الفهرس 
REVIEW OF LITERA TURE
History of tube feedinOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Adequate nutrition is essential for maintenance of physiologic homeostasis. Individualized, adequate nutritional support in the peri-operative period decreases morbidity and mortality. Gastric feeding tubes provide long-term nutrition to patients who are otherwise unable to eat. Many patients who receive feeding tubes have severe underlying disease states. Postoperative enteral nutrition is a widely accepted route of application for nutrition formulas due to a low complication rate, a good acceptance by patients and a favorable cost-effectiveness. Enteral feeding is a more economical route than parenteral feeding. Complications that represent the most important problem of parenteral nutrition are far less common during enteral nutrition. The choice of tube feeding formula depends on the age of the patient, the condition of the gastrointestinal tract, and the disease of the patient. Enteral nutrition has been identified as the preferred method of nutritional support in the critically ill and is widely used for all hospitalized patients for whom oral intake is considered inappropriate .The present study aimed to prepare some enteral feeding formulas in form of powder. Such formulas are suitable to feed patients in special cases. These formulas designed to be :Nutritionally appropriate based on the idea of feeding the carbohydrate, protein and fat ratio to cover the daily requirements of patient and clinically suitable for his case . Free of significant bacterial contamination .Easy to administer, of consistent viscosity when solving them in water to facilitate their passing through the tube.Low in cost All raw materials used for the preparation of the different therapeutic tube feeding formulas were purchased from local market in Shibin El-Kom City, Minufiya government. These materials were yogurt, vegetables, fruit, cereals, legumes, fish ( silver carp ), oil and xanthene gum .
Four therapeutic formulas were prepared by these materials using the methods of six exchange list for meal planning .The first formula contained a normal diet and it can be used in the conditions of anorexia nervosa and after surgery. It contained ( 2500 kcal , 25% of the total calorie fat, 15 % of total calorie protein and 60 % of total calorie carbohydrate ) .The second formula contained high calorie and protein diet and low fat. It can be used in the conditions of burns and cancer especially head and neck cancer. It contained ( 3000 kcal, 17 % of the total calorie fat, 20 % of total calorie protein and 63 % of total calorie carbohydrate ) .
The third formula contained low carbohydrate and low fat diet and it can be used in the conditions of cardiovascular disease, thrombus and diabetes mellitus. It contained ( 2000 kcal, 20% of the total calorie fat, 25 % of total calorie protein and 55 % of total calorie carbohydrate ) .The fourth formula was a restrictive protein and fat diet and it can be used in the condition of hepatic coma. It contained ( 1800 kcal, 20% of the total calorie fat, 30 gm protein and 330 gm carbohydrate ) .All raw materials were washed with tap water. Vegetables and fish were blanched in boiling water until cooked . Legumes were soaked in tap water for six hours then cooked in boiling water. After cooking of raw materials the ingredients of each formula were mixed will using household mixer (Braun, Germany), also oil and honey were mixed with the ingredients, and then the formulas were drying by two methods.A): heat drying B): freeze drying Xanthene gum was added to each formula at 1.5 to 2 % to form a suspension. All formulas were vacuum packed in polypropylene metalized bags. Packed samples were stored in a refrigerator at 5 °C. Each formula was re hydrated to obtain a suspension with a suitable viscosity to flow through the tube of tube feeding .Formulas samples were subjected to analysis in order to determine: Protein, fat, fiber, ash and moisture .
Minerals content (sodium, potassium, calcium, phosphorus and iron ) .Physical properties included :-Water holding capacity (WHC) .Specific gravity and PH .Volume and specific volume .
-Viscosity .In-vitro protein digestibility included True digestibility (TD) -% Apparent digestibility (AD)TBA value .Peroxide value . .Microbiological analysis included : Colifrom group Total bacterial count Mold & yeast count Proteolytic bacterial count -Lipolytic bacterial count . Results are reported as mean ± SE The obtained results showed that Dried formula No.1 contained 17.14 % protein, 12.07 % fat, 64.93 % total carbohydrate, 3.685 % crude fiber, 1.11 % ash and 1.067% moisture. Each 100 gm of dried formula No.1 provided 424.147 kcal. While the mean values of freeze-dried formula No.1 were 17.26 % protein, 12.65 % fat, 63.99 % total carbohydrate, 3.76 % crude fiber, 1.28 % ash and 1.07 % moisture. Total calorie was 423.794 kcal / 100 gm . Sodium, potassium, calcium, phosphorus and iron contents of dried formula No.1 were 174.2, 601.9, 209, 388.7 and 3.6 mg / 100gm respectively. While the mean values of freeze-dried formula were 176.4, 604.3, 211, 389.9 and 3.7 mg/100gm respectively The patient should received 575 gm from dried or freeze-dried formula No.1 to cover his normal requirements of calories, protein, fat and total carbohydrate. This formula can be used for the patient needs normal diet as suffering from anorexia nervosa and