Rama Med J I Original Article

The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction
in Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin
Kulapong Jayanama1, Piyanuch Maitreejorn2, 3, Thanwarin Tangsermwong2, Pariya Phanachat4,
Prapimporn Chattranukulchai4, Patcharavee Tanlakit2, Daruneewan Warodomwichit4
1
Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
2
Division of Nutrition and Dietetics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3
Division of Nutrition, Pak Phayun Hospital, Phatthalung, Thailand
4
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Background: The requirement of a hospital-made, blenderized diet, as a generally Corresponding Author:

used and complete polymeric formula, is increasing beyond supply availability Daruneewan Warodomwichit
and accessibility. A ready-to-use blenderized diet with chicken and pumpkin in Department of Medicine,
a retort pouch was developed from regular use formula by nutritionists and Faculty of Medicine
dietitians to solve these problems. However, its clinical outcomes should be Ramathibodi Hospital,
evaluated. Mahidol University,
270 Rama IV Road, Ratchathewi,
Objectives: To assess the efficacy and safety of a ready-to-use blenderized
Bangkok 14000, Thailand.
diet, and to examine the satisfaction of patients and caregivers.
Telephone: +66 2201 1301,
Methods: Thirty adult patients in Ramathibodi Hospital with absolute tube +66 2201 0082
feeding were included in a pre-post treatment comparative study and fed Fax: +66 2201 1715
with the study formula for 14 days. Body composition measurements, Email: [email protected]
nutritional status, clinical parameters, and biochemical tests were collected
at baseline and day 14 after feeding. Complications were monitored daily.
Satisfaction was evaluated at day 14.
Results: This study reported statistically significant improvements in
nutritional status (P < .001), albumin (P = .003), prealbumin (P = .007),
total lymphocytic count (P = .004), and phase angle (P = .02) after 14-day
feeding. No major complications were reported. Satisfaction of product use
was evaluated in the level of satisfied (27%) and very satisfied (73%).
Conclusions: The present study revealed that a ready-to-use blenderized diet
with chicken and pumpkin was efficacious in ameliorating nutritional status,
nutrition-related blood tests, and phase angle without any major complications.
Keywords: Blenderized diet, Enteral nutrition, Nutritional status, Malnutrition,
Phase angle
Rama Med J: doi:10.33165/rmj.2019.42.4.191337
Received: June 10, 2019 Revised: October 7, 2019 Accepted: December 2, 2019

12 Rama Med J Vol.42 No.4 October - December 2019

The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

increased osmolarity, viscosity, and physical and chemical

Introduction instability were found in homemade blenderized enteral
The prevalence of malnutrition is higher in hospitalized diets compared with standard blenderized diets.
patients1, 2 and those with a chronic illness3 comparing Furthermore, the homemade blenderized diets
with the general population. Malnutrition, particularly in contained less than half of the prescribed energy and
terms of protein malnutrition, is associated with worsening macronutrients, and resulted in diarrhea, tube feeding
clinical outcomes, impairment of functional status, obstruction, and inadequate nutrient intake.12 Given
immune system, wound healing, and cognitive function, these reasons and the inconvenience of self-preparation,
as well as increase in hospital readmission and mortality rate.4 many patients decide to order blenderized diets from
Prolonged, inadequate dietary consumption can lead to hospitals. The higher blenderized diet requirement
malnourishment. Appropriate nutritional management becomes a burden of hospital personnel to produce and
plays an important role in prevention and improvement wasting patients’ time in daily transportation to the hospital.
of this condition. Oral supplements or enteral feeding Consequently, a ready-to-use blenderized diet with
should be considered in patients eating less than daily chicken and pumpkin in a retort pouch was created to
dietary requirement.5 address these problems. This product has a long shelf
In patients with intact gastrointestinal function, life (up to 3 months), which prevents microbial agents
enteral nutrition is a preferable method due to lower and preserves macronutrients. However, its efficacy and
severe complications and better clinical outcomes such as safety in patients must be confirmed.
reduced infections, hospital costs, and length of stay.6-8 This study aimed to assess the efficacy and safety
Moreover, this feeding method can preserve healthy gut of a ready-to-use blenderized diet with chicken and
function such as minimized villi atrophy, endocrine organ pumpkin in a retort pouch and to evaluate the satisfaction
function, barrier against bacteria, and immunological of patients and their caregivers with this product.
function.9, 10 Because of these reasons, enteral feeding is
increasingly used to ensure that patients receive their
nutritional needs in both hospital and community setting.11 Methods
Blenderized diet is a complete polymeric formula Study Population
for tube feeding in patients with normal gastrointestinal The study was designed as a pretreatment and
function. This diet is produced from blended natural posttreatment comparative, open-label study conducted
foods by dietitians or nutritionists with standardized in the in-patient unit at Ramathibodi Hospital. Thirty
control and served for hospital-based use. The advantages adult patients who required tube feeding for total energy
of this diet are the tailor-made formulas, natural sources intake at least 14 days were included. Participants received
of products, and lower costs.12 However, it must be used other sources of calories (eg, oral diet or parenteral nutrition),
within 24 hours of production.13, 14 had contraindication to enteral feeding (ie, gut obstruction,
Nowadays, the number of patients with chronic intestinal failure and malabsorption), and had the condition
illness outside the hospital is continuously increasing such as impaired renal function (estimated glomerular
and blenderized diet is prepared and used at home by filtration rate [eGFR] less than 60 mL/min/1.73 m2 or
patients or their caregivers, as well as during nursing proteinuria more than 3.5 g/day), severe hepatic injury
home care by specialized health providers, particularly (Child-Pugh score class C), pregnancy, breast-feeding,
after hospital discharge. Previous studies15, 16 showed severe sepsis, hemodynamic instability, abnormal metabolic
that higher amounts of bacterial contamination and diseases (ie, thyroid diseases), and allergy for study

