Should blood biochemistry be monitored in patients on long term enteral feeding? Scoping Review

Abstract

Abstract: Background: Enteral nutrition is usually applied to patients who cannot receive adequate nutrition orally. Percutaneous endoscopic gastrostomy (PEG ) and percutaneous endoscopic jejunostomy (PEJ) feeding are two effective methods of long-term enteral feeding ( ≥4 weeks). However, patients undergoing long-term enteral feeding are at high risk of a trace elements deficiency. For instance, copper, zinc, selenium, and iron deficiencies have been reported in such patients. Therefore, regular blood biochemistry tests should be conducted on these patients to avoid complications. The aim of this review was to identify research on trace element deficiencies arising from long-term enteral feeding and examine the frequency with which the blood biochemistry of adult patients receiving enteral feeding. Method: This scoping review was based on a search of electronic databases (Science Direct, SAGE, PubMed and Ovid) and grey literature (ResearchGate and Health Science Online) using key terms. Inclusion/exclusion criteria were applied to identify studies reporting a trace elements deficiency in long-term enteral feeding. Articles published in the English language from 2000 to 2019 were selected. Results: This scoping review included eleven studies comprising a total of 723 participants aged between 18-104 years old and three sets of guidelines. Four out of seven studies reported a significant reduction in serum copper in long-term tube-fed patients (p <0.001), six out of seven reported a significant reduction in zinc levels (p <0.0, one out of five reported a significant reduction in selenium levels (p <0.0001), and one out of three found no significant iron deficiency in patients undergoing long-term tube feeding. Conclusion: The presence of a trace elements deficiency in patients undergoing PEG and PEJ was very common. More than half of the patients had at least one abnormality. The most frequent were cooper and zinc deficiencies. The results of the review show the necessity of routinely monitoring those undergoing PEG and PEJ feeding to avoid negative outcomes.