Nutrition Diagnoses According to the International Terminology: Challenges and Effectiveness of the Care Process in Home Enteral Nutrition
DOI:
https://doi.org/10.12957/demetra.2026.92143Keywords:
Diagnosis. Enteral Nutrition. Nutritional Therapy. Nutritional Assessment. Nutrition Surveys. Home Care.Abstract
Objective: To identify the nutritional diagnoses (DN) of people using home enteral nutrition (NED), through the application of the second step of the Nutrition Care Process (PCN), using the Standardized Nutrition Care Process Terminology (TPCN). Methods: Observational, cross-sectional and descriptive study with people using NED assisted by the Program of Nutritional Care for People with Special Feeding Needs (PAN) of a municipality in the Southern region of Brazil. Data collection occurred between June 2016 and February 2018, including socioeconomic, demographic, food security, medical history, nutritional status, and food consumption data, and were obtained from people using NED and their caregivers. The DN were identified according to the TPCN of the Academy of Nutrition and Dietetics (AND), organized into three domains: Intake (IN), Clinical Nutrition (NC), and Nutritional Behavior/Environment (CN). Results: 123 people participated, with a mean age of 63.7 ± 21.1 years and a per capita income of 2.6 minimum wages; 41 DN were identified, the most prevalent being: suboptimal fiber and vitamin D intake (100%), swallowing with difficulty (100%), physical inactivity (79.7%), suboptimal self-care management (79.7%), self-feeding with difficulty (79.7%), suboptimal magnesium (68.3%) and folate (67.5%) intake, unintentional weight loss (56.9%), food insecurity (51.2%), and suboptimal protein intake (50.4%). Conclusion: The most frequent DN are related to the intake of essential nutrients, difficulties with swallowing and self-feeding, self-care, and physical activity practice. The standardized diagnosis can guide prioritization and increase the effectiveness of home nutritional intervention.
Downloads
References
1. Mundi MS, Mohamed Elfadil O, Olson DA, Pattinson AK, Epp LM, Miller LD, et al. Home enteral nutrition: A descriptivestudy. Journalof Parenteraland Enteral Nutrition. 12 de maio de 2023;47(4):550–62. https://doi.org/10.1002/jpen.2498
2. Wanden-Berghe C, Patino-Alonso MC, Galindo-Villardón P, Sanz-Valero J. Complications Associated with Enteral Nutrition: CAFANE Study. Nutrients. 1o de setembro de 2019;11(9):2041. https://doi.org/10.3390/nu11092041
3. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, et al. ESPEN guideline on home enteral nutrition. Clinical Nutrition. janeiro de 2020;39(1):5-22. https://doi.org/10.1016/j.clnu.2019.04.022
4. Byrnes C, Mockler D, Lyons L, Loane D, Russell E, Bennett AE. A scoping review of best practices in home enteral tube feeding. Prim Health Care Res Dev. 4 de agosto de 2022;23:e43.n https://doi.org/10.1017/S1463423622000366
5. Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of Home Parenteral and Enteral Nutrition in the United States. Nutrition in Clinical Practice. 17 de dezembro de 2017;32(6):799–805. https://doi.org/10.1177/0884533617718472
6. Wanden-Berghe C, Campos Martín C, Álvarez Hernández J, Burgos Peláez R, Matía Martín P, CuerdaCompés C, et al. The NADYA-SENPE Home Enteral Nutrition Registry in Spain: years 2018 and 2019. Nutr Hosp. 2021. https://doi.org/10.20960/nh.03663
7. Mazur CE, Chavoni Zago RC, Schieferdecker MEM, Cesário Pereira Maluf EM. Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy. Nutr Hosp. 2019. https:https://dx.doi.org/10.20960/nh.02606.
8. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição. Ministério da Saúde. Brasília: Ministério da Saúde; 2013. [Acesso em 30 de setembro de 2025]. Disponível em: https://www.gov.br/saude/pt-br/composicao/saps/pnan
9. Brasil. Lei no 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional – SISAN com vistas em assegurar o direito humano à alimentação adequada e dá outras providências. Diário Oficial da União. Brasília: Diário Oficial da União; 2006. p. 1. [Acesso em 30 de setembro de 2025]. Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2006/lei/l11346.htm
10. Santos DC dos, Ataide CDG, Mota da Costa N, Oliveira Junior VP de, Egea MB. Blenderized formulations in home enteral nutrition: A narrative review about challenges in nutritional security and food safety. Nutr Rev. 2022;80(6):1580–98. https://doi.org/10.1093/nutrit/nuab121
11. Skipper A. Applying the nutrition care process: nutrition diagnosis and intervention. SupportLine. 2007;29(6):12–23. [Acesso em 30 de setembro de 2025]. Disponível em: https://www.andeal.org/files/file/Skipper_Article%20%282%29.pdf
12. Martins C. Diagnósticos em nutrição: fundamentos e implementação da padronização internacional. Artmed Editora; 2016.