Rama Med J Vol.42 No.4 October - December 2019 13

 The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

formula composition were excluded. Baseline data of Study Formula

participants including age, sex, and medical history A ready-to-use blenderized diet with chicken and
were recorded. Anthropometric measurements and pumpkin in a retort pouch is a standard and complete
physical examination were performed by the same enteral formula for patients with intact gastrointestinal
physician in nutrition specialist. Nutritional information, function who require tube feeding, developed under
including 24-hour dietary recall, was collected by the cooperation between Faculty of Medicine Ramathibodi
same well-trained dietitian from patients, caregivers, or Hospital and Charoen Pokphand Foods Public Company,
nursing staffs. All clinical data, blood, and urine were Ltd; and provided by Charoen Pokphand Foods Public
also collected at baseline and 14 days postintervention. Company, Ltd. The formula is composed of chicken
All participants had been fed by the intermittent breast, pumpkin, banana, egg, rice bran oil, soy lecithin,
method with a ready-to-use blenderized diet with glucose syrup, iodine salt, calcium carbonate, and water.
chicken and pumpkin via tube in 25 - 30 kcal/kg/day In terms of macronutrient composition, this formula
of energy for 14 days. All complications related to contains moderately high protein (16.35% of total
feeding, including nausea, vomiting, diarrhea, aspiration, energy) (Table 1). This ready-to-use formula is prepared
clogged tubes, and allergies, were closely monitored by sterilization method and preserved in a retort pouch.
daily. Diarrhea was defined as passage of loose stools Each package contains 300 mL and has a shelf life
often with more frequent bowel movements.17 of 90 days at room temperature (25°C). Measures of
Satisfaction in the feeding-formula product was food quality and safety control including physical
anonymously assessed by patients and caregivers using a and chemical properties, microbiological tests, and
1 (very dissatisfied) to 5 (very satisfied) rubric scale at heavy metal analysis were also evaluated as required
the end of study. Sample size was strategic by comparing by law.
with the number of participants in the previous studies
which were similar to this study in term of study design Measurement and Laboratory Determinations
and intervention.18, 19 All measurements were performed on days 0 and 14
under fasting conditions for 8 hours. Anthropometric
Ethics Approval and Consent to Participate parameters including weight and height were measured with
The protocol was approved by the Ethics Committee on standard techniques by the same physician. Blood samples
Researches Involving Human Subjects, Faculty of Medicine, were obtained under aseptic conditions and analyzed by
Ramathibodi Hospital, Mahidol University (MURA2014/633 standard methods for complete blood count, serum albumin,
on December 18, 2014). Before participation in this study, prealbumin, lipid profile, creatinine, liver function tests and
written informed consent was obtained from each participant. electrolytes, and plasma glucose.

