi K, Furuta K, et al. Efficacy of half-solid nutrient for the elderly patients with percutaneous endoscopic gastrostomy. J Clin Biochem Nutr. 2011;48:226–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Tabei I, Kubo H, Yano F, Inada H. The effect of viscosity regulating solution for enteral nutrition against gastro esophageal reflux [in Japanese]. Jpn J Gastroenterol Surg. 2003;36:71–7.CrossRefGoogle Scholar
  29. Takemura Y, Yamashita S, Seiki M, Yamamoto T, Fukuda H. Changes in the physical properties of semisolid nutritional preparations in artificial gastric juice [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2011;26:1255–64.Google Scholar
  30. Wakita M, Masui H, Ichimaru S, Amagai T. Determinant factors of the viscosity of enteral formula – basic analysis of the thickened enteral formula. Nutr Clin Pract. 2012;27:82–90.CrossRefPubMedGoogle Scholar
  31. Yoshida S, Minei K, Yoshimi Takenouch Y, Wakunami A. Nutrition support using semi-solid diet with tube feeding in hospitalized elder patients [in Japanese]. J Jpn Soc Parenter Enteral Nutr. 2008;23:43–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Nutrition ManagementKobe City Medical Center General HospitalKobeJapan
  2. 2.Department of Food Science and NutritionSchool of Human Environmental Sciences, Mukogawa Women’s UniversityNishinomiyaJapan

Personalised recommendations