13. Fidelix MSP. Manual orientativo: Sistematização do cuidado de nutrição. São Paulo: Associação Brasileira de Nutrição. 2014;66.[Acesso em 30 de setembro de 2025]. Disponível em: https://www.asbran.org.br/storage/arquivos/PRONUTRI-SICNUT-VD.pdf
14. Diniz MAA, Melo BR de S, Neri KH, Casemiro FG, Figueiredo LC, Gaioli CCL de O, et al. Estudo comparativo entre cuidadores formais e informais de idosos. Cien Saude Colet. novembro de 2018;23(11):3789–98. https://doi.org/10.1590/1413-812320182311.16932016
15. Santos LP dos, Lindemann IL, Motta JV dos S, Mintem G, Bender E, Gigante DP. Proposta de versão curta da Escala Brasileira de Insegurança Alimentar. Rev Saude Publica. 2014;48:783-9. https://doi.org/10.1590/S0034-8910.2014048005195
16. Chumlea WC, Roche AF, Steinbaugh ML. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc. 1985;33(2):116-20. https://doi.org/10.1111/j.1532-5415.1985.tb02276.x
17. Chumlea WC, Guo S, Roche AF, Steinbaugh ML. Prediction of body weight for the nonambulatory elderly from anthropometry. J Am Diet Assoc. 1988;88(5):564–8. https://doi.org/10.1177/088453368800300513
18. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Brasília: Cuidados em terapia nutricional; 2015. [Acesso em 30 de setembro de 2025]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/cuidados_terapia_domiciliar_v3.pdf
19. Yang H, Hou L, Sun HM, Ye SH. Comparison of micronutrients in adult enteral formulas widely used in clinical practice. Food Sci Nutr. 2023;11(10):6096–105. https://doi.org/10.1002/fsn3.3545
20. Brasil. Ministério da Saúde. Pesquisa de orçamentos familiares 2008-2009: tabela de medidas referidas para os alimentos consumidos no Brasil. Publication. Rio de Janeiro: IBGE; 2011. [Acesso em 30 de setembro de 2025]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50000.pdf
21. Universidade Estadual de Campinas (UNICAMP). Tabela Brasileira de Composição de Alimentos (TACO). 4o ed. Vol. 1. Campinas: UNICAMP; 2011. [Citado 30 de setembro de 2025]. Disponível em: https://www.nepa.unicamp.br/tabela-brasileira-de-composicao-de-alimentos-4a-edicao
22. Compounding PN. Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr. 2004;28:S39. https://doi.org/10.1002/ncp.11064
23. Trumbo P, et al. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. National Academies Press; 2005. https://doi.org/ 10.1016/s0002-8223(02)90346-9
24. National Academies (US). Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. National Academies Press; 2005. https://doi.org/10.17226/10925
25. National Academies (US). . Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. 1999. https://doi.org/10.17226/5776
26. National Academies (US).Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.Washington (DC): National Academies Press (US); 1998. PMID: 23193625. 2000. https://doi.org/10.17226/6015
27. National Academies (US). Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. National Academies Press; 2002. https://doi.org/ 10.17226/10026
28. August D. Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients. J Parenter Enteral Nutri (JPEN). 2002;26. https://doi.org/10.1177/0148607102026001011
29. Bittencourt AF, Martins JR, Logullo L, Shiroma G, Horie L, Ortolani MC, et al. Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study. Nutrition in clinical practice. 2012;27(4):533–9. https://doi.org/ 10.1177/0884533612449488
30. Organization WH. Obesity: preventing and managing the global epidemic: report of a WHO consultation. 2000. [Acesso em 30 de setembro de 2025]. Disponível em: https://apps.who.int/iris/bitstream/10665/42330/1/WHO_TRS_894.pdf
31. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? Journal of parenteral and enteral nutrition. 1987;11(1):8–13. https://doi.org/10.1177/014860718701100108
32. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The lancet. 2007;370(9596):1453-7. https://doi.org/10.1016/j.jclinepi.2007.11.008
33. United States. Medicare. Medicare. 2024 [citado 30 de setembro de 2025]. Enteral and parenteral nutrition: nutrients, suppliesandequipment. [Acesso em 30 de setembro de 2025]. Disponível em: https://www.medicare.gov/coverage/enteral-parenteral-nutrition-nutrients-supplies-equipment
34. de Sousa LRM, Will KL. Fortalecendo a rede de atenção às necessidades alimentares especiais: uma experiência com fórmulas enterais semiartesanais, em Piraquara-PR. DEMETRA: Alimentação, Nutrição & Saúde. 2017;12(3):767–79. https://doi.org/10.12957/demetra.2017.30161
35. Thieme RD, Schieferdecker MEM, Ditterich RG. Idosos em terapia nutricional enteral no domicílio: integração das políticas públicas nacionais e programas municipais. Revista Brasileira de Geriatria e Gerontologia. 2020;23:e200157. https://doi.org/10.1590/1981-22562020023.200157
36. Mezzomo TR, Fiori LS, de Oliveira Reis L, Schieferdecker MEM. Nutritional composition and cost of home-prepared enteral tube feeding. Clin Nutr ESPEN. 2021;42:393–9. https://doi.org/ 10.1016/j.clnesp.2020.12.016