Table 1. Macronutrient Composition in the Study Formula

Nutrient Amount (per 100 g), g Energy (per 100 g), kcal Amount (per 1000 kcal), g Distribution of Energy, %
Protein 4.50 18.00 40.87 16.35
Carbohydrate 14.32 57.28 130.05 52.02
Fat 3.87 34.83 35.15 31.63
Energy - 110.11 - 100.00
Fiber 1.08 - 9.81 -

14 Rama Med J Vol.42 No.4 October - December 2019

The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

The nutritional screening was performed by the

same well-train dietitian using Nutrition Alert Form Results
(NAF).20 The NAF comprises simplified malnutrition A total of 30 patients were enrolled; 60% of those
screening tools modified from the original version of were male. The mean age was 57.91 years (SD, 17.22;
the Subjective Global Assessment (SGA)21 and validated range, 24.00 - 86.00). At baseline, the mean BMI was
in the Thai population. This tool is composed of 19.23 kg/m2 (SD, 3.65) and 43.33% of patients had
8 sections: height, weight and body mass index (BMI), BMI less than 18.5 kg/m2. Regarding nutritional status,
body build, weight change, dietary intake change, 63.33% of participants were severely malnourished as
gastrointestinal symptoms, functional capacity and measured using NAF. The majority of participants
patient’s disease, and added serum albumin levels were oncological patients (46.67%), followed by
and total lymphocyte counts for patients whose weight patients with cerebrovascular disease (33.33%) (Table 2).
could not be taken. NAF is calculated as a score and
classified participants into 3 groups: NAF A or normal Table 2. Baseline Characteristics of Participants (N = 30)
to mild malnutrition (score, 0 - 5); NAF B or moderate Characteristic No. (%)
malnutrition (score, 6 - 10); and NAF C or severe Gender
malnutrition (score, ≥ 11). Male 18 (60.00)
Body compositions such as fat mass, skeletal Female 12 (40.00)
muscle mass, extracellular and intracellular water, Age, y
and phase angle were measured by the same physician ≤ 60 14 (46.67)
in clinical nutrition, using bioelectrical impedance > 60 16 (53.33)
analysis (BIA).22 BIA machine was a multi-frequency
BMI, kg/m 2
impedance analyzer (model InBody S10, Biospace Co,
< 18.5 13 (43.33)
Ltd, Seoul, Korea) providing 6 different frequency
impedance measurements (1, 5, 50, 250, and 1000 kHz). 18.5 - 22.9 14 (46.67)
Phase angle is the tan value of the ratio of reactance versus ≥ 23.0 3 (10.0)
electric resistance, reported by BIA at 50 kHz. The low angle NAF group
is associated with malnutrition and high mortality rate.22-24 A 2 (6.67)
B 9 (30.00)
Statistical Analysis C 19 (63.33)
Means and standard deviation (SD) for continuous Feeding route
variables and frequencies (%) for binary or categorical Nasogastric tube 26 (86.67)
variables were presented. Paired t test or Wilcoxon Gastrostomy 4 (13.33)
signed rank test and chi-square test were used to compare Underlying disease
anthropometric measurements, nutritional status, and Malignancy 14 (46.67)
clinical parameters between baseline and after study
Head and neck cancer 11 (36.67)
formula feeding at 2 weeks. A P value less than .05 was
Brain cancer 2 (6.67)
considered statistically significant. The statistical
analysis was conducted using SPSS version 24.0 (IBM Other cancers 1 (3.33)
SPSS Statistics for Windows, Version 24.0. Armonk, Cerebrovascular disease 10 (33.33)
NY: IBM Corp; 2016). Others 6 (20.00)
Abbreviations: BMI, body mass index; NAF, nutrition alert form.

