Generic placeholder image

Current Nutrition & Food Science

Author(s): Fuadiyah Nila Kurniasari*, Susetyowati Susetyowati, Mardiah Suci Hardianti and Anggun Rindang Cempaka

DOI: 10.2174/1573401319666230608162235

DownloadDownload PDF Flyer Cite As
Nutritional Value and Physical Quality of Oral Nutritional Supplements Made from Purple Sweet Potatoes to Treat Malnutrition in Patients with Cancer

Page: [262 - 270] Pages: 9

  • * (Excluding Mailing and Handling)

Abstract

Background: Malnutrition often occurs in patients with cancer, which eventually leads to decreasing response to therapy and increased morbidity and mortality rate. Oral Nutrition Supplements (ONS) are necessary to provide additional nutritional intervention to prevent and treat malnutrition in cancer patients. Purple sweet potato is a local food that is abundantly available in Indonesia and can be utilized as a basic ingredient for producing a modified ONS formula that is not only high in nutritional value but also has good physical quality.

Objective: This study aimed to evaluate the nutritional value and physical quality of purple sweet potato-based ONS.

Methods: A new local food-based formula was formulated by using purple sweet potato as the main ingredient. This new formula, which was then mentioned as the treatment formula, was subsequently compared with the control formula. The control formula was made from ingredients commonly used for producing ONS in hospitals in Indonesia, such as milk powder, sugar, oil, and other additives such as maltodextrin and creamer. Meanwhile, the treatment formula was labelled into three treatment formulas based on the differences in the proportions of white egg flour and whey protein as a protein source in each treatment formula. The treatment formula was formulated by using local ingredients of purple sweet potato flour and egg white flour by adding whey protein, extra virgin olive oil, omega-3 powder, sugar, and creamer. A proximate analysis was conducted to analyze the nutrient content of the formula and the viscosity and osmolarity tests were conducted to evaluate the physical qualities of the formula. The laboratory analysis results were described as descriptive data, then analyzed by using One-Way ANOVA. The determination of the best treatment formula in the form of effectiveness (Nh).

Results: The results of the proximate test and physical quality showed that the best formula based on the highest Nh value of 0.75 was P3 with 245 kcal energy, 8.8 g (14%) protein, 6.5 g (24%) fat, and 37.8 g (62%) carbohydrate, viscosity 28.1 cP, and osmolarity 492.3 mOsm (iso-osmolar) per serving size (200 ml).

Conclusion: Formula P3 which contains more egg white flour than whey protein is the best formula that has the best nutritional value and good physical quality.

