Bacterial contamination and nutritional adequacy of enteral
tube feedings in Iran
Mahsa Mahinkazemi
1
, Ali Tarighat-Esfanjani
2
, Abdolrasoul Safaiyan
3
1
School of Nutrition, Tabriz University of Medical Sciences, Tabriz, I. R. Iran;
2
School of Nutrition, Tabriz University of
Medical Sciences Attar Nishabouri St., Tabriz, I. R. Iran - E-mail: Tarighata@tbzmed.ac.ir;
3
School of Health Sciences, Ta-
briz University of Medical Sciences, Tabriz, I. R. Iran
Summary. Background: In spite of recent advances in nutritional support, researches are often unclear and, in
many cases, conficting in regard to the most appropriate formulas. Tis study aimed to evaluate nutritional
adequacy and bacterial contaminations of enteral feedings (EFs) that are used in the intensive care units
(ICUs) of hospitals in Tabriz, Iran. Methods: Tis experimental study was carried out on 54 EFs samples; 36
blenderized tube feedings (BTFs) and 18 commercial powder feedings (CPFs) of patients in the ICUs. En-
ergy and macronutrients contents of formulas were measured and compared with estimated needs of patients.
Tirty-six BTFs samples (18 after preparation and 18 after 18 hour keeping in refrigerator) and 18 CPFs
samples immediately after preparation were tested for the presence of total coliforms, Escherichia coli (E.
coli), Staphylococcus aureus (S. aureus), Listeria monocytogenes (L. monocytogenes), and Salmonella. Results: Te
energy density (ED) of BTFs (0.74±0.02 kcal/mL) were higher than CPFs (0.59±0.02 kcal/mL) and both
lower than predicted values (p<0.001). Te energy and macronutrients content were signifcantly diferent
(p<0.001) between BTFs and CPFs. Total coliforms of BTFs were less than 2 MPN/gr in both times, but
6 (33%) of CPFs samples were 6.41±2.43 MPN/gr. E. coli contamination were detected only in CPFs and
S. aureus, Salmonella, and L. monocytogenes in both EFs were not detected. Conclusion: Given that low energy
and macronutrient contents of both types of EFs, and bacterial contamination of CPFs, it is necessary to pay
attention to the quality, safety, and appropriate type of formulas.
Key words: enteral nutrition, nutritional support, enteral formula
Progress in Nutrition 2017; Vol. 19, N. 3: 283-290 DOI: 10.23751/pn.v19i3.5139 © Mattioli 1885
Original article
Introduction
About 30%-60% of patients admitted to hospitals
are not in good conditions and they have degrees of
malnutrition (1). Tis is about 48% in our country (2).
Proper nutritional intervention is the frst step to pre-
vent malnutrition. Nutritional support strategies include
adding supplements to the diets, enteral feeding (EF)
- commercial prepared formulas or hospital prepared
feeds- and partial or total parenteral nutrition (3, 4).
EF was started in the early 20th century and has
become one of the most common and preferred meth-
ods of nutritional support in patients with a functional
gastrointestinal tract, that cannot satisfy their nutrition-
al requirements. Despite worldwide access to commer-
cial formulas, some still prefer to use blenderized tube
feedings (BTFs). BTFs contain natural foods such as
milk, egg, meat, soft fruit, oils, and vegetables. Econom-
ic reasons and/or lack of easy and inexpensive access to
commercial feedings, cultural issues and fexibility in the
preparation of BTFs can be the most important reasons
justify the use of these formulas (4-10).
Whole food/blenderized formula only considered
for use in medically stable patients with no signs of in-