Rama Med J Vol.42 No.4 October - December 2019 15

 The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

Each participant was provided the same amount of liver function tests, and serum creatinine was observed
diet during 14 days of intervention. All participants were between baseline and after 2 weeks of blenderized diet
able to receive an adequate amount of energy and protein. feeding (Table 3).
The average energy and protein intakes during the study Regarding other adverse effects, 2 participants were
were 1386.42 ± 217.15 kcal/day (28.55 ± 6.87 kcal/kg/day) reported having diarrhea from days 2 to 4 after feeding;
and 68.83 ± 10.8 g/day (1.42 ± 0.34 g/kg/day), respectively. however, the stool reports in both cases described only
The mean energy and protein intakes did not significantly an increase of stool frequency without changes in
differ to the dietary consumptions before receiving consistency or evidence of infection, and the defecation
study formula. became normal on day 5. Bloating and abdominal
To compare between pre and post 2-week feeding, distention were presented in 2 cases by the same
nutritional status was significantly improved in median participants for 1 day (on day 2) in the first case and
NAF score (from 12.50 to 8.00) and nutritional status for 5 days (from day 2 to day 6) in the other. No vomiting,
level from NAF B to NAF C (P < .001). The percentage aspiration, allergies, nor clogging of tubes was detected
of severely malnourished patients (NAF C) was also (Table 4).
reduced from 63.3% to 33.3%. Furthermore, biochemical This study also evaluated the satisfaction of patients
tests related to nutritional status were improved. Means or their caregivers in study product use. All assessments
for serum albumin, pre-albumin, and total lymphocyte indicated a score of 4 (satisfied) or 5 (very satisfied) and
count were also significantly increased. In addition, 73% were 5 points. Some favorable comments indicated
the mean phase angle was increased from 4.59 to 6.74 that the product was convenient and easy use, the product
degrees (P = .02). Nonetheless, no statistically significant can save time in purchase and preparation, and the care
changes were found in body composition and BMI. giver feel trust in the product since the product is prepared
With regards to biochemical change, a statistically and controlled by hospital. Additionally, some suggestions
significant decline in mean plasma glucose levels from for development opportunities were the bag should vary
6.01 to 5.57 mmol/L (118.4 to 100.4 mg/dL) was observed in size, and the packaging should be easy to storage
(P = .002). No significant difference in lipid profile, after opening.

Table 3. Comparison of Dietary Intake, Anthropometric Measurements, Nutritional Status, and Clinical Parameters
Between Baseline and 2 Weeks After Blenderized Diet Feeding (N = 30)
Mean ± SD
Clinical Parameter P Value**
Baseline Week 2
Dietary data*
Energy intake, kcal/day 1299.00 ± 368.24 1386.42 ± 217.15 .84
Protein intake, g/day 65.76 ± 15.30 68.83 ± 10.80 .65
BMI, kg/m 2
19.23 ± 3.65 19.37 ± 3.51 .39
Nutritional status
NAF score, median [IQR] 12.50 [7.75 - 14.00] 8.00 [6.00 - 12.00] < .001
NAF group, No. (%)
A 2 (6.67) 3 (10.00)
B 9 (30.00) 17 (56.67) .02
C 19 (63.33) 10 (33.33)

16 Rama Med J Vol.42 No.4 October - December 2019

The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

Table 3. Comparison of Dietary Intake, Anthropometric Measurements, Nutritional Status, and Clinical Parameters
Between Baseline and 2 Weeks After Blenderized Diet Feeding (N = 30) (Continued)
Mean ± SD
Clinical Parameter P Value**
Baseline Week 2
Body composition
Skeleton muscle mass, kg 19.48 ± 4.47 19.52 ± 4.19 .90
Fat mass, kg 13.53 ± 9.30 13.80 ± 8.90 .63
Body fat, % 24.82 ± 13.32 25.42 ± 12.26 .62
ECW/TBW 0.40 ± 0.01 0.40 ± 0.01 .17
Albumin, g/L 26.66 ± 4.78 28.63 ± 4.65 .003
Prealbumin, g/L 19.25 ± 9.38 22.18 ± 9.20 .007
Total lymphocyte count, 10 /L)
9
1.32 ± 0.48 1.73 ± 0.85 .004
Fasting plasma glucose (mmol/L) 6.01 ± 1.07 5.57 ± 1.19 .002
Lipid profile
Triglycerides (mmol/L) 1.35 ± 1.11 1.42 ± 0.87 .61
Cholesterol (mmol/L) 4.49 ± 1.05 4.33 ± 0.97 .22
HDL-c (mmol/L) 1.09 ± 0.30 1.10 ± 0.27 .31
LDL-c (mmol/L) 2.71 ± 0.77 2.55 ± 0.76 .23
Creatinine (µmol/L) 73.37 ± 29.17 69.84 ± 26.52 .15
Alkaline phosphatase (U/L) 111.37 ± 43.51 101.23 ± 32.53 .07
Aspartate aminotransferase (U/L) 33.47 ± 18.42 28.57 ± 12.91 .14
Hemoglobin (g/L) 111.00 ± 13.31 113.67 ± 15.12 .23
Phase angle, degree 4.59 ± 2.72 6.74 ± 4.60 .02
Abbreviations: BMI, body mass index; ECW, extracellular water; HDL-c, high-density lipoprotein cholesterol; IQR, interquartile range;
LDL-c, low density lipid cholesterol; NAF, nutrition alert form; SD, standard deviation; TBW, total body water.
*
Dietary intake before received the study formula at baseline.
**
There were statistical significance between baseline and after 2-week fed with study formula when P value < 0.05.