after surgery Protein, fat, total carbohydrate, crude fiber, ash and moisture contents of dried formula No.2 were 21.36 and 7.45, 64.57, 3.64, 1.92 and 1.06 % respectively. It provided 388.174 kcal / 100 gm. Freeze-dried formula No.2 contained 22.22 % protein, 8.15 % fat, 62.74 % total carbohydrate, 3.66 % crude fiber, 2.02 % ash, 1.2 % moisture, and provided 384.53 kcal / 100 gm .Dried formula No.2 contained 149.1 mg/100 gm sodium, 570.3 mg/100gm potassium, 231.2 mg / 100 gm calcium, 373.8 mg/100 gm phosphorus and 4.8 mg/100 gm iron. These values showed insignificantly different with that of freeze-dried formula No.2 .The patient need 750 gm of dried or freeze-dried formula No.2 to cover his daily requirements. Because of higher calories and protein contents of this formula, it was valid to cover the daily requirements for burn and cancer patients . The mean values of protein and fat, total carbohydrate, crude fiber, ash and moisture of dried formula No.3 were 25.33, 8.99, 55.35, 6.35, 2.364 and 1.63 % respectively. It provided 378.174 kcal /100gm. Freeze-dried formula No.3 contained 27.4 % protein, 9.22 % fat, 52.95 % total carbohydrate, 6.45 % crude fiber, 2.37 % ash and 1.6 % moisture. It provided 378.56 kcal / 100 gm .The mean values of sodium, potassium, calcium, phosphorus and iron contents of dried formula No.3 were 134.5, 703.5, 318, 401.4 and 3.6 mg / 100gm respectively. These values were nearly equal with that of freeze-dried formula and showed insignificantly different Concerning formula No.3, the amount needed to cover daily requirements was 500 gm. This formula contained 31.75 gm fiber from dried and 32.25 gm from freeze-dried. This formula was suitable to cover daily requirements of cardiac and diabetic patients because it contained low carbohydrate and fat and provided 31.75 gm fiber from dried formula and 32.25 gm from freeze-dried.
Dried formula No.4 contained 7.15% protein, 9.72 % fat, 79.07 % total carbohydrate, 1.57 % crude fiber, 1.47 % ash and 1.02 % moisture and provided 426.05 kcal / 100 gm. Freeze-dried formula No.4 contained 7.38 % protein, 9.82 % fat, 78.63 % total carbohydrate, 1.66 % crude fiber, 1.48 % ash and 1.03 % moisture. Total calorie was 425.78 kcal / 100 gm . Dried and freeze-dried formula No.4 were insignificantly different in minerals content . The patient need to receive 420 gm of dried or freeze-dried formula No.4 to cover daily requirements. Protein content was 30 gm of dried formula and 31 gm of freeze-dried, so this formula was suitable to cover the daily requirements for hepatic coma .Physical properties S.gravity, s.volume and viscosity of freeze-dried formula No.1 were significantly higher than dried formula. Dried and freeze-dried formula No.1 provided 0.77 Kcal/ml and 0.74 Kcal/ml respectively . S.gravity of dried formula No.2 was significantly increased than that of freeze-dried, while freeze-dried was significantly higher in s.volume, viscosity and pH than dried formula. Dried and freeze-dried formula No.2 provided 0.78 Kcal/ml and 0.79 Kcal/ml respectively .Freeze-dried formula No.3 was significantly higher in s.volume and pH than dried formula. While dried formula was significantly higher than freeze-dried in s.gravity and viscosity. Dried and freeze-dried formula provided 0.63 Kcal/ml . Freeze-dried formula No.4 was significantly higher in s.volume than dried. While dried formula was significantly higher than freeze-dried in viscosity. Dried and freeze-dried formula No.4 provided 0.82 Kcal/ml and 0.85 Kcal/ml respectively .In- vitro protein digestibility The values of true digestibility and apparent digestibility were significantly higher in freeze-dried formulas No.1, 2, 3 and 4 than that of dried formula .TBA value :
Freeze-dried formula No.1, 2, 3 and 4 showed a significant decreased in TBA value than dried at zero time and after 6 months of storage period. TBA values were increased gradually of both dried and freeze-dried formulas during storage period at 5 OC . Peroxide value :
Freeze-dried formula No.1, 2, 3 and 4 showed a significant decreased in peroxide value than dried at zero time and after 6 months of storage period. Peroxide values were increased gradually of both dried and freeze-dried formulas during storage period at 5 OC .Microbiological aspects of therapeutic formulas :All processed formulas were free from coli forms throughout storage period.All formulas were microbial safe for consumption by the patients. Total count were ranged from 60 to 450 microorganism /gm formula. This microbial load of such prepared formulas is within the permitted limit of the Egyptian Standard No.135 ( 1998 ) which mentioned that the TBC must be lower than 1000 / gm of foods which prepared by heating temperature. All formulas were negative for the growth of both yeast & mold .All formulas were relatively low in their proteolytic and lipolytic bacterial count due to application of proper hygienic practices during all stage of formulas production in addition to storage of samples under safe conditions with tightly closing of pages vacuum packed .Costs of different prepared therapeutic formulas compared to that prepared in hospitals kitchens
The present formulas have a lower cost than the diet prepared in hospitals kitchens and make a spare of ( 562.55, 388.14, 806.74 and 803 P.T ) of formulas No.1, 2, 3 and 4 respectively. This offer great economical advantages for the Egyptian consumers, especially the low income families .