title: Nutritional content of modular feeds: how accurate is feed production?
abstract: OBJECTIVE
  This prospective, observational study examined the accuracy of modular feed preparation for children with complex medical conditions requiring specialist feeds.
  
  
  METHODS
  Participants who regularly prepare special feeds at home were observed preparing two feeds with equivalent nutrient composition: a 2-ingredient (2-IF) and 6-ingredient feed (6-IF) under research-conditions, and 8 weeks later under home-conditions. The same feeds (2-IF and 6-IF) prepared by a trained feed-maker served as controls. Biochemical analysis of nutrient content was performed as an objective measure of feed preparation accuracy.
  
  
  RESULTS
  52 participants were studied: one patient and 51 caregivers. Biochemical nutrient analysis was inaccurate for both feeds including control-feeds but was better for the 2-IF. Both feeds were lower in fat than the expected calculation but more so in the 6-IF than the 2-IF (median: 34% vs 84% of calculated research-condition values and 66% vs 90% home-conditions; p<0.0001). Conversely zinc was higher in the 6-IF than the 2-IF (median: 127% vs 87% research-conditions and 130% vs 89% home-conditions; p<0.0001). Preparation errors included: incorrect use of equipment, poor recipe adherence and ingredient measurement mistakes. Even in control-feeds there was equipment inaccuracy, poor ingredient emulsification and ingredient residue left in mixing/measuring containers. Fewer errors occurred with powdered than liquid ingredients.
  
  
  CONCLUSIONS
  Many errors associated with special feed production are difficult to control. Carers of children with complex medical conditions require improved preparation equipment and techniques and the development of premeasured or combined ingredient preparations to maximise feed accuracy and minimise clinical risk.
authors: Dietetic Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. evanss21@me.com
authors: Sharon
authors: S
authors: Evans
authors: Anne
authors: A
authors: Daly
authors: Catherine
authors: C
authors: Ashmore
authors: Hulya
authors: H
authors: Gokmen-Ozel
authors: Rosemary
authors: R
authors: Dileva
authors: Belinda
authors: B
authors: Dumbleton
authors: Satnam
authors: S
authors: Chahal
authors: Anita
authors: A
authors: Macdonald
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000737:chemistry* / Q000592:standards*; D008297:Male; D009753:Nutritive Value; D011446:Prospective Studies