Table 4. Number of Cases With Side Effects

No.
Side Effect
Day 0 Day 2 Day 4 Day 6 Day 8 Day 10 Day 12 Day 14
Diarrhea 0 2 2 0 0 0 0 0
Gastrointestinal side effects
Vomiting 0 0 0 0 0 0 0 0
Bloating 0 2 1 1 0 0 0 0
Abdominal distention 0 2 1 1 0 0 0 0
Aspiration 0 0 0 0 0 0 0 0
Allergy 0 0 0 0 0 0 0 0
Product physical change (color or consistency) 0 0 0 0 0 0 0 0
Clog of tube feeding 0 0 0 0 0 0 0 0

Rama Med J Vol.42 No.4 October - December 2019 17

 The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

achieve this result. Some patients in this study were

Discussion dependent and cannot perform active exercise, especially
Optimized nutritional management prevents and resistance exercise. Nevertheless, the ready-to-use formula
improves malnutrition and its related diseases. Owing could maintain body weight and skeletal muscle mass.
that enteral feeding is efficacious, physiological and Since phase angle is a parameter correlated with malnutrition
tolerated well in general patients, enteral nutrition via and mortality of hospitalized patients,23-25 its alteration
tube feeding is recommended in inadequate oral intake may reflect a good health signal in the participants.
patients with intact gastrointestinal function5 for achieve In terms of safety, only minor side effects were
feeding goals and resulting in improved malnutrition. reported in a few cases and all symptoms resolved
The ready-to-use blenderized diet with chicken and spontaneously over a short period of time. No major
pumpkin is a standard, complete enteral formula events, including aspiration or food allergies, were
developed from a Ramathibodi Hospital blenderized reported during the 14 days of intervention. Because of
diet, which has been made for feeding in hospitalized the standardized preparation and sterilization process,
patients since 1972. The present study examined the no physical change of the blenderized diet was observed
efficacy and safety of a ready-to-use blenderized diet during the intervention within 3 months following
with chicken and pumpkin in a retort pouch and evaluated production. Common pathogens could not be detected
the satisfaction in this product. All participants tolerated from microbiological tests. Nutritional status (using
the study diet and received an adequate energy and NAF) of patients fed with study formula stored less than
protein balance. The nutritional status was also significant 2 months and more than 2 months did not significantly
improved after receiving the study diet for 2 weeks. differ at the end of study (data were not shown).
This study revealed feeding with ready-to-use Concerning metabolic complications, neither kidney
formula improve nutritional status evaluated using NAF nor liver abnormalities were observed in the participants
and nutrition-related biochemistry parameters such as during 2 weeks of study. This showed the safety of the
serum albumin, serum prealbumin, and total lymphocyte ready-to-use formula.
count. This confirmed the efficacy of the formula in In terms of satisfaction, both patients and their
improving malnutrition. By 24-hour dietary recall, caregivers appreciated this diet compared with a traditional
the amount of energy and protein intake did not differ blenderized diet. Moreover, the study formula received
between the previous and during the study periods. additionally positive comments related its preparation,
Before the study, the percentage of patients fed with using and confidence.
home-made blenderized diet, prescribed commercial This is the first study of ready-to-use, in a retort
formula, and consuming per oral were 63.3, 13.3, and pouch, and hospital-based blenderized diet in Thailand.
23.3, respectively. The amelioration of nutritional status Comparing with other enteral formula, this blenderized
could be resulted from adequate macronutrient receive diet is more advantageous that it is a moderately
as prescription, good compliance, nutrient balance, high-protein, low-carbohydrate, and well-tolerated
and easy digestion and absorption. formula and is previously prescribed in hospital for
This study found that participants improved in almost 5 decades. These properties benefit in positive
their phase angles. However, significant changes in protein-nitrogen balance, improved plasma glucose
other body compositions were not demonstrated during management, adequate intake and good compliance.18, 26
this 2-week study. Given that a significant increase in However, the present study has some limitations
skeleton mass requires many factors, a longer duration should be concerned. The number of participants is
of study and physical intervention may be required to modest but the sample size does not much differ comparing

