Can Nutritional Milk Powder Replace Liquid Diet for Tube Feeding?

Can tube feeding with milk be replaced by direct sales nutritional milk powder?

Hello: My father has dementia and has lost his swallowing function, so the doctor inserted a nasogastric tube.
Initially, he was receiving six cans of enteral nutrition (Nutrison) per day in the hospital, but after returning home, my sister insisted on replacing it with Ensure Appeal nutritional formula.
Now he is experiencing diarrhea almost every day, 4-5 times, and when he has chocolate-flavored formula, the stool is also chocolate-colored.
I feel something is not right, but my sister responds that according to the dietitian, since what goes in is liquid, it is normal for the output to be loose.
She says if we are worried about dehydration, we should just increase fluid intake.
Is what she is saying correct? Could this lead to any problems?

Wunai de didi, 20~29 year old female. Ask Date: 2013/06/12

Dr. Cai Xiuwen reply Nutrition

Hello! Stroke patients and those receiving enteral feeding rely entirely on specialized nutritional products to meet their daily nutritional needs, as these specific nutritional requirements are often difficult to obtain from regular diets.
Therefore, it is safer for patients on long-term enteral feeding to use specialized nutritional products that comply with the regulations set by the Department of Health.
The nutritional products provided by hospitals should adhere to the standards for specialized nutrition.
Due to the prevalence of products on the market that lack approval from the Department of Health, we recommend checking the nutritional formula you mentioned on the Department of Health's food information website to ensure its compliance.

Diarrhea typically refers to an increase in the water content of stool, occurring more than three times a day, with stool volume exceeding the normal average (approximately 200 grams per day).
However, it is important to consider individual bowel habits.
Using enteral feeding formulas does not necessarily lead to diarrhea.
If there are multiple episodes of diarrhea daily, it is essential to monitor skin integrity (to prevent anal fissures) and ensure adequate hydration to avoid dehydration (noting if urine output decreases or becomes concentrated).
Wishing you peace and health.
This response is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Department of Health.

Reply Date: 2013/06/12

More Info

When it comes to tube feeding, especially for individuals with swallowing difficulties or conditions like dementia, the choice of nutritional products is crucial for maintaining health and preventing complications. In your case, it seems that your father is experiencing significant gastrointestinal distress, specifically diarrhea, after switching from a specialized nutritional formula (like Nutren) to a different nutritional milk powder (like Ensure).
Firstly, it's important to understand that not all nutritional products are created equal. Specialized formulas designed for tube feeding, such as Nutren, are specifically formulated to meet the nutritional needs of individuals who cannot consume food orally. These formulas are designed to be easily digestible and to provide a balanced mix of macronutrients (proteins, fats, and carbohydrates), vitamins, and minerals. They also consider the osmolarity, which is crucial for preventing gastrointestinal issues like diarrhea.

On the other hand, nutritional milk powders like Ensure may not be suitable for tube feeding without proper medical guidance. While they are marketed as nutritional supplements, they may not have the same balance of nutrients or the appropriate consistency for tube feeding. The fact that your father is experiencing diarrhea, especially with flavored versions (like chocolate), suggests that the formula may not be well tolerated by his digestive system. The color of the stool matching the flavor of the milk powder indicates that the body is not fully absorbing the nutrients, which can lead to malabsorption and further gastrointestinal issues.

Your sister's assertion that liquid intake is normal and that the output being liquid is acceptable is not entirely accurate. While it is true that tube feeding can lead to liquid stools, frequent diarrhea (4-5 times a day) is concerning and can lead to dehydration and electrolyte imbalances. It's essential to monitor the consistency and frequency of bowel movements closely. If diarrhea persists, it may indicate that the nutritional formula is not suitable for your father's condition, or it could be a sign of an underlying issue that needs to be addressed.

In this situation, I recommend consulting with a healthcare professional, preferably a registered dietitian or a physician specializing in nutrition. They can evaluate your father's specific needs, assess the appropriateness of the current nutritional powder, and determine if a return to a specialized tube feeding formula is necessary. They may also suggest modifications to the feeding regimen, such as adjusting the rate of feeding, the concentration of the formula, or even switching back to a more suitable product.

Additionally, it’s crucial to ensure that your father is adequately hydrated, especially if he is experiencing diarrhea. Dehydration can exacerbate health issues and lead to further complications. A healthcare professional can provide guidance on how to maintain hydration while managing his nutritional needs.

In summary, while nutritional milk powders can be beneficial in certain contexts, they may not be appropriate for tube feeding without professional guidance. The gastrointestinal symptoms your father is experiencing warrant a reassessment of his nutritional intake and feeding strategy. Always prioritize professional advice when it comes to dietary changes, especially for individuals with complex health needs.

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