37. Folwarski M, Kłęk S, Zoubek-Wójcik A, Szafrański W, Bartoszewska L, Figuła K, et al. Home enteral nutrition in adults—nationwide multicenter survey. Nutrients. 2020;12(7):2087. https://doi.org/ 10.3390/nu12072087
38. Vieira MMC, Santos VFN, Bottoni A, Morais TB. Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults. Clinical Nutrition. 2018;37(1):177–81. https://doi.org/ 10.1016/j.clnu.2016.11.020
39. Gazan R, Vieux F, Mora S, Havard S, Dubuisson C. Potential of existing online 24-h dietary recall tools for national dietary surveys. Public Health Nutr. 2021;24(16):5361–86. https://doi.org/ 10.1017/S1368980021003517
40. Tang H, Yang M. Nutritional assessment in patients with chronic diseases: Tools, challenges, and future directions. Vol. 15, Nutrients. MDPI; 2023. p. 4794. https://doi.org/ 10.3390/nu15224794
41. Azzollini V, Dalise S, Chisari C. How does stroke affect skeletal muscle? State of the art and rehabilitation perspective. Front Neurol. 2021;12:797559. https://doi.org/ 10.3389/fneur.2021.797559
42. Bendavid I, Lobo DN, Barazzoni R, Cederholm T, Coëffier M, de van der Schueren M, et al. The centenary of the Harris–Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group. Clinical nutrition. 2021;40(3):690–701. https://doi.org/ 10.1016/j.clnu.2020.11.012
43. de Melo VX, Mezzomo TR, Dall’igna ALA, Dengo V de AM, Stangarlin-Fiori L, Schieferdecker MEM, et al. Does the nutritional composition and category of administered enteral nutrition affect the nutritional status of patients receiving home nutritional therapy? Clin Nutr ESPEN. 2022;49:270–7. https://doi.org/10.1016/j.clnesp.2022.03.042
44. D’Onofrio V, Del Chierico F, Belci P, Vernocchi P, Quagliariello A, Reddel S, et al. Effects of a symbiotic formula on functional bowel disorders and gut microbiota profile during long-term home enteral nutrition (LTHEN): a pilot study. Nutrients. 2020;13(1):87. https://doi.org/10.3390/nu13010087
45. Serra J, Alcedo J, Barber C, de Los Ríos CC, Jordi S, Javier A, et al. Review document of the Spanish Association of Neurogastroenterology and Motility on the management of opioid-induced constipation. Revista Española de EnfermedadesDigestivas. 2024;116(10):546–53. https://doi.org/ 10.3390/nu13010087
46. Van Der Schoot A, Drysdale C, Whelan K, Dimidi E. The effect of fiber supplementation on chronic constipation in adults: an updated systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2022;116(4):953–69. https://doi.org/ 10.1093/ajcn/nqac184
47. Cui J, Xie F, Yue H, Xie C, Ma J, Han H, et al. Physical activity and constipation: A systematic review of cohort studies. J Glob Health. 2024;14:04197. https://doi.org/ 10.7189/jogh.14.04197
48. Gramlich L, Hurt RT, Jin J, Mundi MS. Home enteral nutrition: towards a standard of care. Nutrients. 2018;10(8):1020. https://doi.org/ 10.3390/nu10081020
49. Lim SER, Cox NJ, Tan QY, Ibrahim K, Roberts HC. Volunteer-led physical activity interventions to improve health outcomes for community-dwelling older people: a systematic review. Aging Clin Exp Res. 2021;33:843–53. https://doi.org/ 10.1007/s40520-020-01556-6
50. Neil-Sztramko SE, Teggart K, Moore C, Sherifali D, Fitzpatrick-Lewis D, Coletta G, et al. Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review. BMC Geriatr. 2022;22(1):539. https://doi.org/10.1186/s12877-022-03170-9
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Giuliane de Matos Wrobel, Sandra Patrícia Crispim, Estela Iraci Rabito, Rubia Daniela Thieme, Maria Eliana Madalozzo Schieferdecker
This work is licensed under a Creative Commons Attribution 4.0 International License.
STATEMENT OF AUTHORSHIP RESPONSIBILITY
Title of the manuscript:
________________________________________________________
1. Statement of responsability
I certify that I have participated in the work above specified and take public responsibility for its content.
I certify that the manuscript represents an original work and that none of the material in the manuscript has been previously published, is included in another manuscript, or is currently under consideration for publication elsewhere, whether in printed form or in electronic media, except that described in the attachment.
In case of acceptance of this text by Demetra: Alimentação, Nutrição & Saude, I declare to be in accordance with the policy of public access and copyright adopted by Demetra, which provides as follows: (a) the authors retain the copyright and grant to the Journal the right of first publication, the work being simultaneously licensed under the Creative Commons Attribution License, which allows the sharing of the work with acknowledgment of authorship and initial publication in this journal; (b) authors are authorized to enter additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal; and (c) authors are permitted and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this may lead to productive changes, as well as increase the impact and citation of the published work.
2. Conflict of Interest Statement
I certify that there is no conflict of interest in connection with the submitted article.
Date, signature and full address of all authors.