18 Rama Med J Vol.42 No.4 October - December 2019

The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

with the previous studies with the same design and tube-fed patients without major complications. Moreover,
intervention in Thai population. 18, 19 There was no this diet was the convenience and easy use confirmed by
control group owing that the study was designed as the satisfaction of the patients and their caregivers.
preintervention and postintervention. The majority of Additionally, this enteral product could be practical
participants in this study were patients with oncological to use in both hospital and community settings owing
and cerebrovascular disease; nonetheless, the common to containing complete nutrients, being prepared with
diseases of patients requiring an enteral feeding in both a hospital-based composition, and possessing a long
hospital and homecare setting are stroke and cancer. shelf life.
Further studies in different settings and large population
are warranted to confirm the efficacy of this dietary
formula in long-term and real life use. Acknowledgements
The authors are grateful to all patients who participated
in this study, the health care personnel of the in-patient
Conclusions units of Ramathibodi Hospital who took care of patients
The enteral feeding with a ready-to-use blenderized in this study and collected important clinical information,
diet with chicken and pumpkin ameliorated nutritional and Charoen Pokphand Foods Public Company, Ltd,
status, nutrition-related lab tests, and phase angle in which provided the diet formula.

References 2006;90(5):887-907. doi:10.1016/ 8. Elke G, Schadler D, Engel C, et al.

1. Edington J, Boorman J, Durrant ER, j.mcna.2006.05.010. Current practice in nutritional
et al. Prevalence of malnutrition 5. Feinberg J, Nielsen EE, Korang SK, support and its association with
on admission to four hospitals et al. Nutrition support in hospitalised mortality in septic patients--
in England. The Malnutrition adults at nutritional risk. results from a national, prospective,
Prevalence Group. Clin Nutr. Cochrane Database Syst Rev. multicenter study. Crit Care Med.
2000;19(3):191-195. doi:10.1054/ 2017;5:CD011598. doi:10.1002/ 2008;36(6):1762-1767. doi:10.1097/
clnu.1999.0121. 14651858.CD011598.pub2. CCM.0b013e318174dcf0.
2. Correia MI, Campos AC, ELAN 6. Seron-Arbeloa C, Zamora-Elson M, 9. Alpers DH. Enteral feeding and
Cooperative Study. Prevalence of Labarta-Monzon L, Mallor-Bonet T. gut atrophy. Curr Opin Clin Nutr
hospital malnutrition in Latin Enteral nutrition in critical care. Metab Care. 2002;5(6):679-683.
America: the multicenter ELAN J Clin Med Res. 2013;5(1):1-11. doi:10.1097/01mco.0000038812.
study. Nutrition. 2003;19(10): doi:10.4021/jocmr1210w. 16540.72.
823-825. doi:10.1016/S0899-9007 7. Gramlich L, Kichian K, Pinilla J, 10. Wilmore DW, Smith RJ,
(03)00168-0. Rodych NJ, Dhaliwal R, Heyland O’Dwyer ST, Jacobs DO, Ziegler
3. Norman K, Pichard C, Lochs H, DK. Does enteral nutrition compared TR, Wang XD. The gut: a central
Pirlich M. Prognostic impact of to parenteral nutrition result in organ after surgical stress. Surgery.
disease-related malnutrition. Clin better outcomes in critically ill 1988;104(5):917-923.
Nutr. 2008;27(1):5-15. doi:10.1016/ adult patients? a systematic review 11. Holmes S. Enteral nutrition:
j.clnu.2007.10.007. of the literature. Nutrition. 2004; an overview. Nurs Stand. 2012;
4. Chapman IM. Nutritional disorders 20(10):843-848. doi:10.1016/j.nut. 26(39):41-46. doi:10.7748/ns2012.
in the elderly. Med Clin North Am. 2004.06.003. 05.26.39.41.c9133.

Rama Med J Vol.42 No.4 October - December 2019 19

 The Amelioration of Nutritional Status and Phase Angle, Safety, and Satisfaction in
Tube-Fed Patients With Ready-to-Use Blenderized Diet With Chicken and Pumpkin

