Comparative assessment of diets and supplements for nutritional therapy

ABSTRACT

Technology: Diet and enteral formulations for home nutritional support.

Indication: Patients undernourished or at risk of malnutrition, with or without specific nutritional deficiencies.

Question: What kinds of diets are available for home enteral nutrition therapy and what is the estimate for its monthly cost?

Methods: We searched for national publications related to the areas of nutrition and publications of the Brazilian Society of Nutrition, Brazilian Association of Nutrology, Brazilian Association of Nutrition, Nutritionists Professional Council and the Guidelines Project (Projeto Diretrizes). In addition, we conducted searches in the journals of the field for scientific articles and protocols on standard enteral diets and formulas for home nutritional support. Pricing information and description of the diets were verified by direct application to the manufacturer, by consulting the platforms “Compras Net” of the federation; Minas Gerais state “Compras Net” and the “Banco de Preços em Saúde”. Prices were also retrieved in a retail prices dissemination website. Finally we estimated monthly treatment costs of providing some diets based on the found values.

Results: We found three nutritional therapy protocols in Brazil. Of a total of 44 described diets, only 11 were included in more than one protocol. Little information was found in the literature on the prevalence of diseases associated with the use of enteral diets which made it difficult to estimate the number of patients in use of diets in the state of Minas Gerais. Product prices were not available from manufacturers and we observed gaps in the availability of prices on consulted prices banks. In the federal “Compras Net” databank we found 191 codes, and the current price for only 30 products. In the Minas Gerais “Compras Net” bank we found 37 codes, price for three products recorded trading sessions and for 31 products by price registry. In the “Banco de Preços em Saúde” we found 61 registered codes and only five prices. Costs were estimated for the monthly supply of six different diets for children (0-10 years), adolescents and adults. We found that prices vary according to age, patient weight and especially nutrient presentation. In general, the purchase prices for the government were lower than for the end consumer, and we observed public price differences concerning diets for children between 1-10 years of age with exclusive use of this type of diet.

Recommendations: The Nutritional Protocols analyzed have local or regional scope, reflecting specific realities of these regions. For the selection and standardization of formulations it is necessary to know the profile, current demand and the main nutritional needs of patients in Minas Gerais. It is recommended to start the standardization process with diets and formulations present in more than on Nutritional Protocol, incorporating at least one elementary and one semi-elementary formula and their several criteria in order to regulate the indication of these diets. The purchase must be made by price gram or price/milliliter, and open to all registered trademarks that meet the specifications of the standard formulation. The development of Home Nutritional Support Protocols is one way to allow better access and regulation of expenditures, considering the diversity of are available brands in the market and high estimated cost for the supply of these diets.

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