The BLEND (BLenderized Enteral Nutrition Diet) Study was a prospective study of 20 pediatric patients who were transitioned from commercial formulas to blended tube feeds, the first study to prospectively evaluate this transition. Data collected included nutritional status, symptoms, stool microbiota, nutrient intake, and parents’ perspectives for up to 6 months after the transition. 17 of the patients were able to transition to blended tube feeds, 82% of pts taking in more than 75% of calories from blended feeds. Of the patients who did not complete the study, reasons did not include intolerance of blended feeds.

A majority of the outcomes were positive including decreased acid suppressant use, increased bacterial diversity and richness in stool samples, and increased caregiver satisfaction. Constipation rates did not change and stool softener use increased. The study found patients were able to transition off hypercaloric formulas (25%), continuous feeds(35%), and semi-elemental and elemental formulas (15%, 20%) to blended meals without issue. This diet may be difficult for every gtube patient to stick to as required access to high powered blender, a personalized diet prescription, and a majority of patients had 12Fr gtubes. In addition, this study found that patients required 50% more calories to maintain BMI. The patient population included 35% congenital heart disease, 35% genetic syndromes, 10% pulmonary conditions, and 15% neuro and neuromsk conditions.
I found this study very useful as there is very little literature on blended feeds. The positive results will help me discuss blended feeds with families and I also will start suggesting blended feeds more often to patients with poor stool microbiota (recurrent c.diff) and even on more complicated feeding plans (continuous, hypercaloric, and elemental feeds). My patient population by diagnosis differs than in the study and I wonder if my neuro and neuromsk condition heavy population will still have the same symptom results.
Though I have been recommending blended feeds, often it is a hybrid including commercial formulas, commercial blended meal options, or small amounts of food in addition to current tube feeding plan. I find the barriers to families accepting completely blended diet are access to high powered blenders, access to nutritionist for recipes, and access to healthy food options. Even in this study were the first two aforementioned were provided, not all patients were able to transition completely to blended diets in this study therefore making me realize hybrid options may be just as ideal as can provide the benefits of increased stool microbiota diversity and reduced reflux symptoms without the burden of a complete transition.
Kristie Malik, MD
Complex Care, Children’s Hospital at Montefiore