12. Mokhalalati JK, Druyan ME, 2013;28(6):2033-2038. doi:10.3305/ composition with bioelectric
Shott SB, Comer GM. Microbial, nutrhosp.v28in06.6759. impedance (BIA) and dual energy
nutritional and physical quality 17. Schiller LR, Pardi DS, Spiller R, X-ray absorptiometry (DEXA)
of commercial and hospital et al. Gastro 2013 APDW/WCOG among Singapore Chinese. J Sci
prepared tube feedings in Saudi Shanghai working party report: Med Sport. 2011;14(1):33-35.
Arabia. Saudi Med J. 2004;25(3): chronic diarrhea: definition, doi:10.1016/j.jsams.2010.04.005.
331-341. classification, diagnosis. J 23. Thibault R, Makhlouf AM,
13. Mathus-Vliegen EM, Bredius Gastroenterol Hepatol. 2014; Mulliez A, et al. Fat-free mass
MW, Binnekade JM. Analysis of 29(1):6-25. doi:10.1111/jgh.12392. at admission predicts 28-day
sites of bacterial contamination 18. Pisprasert V, Shantavasinkul PC, mortality in intensive care unit
in an enteral feeding system. Rattanachaiwong S, Lepananon T, patients: the international prospective
JPEN J Parenter Enteral Nutr. Komindr S. Moderately high- observational study Phase Angle
2006;30(6):519-525. doi:10.1177/ protein enteral formula improved Project. Intensive Care Med.
0148607106030006519. retinol-binding protein in tube-fed 2016;42(9):1445-1153. doi:10.1007/
14. Sullivan MM, Sorreda-Esguerra P, patients: a multicentre open study. s00134-016-4468-3.
Santos EE, et al. Bacterial Nutr Health. 2017;23(3):203-209. 24. Genton L, Herrmann FR, Spörri A,
contamination of blenderized doi:10.1177/0260106017729959. Graf CE. Association of mortality
whole food and commercial 19. Trakulhoon V, Prammanasudh B. and phase angle measured by
enteral tube feedings in the An open study of efficacy, safety different bioelectrical impedance
Philippines. J Hosp Infect. and body weight changing in analysis (BIA) devices. Clin Nutr.
2001;49(4):268-273. doi:10.1053/ the Blendera-tube fed patients. J 2018;37(3):1066-1069. doi:10.1016/
jhin.2001.1093. Med Assoc Thai. 2012;95(10): j.clnu.2017.03.023.
15. Vieira MMC, Santos VFN, 1285-1291. 25. Vermeulen KM, Leal LL, Furtado
Bottoni A, Morais TB. Nutritional 20. Komindrg S, Tangsermwong T, MC, et al. Phase Angle and
and microbiological quality of Janepanish P. Simplified malnutrition Onodera’s Prognostic Nutritional
commercial and homemade tool for Thai patients. Asia Pac Index in critically ill patients.
blenderized whole food enteral J Clin Nutr. 2013;22(4):516-521. Nutr Hosp. 2016;33(6):1268-1275.
diets for home-based enteral doi:10.6133/apjcn.2013.22.4.06. doi:10.20960/nh.770.
nutritional therapy in adults. 21. Detsky AS, McLaughlin JR, 26. Huhmann MB, Yamamoto S,
Clin Nutr. 2018;37(1):177-181. Baker JP, et al. What is subjective Neutel JM, Cohen SS, Ochoa
doi:10.1016/j.clnu.2016.11.020. global assessment of nutritional Gautier JB. Very high-protein and
16. Borghi R, Dutra Araujo T, status? JPEN J Parenter Enteral low-carbohydrate enteral nutrition
Airoldi Vieira RI, Theodoro de Nutr. 1987;11(1):8-13. doi:10.1177/ formula and plasma glucose control
Souza T, Waitzberg DL. ILSI 014860718701100108. in adults with type 2 diabetes
Task Force on enteral nutrition; 22. Gupta N, Balasekaran G, Victor mellitus: a randomized crossover
estimated composition and costs Govindaswamy V, Hwa CY, trial. Nutr Diabetes. 2018;8(1):45.
of blenderized diets. Nutr Hosp. Shun LM. Comparison of body doi:10.1038/s41387-018-0053-x.

20 Rama Med J Vol.42 No.4 October - December 2019

Rama Med J I Original Article
การศึกษาการดีขึน้ ของภาวะโภชนาการและมุมเฟส ความพึงพอใจ และความปลอดภัย
ในผู้ป่วยที่ได้ รับสารอาหารทางสายยางด้ วยอาหารปั่นพร้ อมใช้ ผสมไก่ และฟักทอง
กุลพงษ์ ชัยนาม1, ปิ ยนุช ไมตรีจร2, 3, ธัญวรินทร ตั้งเสริมวงศ์ 2, ปริย พรรณเชษฐ์ 4, ประพิมพ์พร ฉัตรานุกลู ชัย4,
พัชรวีร์ ทันละกิจ2, ดรุณวี ลั ย์ วโรดมวิจติ ร4
1
สถาบันการแพทย์จกั รี นฤบดินทร์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิ ดล สมุทรปราการ ประเทศไทย
2
ฝ่ ายโภชนาการ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิ ดล กรุ งเทพฯ ประเทศไทย
3
กลุ่มงานโภชนศาสตร์ โรงพยาบาลปากพะยูน พัทลุง ประเทศไทย
4
ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิ ดล กรุ งเทพฯ ประเทศไทย

