Formulações à base de vegetais em pó para aplicação em nutrição enteral domiciliar

Abstract

Enteral nutrition (EN) is considered a therapeutic strategy for individuals with a functioning gastrointestinal tract but unable to maintain sufficient food intake for the maintenance or recovery of nutritional status. Formulations can be industrialized, in powder or liquid form, or homemade, prepared from fresh foods. Natural foods significantly influence the intestinal microbiota due to vitamins, minerals, fibers, and bioactive compounds, such as polyphenols, with recognized prebiotic action. An alternative to homemade formulations is the use of dehydrated powdered foods. In this context, food science and technology seeks to develop formulations based on natural foods, with defined composition, microbiological stability, and technological suitability, ensuring food and nutritional sovereignty in enteral therapy. The study aimed to: evaluate patients undergoing home enteral nutritional therapy (HENT) regarding their perceptions of their feeding method and its impact on quality of life; analyze the microbiological quality of the homemade formulations used; and develop a solid powder product from dehydrated vegetables, characterizing it in terms of physicochemical, chemical, technological, and rheological parameters. The work was structured into four interdependent chapters, which complement each other in building a comprehensive view of home enteral nutritional therapy (HENT). Chapter I presents a literature review on HENT, its evolution, clinical applications, challenges, and perspectives in the care of patients with specific nutritional needs. In Chapter II, a systematic review complementary to the central theme was conducted, entitled "Probiotics: a little help for enteral nutritional therapy in critically ill adults". The objective was to gather evidence on the clinical effects of probiotic administration in patients undergoing EN. Twenty-one studies were analyzed involving patients in different care settings—intensive care units, wards, and homes—with control groups using isolated enteral nutrition or placebo. The results indicated consistent clinical benefits associated with the use of probiotics, including reduced hospitalization time, improved gastrointestinal function, lower incidence of antibiotic-associated diarrhea, and reduced inflammatory and immunological responses, as well as a decrease in ventilatorassociated pneumonia. No significant adverse effects were observed, reinforcing the safe and beneficial potential of this adjuvant strategy to enteral nutrition. Chapter III presents the cross-sectional study entitled “Nutritional and microbiological aspects of formulations and the impact of the use of home enteral nutritional therapy on the quality of life of patients”. Twenty-two patients on home enteral nutritional therapy (HENT) were evaluated, predominantly elderly, bedridden, and dependent, with gastrostomy being the most frequent method (72.7%). Industrialized formulations were the most used (54.5%), while homemade formulations accounted for 27.3%, characterized by low nutritional diversity and risk of contamination resulting from home preparation. The main complications reported were diarrhea (72.7%) and tube obstruction (77.3%). Despite the difficulties, 91% of the participants classified their quality of life as acceptable. The study highlighted the need for multidisciplinary support and continuous nutritional education to optimize the safety and effectiveness of HENT. Finally, Chapter IV describes the technological development of a plant-based powder product formulated for use in enteral nutrition. It was developed from nine plant-based ingredients including kale, ora-pro-nobis, chickpeas, flaxseed, beetroot, turmeric, almond, pumpkin seeds, and sweet potato. Physicochemical (moisture, pH, soluble solids, ash), chemical (proximal composition and energy value), technological (water absorption, solubility, stability and emulsifying activity) and rheological analyses were conducted. Two formulations were developed using a simplex-centroid factorial design, prioritizing protein and lipid content and caloric density. F1, intended for nasoenteral tubes and other routes without filtration, contained 63.94 g/100 g of carbohydrates, 33.86 g/100 g of fiber, 18.60 g/100 g of protein, 5.31 g/100 g of lipids and 377.95 kcal. F2, intended for bolus administration via gastrostomy, contained 46.00 g/100 g of carbohydrates, 9.70 g/100 g of fiber, 21.23 g/100 g of protein, 24.07 g/100 g of lipids and 485.55 kcal. According to ANVISA (2015), F1 can be classified as normoprotein, hypercarbohydrate, hypolipid and rich in fiber, while F2 is normoprotein, hypocarbohydrate and hyperlipid. In administration tests, F1 showed gravitational infusion between 52 and 72 drops/minute, and, in bolus administration, a slow infusion of 60 mL in approximately four minutes, without resistance to the syringe. Both formulations maintained adequate stability, homogeneity, fluidity and osmolality. The results reinforce the relevance of multidisciplinary care and nutritional education for patients, caregivers, and family members, promoting safety and adherence to treatment. The developed formulations proved to be nutritionally viable, approaching the recommendations for enteral nutrition and valuing the use of less processed foods. It is concluded that it is possible to develop powdered products from dehydrated vegetables, with technological stability and nutritional adequacy, constituting an innovative and sustainable alternative for home enteral nutrition. Together, the results of this thesis contribute to the advancement of knowledge about enteral nutritional therapy and reinforce the importance of the integration between science, clinical practice, and technological innovation in the search for safe food solutions aimed at home care.