บทน�ำ: ความต้องการอาหารปั่ นครบสู ตรที่ผลิตโดยโรงพยาบาลซึ่ งเป็ นอาหาร Corresponding Author:

ครบสูตรและใช้กนั ทัว่ ไปก�ำลังเพิม่ ขึ้นจนเกินความพร้อมและการเข้าถึงการให้บริการ ดรุ ณีวลั ย์ วโรดมวิจิตร
อาหารปั่ นผสมไก่และฟักทองในบรรจุภณ ั ฑ์พร้อมใช้จึงถูกพัฒนาขึ้นโดยแพทย์ ภาควิชาอายุรศาสตร์
ด้านโภชนาการและนักก�ำหนดอาหารเพือ่ แก้ไขปัญหานี้ อย่างไรก็ตาม จ�ำเป็ นต้องมี คณะแพทยศาสตร์
การประเมินผลลัพธ์ทางคลินิกของอาหารนี้ โรงพยาบาลรามาธิบดี
วัตถุประสงค์: เพือ่ ศึกษาประสิ ทธิภาพและความปลอดภัยของอาหารปั่นพร้อมใช้ มหาวิทยาลัยมหิ ดล
และความพึงพอใจของผูป้ ่ วยและผูด้ ูแล 270 ถนนพระรามที่ 6
แขวงทุ่งพญาไท เขตราชเทวี
วิธีการศึกษา: การศึกษาเชิงทดลองเปรี ยบเทียบผลก่อนและหลังได้รับสารอาหาร กรุ งเทพฯ 10400 ประเทศไทย
เป็ นเวลา 14 วัน ในกลุม่ ตัวอย่างผูป้ ่ วยผูใ้ หญ่ที่ได้รับสารอาหารทางสายยางเท่านั้น โทรศัพท์ +66 2201 1301,
จ�ำนวน 30 คน ณ โรงพยาบาลรามาธิบดี โดยการวิเคราะห์องค์ประกอบของร่ างกาย +66 2201 0082
ภาวะทางโภชนาการ ตัวชี้ วดั ทางคลินิก และผลตรวจทางชี วเคมี เปรี ยบเทียบ โทรสาร +66 2201 1715
ก่อนและหลังได้รับสู ตรอาหารเป็ นเวลา 14 วัน ติดตามภาวะแทรกซ้อนทุกวัน อีเมล [email protected]
และประเมินความพึงพอใจในวันที่ 14 ของการศึกษา
ผลการศึกษา: จากกลุม่ ตัวอย่างผูป้ ่ วย จ�ำนวน 30 คน พบว่า หลังได้รับสูตรอาหาร
เป็ นเวลา 14 วัน ผูป้ ่ วยมีภาวะโภชนาการ (P < .001) ระดับอัลบูมิน (P = .003)
ระดับพรี อลั บูมิน (P = .007) จ�ำนวนเม็ดเลือดขาวชนิดลิมโฟไซต์ (P = .004) และ
มุมเฟส (P = .02) ดีข้นึ อย่างมีนยั ส�ำคัญ ไม่พบภาวะแทรกซ้อนทีส่ ำ� คัญ ความพึงพอใจ
ต่อการใช้ผลิตภัณฑ์อยูใ่ นระดับน่ าพอใจ (ร้อยละ 27) และระดับน่ าพอใจมาก
(ร้อยละ 73)
สรุป: การศึกษานี้แสดงให้เห็นว่าอาหารปั่นผสมไก่และฟักทองในบรรจุภณั ฑ์พร้อมใช้
มีประสิทธิภาพท�ำให้ภาวะโภชนาการ ผลตรวจทางห้องปฏิบตั กิ าร และมุมเฟสดีข้ นึ
โดยปราศจากภาวะแทรกซ้อนที่สำ� คัญ
ค� ำ ส� ำ คั ญ : อาหารปั่ น การให้ อ าหารเข้า ทางเดิ น อาหาร ภาวะโภชนาการ
ภาวะทุพโภชนาการ มุมเฟส
Rama Med J: doi:10.33165/rmj.2019.42.4.191337
Received: June 10, 2019 Revised: October 7, 2019 Accepted: December 2, 2019

Rama Med J Vol.42 No.4 October - December 2019 21