Graphical Abstract

[1]
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 Cancers in 185 countries. CA Cancer J Clin 2021; 71(3): 209-49.
[http://dx.doi.org/10.3322/caac.21660] [PMID: 33538338]
[2]
Ministry of Health of the Republic of Indonesia. The main results of the 2018 Riskesdas Jakarta, Indonesia. 2018.
[3]
Muscaritoli M, Lucia S, Farcomeni A, et al. Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget 2017; 8(45): 79884-96.
[http://dx.doi.org/10.18632/oncotarget.20168] [PMID: 29108370]
[4]
Marshall KM, Loeliger J, Nolte L, Kelaart A. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr 2019; 38(2): 644-51.
[http://dx.doi.org/10.1016/j.clnu.2018.04.007] [PMID: 29789167]
[5]
Sandmæl JA, Sand K, Bye A, Solheim TS, Oldervoll L, Helvik AS. Nutritional experiences in head and neck cancer patients. Eur J Cancer Care 2019; 28(6): e13168.
[http://dx.doi.org/10.1111/ecc.13168] [PMID: 31571296]
[6]
Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr 2021; 40(5): 2898-913.
[http://dx.doi.org/10.1016/j.clnu.2021.02.005] [PMID: 33946039]
[7]
Uí Dhuibhir P, Collura N, Walsh D. Complete oral nutritional supplements: Dietitian preferences and clinical practice. J Diet Suppl 2019; 16: 40-50.
[8]
Fietkau R, Lewitzki V, Kuhnt T, Hölscher T, Hess CF, Berger B, et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: Results of a randomized, controlled, multicenter trial. Cancer 2013; 119: 3343-53.
[9]
Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36(1): 49-64.
[http://dx.doi.org/10.1016/j.clnu.2016.09.004] [PMID: 27642056]
[10]
Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr 2006; 25(2): 180-6.
[http://dx.doi.org/10.1016/j.clnu.2006.02.007] [PMID: 16697086]
[11]
Martínez-Matsumoto P, Castillo-Martínez L, Medina-Vera I, Tello-Santillán J, Reyes-Ramírez AL, Serralde-Zúñiga AE. Risk of malnutrition and oral nutritional support in a cohort of hospital inpatients. Rev Esp Nutr Hum Diet 2017; 29: 2008-10.
[http://dx.doi.org/10.14306/renhyd.26.2.1635]
[12]
Baldwin C, Smith R, Gibbs M, Weekes CE, Emery PW. Quality of the evidence supporting the role of oral nutritional supplements in the management of malnutrition: An overview of systematic reviews and meta-analyses. Adv Nutr 2021; 12(2): 503-22.
[http://dx.doi.org/10.1093/advances/nmaa108] [PMID: 32945835]
[13]
Huynh DTT, Devitt AA, Paule CL, et al. Effects of oral nutritional supplementation in the management of malnutrition in hospital and post‐hospital discharged patients in India: A randomised, openlabel, controlled trial. J Hum Nutr Diet 2015; 28(4): 331-43.
[http://dx.doi.org/10.1111/jhn.12241] [PMID: 24809429]
[14]
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017; 36: 11-48.
[http://dx.doi.org/10.1016/j.clnu.2016.07.015]
[15]
Zhu M, Yang X, Xiu D, Yang Y, Li G, Hu W, et al. Effect of oral nutritional supplementation on the post-discharge nutritional status and quality of life of gastrointestinal cancer patients after surgery: A multi-center study. Asia Pac J Clin Nutr 2019; 28: 450-6.
[http://dx.doi.org/10.6133/apjcn]
[16]
Aoyama T, Nakazono M, Nagasawa S, Segami K. Clinical impact of perioperative oral nutritional treatment for body composition changes in gastrointestinal cancer treatment. Anticancer Res 2021; 41(4): 1727-32.
[http://dx.doi.org/10.21873/anticanres.14937] [PMID: 33813376]
[17]
Mello AT, Borges DS, de Lima LP, Pessini J, Kammer PV, Trindade EBSM. Effect of oral nutritional supplements with or without nutritional counselling on mortality, treatment tolerance and quality of life in head-and-neck cancer patients receiving (chemo)radiotherapy: A systematic review and meta-analysis. Br J Nutr 2021; 125(5): 530-47.
[http://dx.doi.org/10.1017/S0007114520002329] [PMID: 32594952]
[18]
Grupińska J, Budzyń M, Maćkowiak K, et al. Beneficial effects of oral nutritional supplements on body composition and biochemical parameters in women with breast cancer undergoing postoperative chemotherapy: A propensity score matching analysis. Nutrients 2021; 13(10): 3549.
[http://dx.doi.org/10.3390/nu13103549] [PMID: 34684550]
[19]
Qin N, Jiang G, Zhang X, Sun D, Liu M. The effect of nutrition intervention with oral nutritional supplements on ovarian cancer patients undergoing chemotherapy. Front Nutr 2021; 8: 685967.
[http://dx.doi.org/10.3389/fnut.2021.685967] [PMID: 34249995]
[20]
Faidah FH, Moviana Y, Isdiany N, Surmita S, Hartini PW. Formulation of enteral food based on tempe flour as an alternative to high protein enteral food. Journal of health research poltekkes depkes bandung 2019; 11(2): 67-74.
[http://dx.doi.org/10.34011/juriskesbdg.v11i2.702]
[21]
Lestari S, Rahmawati M, Shita D EL. Modification of powdered, ready to brew hospital-made formula. Jurnal Gizi dan Kesehatan 2019; 11: 11-8.
[http://dx.doi.org/10.35473/jgk.v11i26.51]
[22]
Hurt RT, Epp LM, Duellman WM, et al. Blenderized tube feedings for adult patients on home enteral nutrition: A pilot study. J Altern Complement Med 2019; 25(4): 413-6.
[http://dx.doi.org/10.1089/acm.2018.0227] [PMID: 30596514]
[23]
Spurlock AY, Johnson TW, Pritchett A, et al. Blenderized food tube feeding in patients with head and neck cancer. Nutr Clin Pract 2022; 37(3): 615-24.
[http://dx.doi.org/10.1002/ncp.10760] [PMID: 34462968]
[24]
Candido Franca S, Rupp de Paiva SA, Borgato MH, et al. Homemade diet versus diet industrialized for patients using alternative feeding tube at home- an integrative review. Nutr Hosp 2017; 34(5): 1281-7.
[http://dx.doi.org/10.20960/nh.1301] [PMID: 29280640]
[25]
Ojo O, Rodrigues A, Adegboye A, Ojo OO, Wang X, Brooke J. The microbial quality and safety of blenderised enteral nutrition formula: A systematic review. Int J Environ Res Public Heal 2020; 17: 1-12.
[http://dx.doi.org/10.3390/ijerph17249563]
[26]
Lestari LA. Susetyowati, Setyopranoto I, Probosuseno, Astuti H. Physicochemical and organoleptic properties of local food-based enteral nutrition product to mitigate patient malnutrition. Curr Nutr Food Sci 2021; 17(5): 509-15.
[http://dx.doi.org/10.2174/1573401316999200922090202]
[27]
Susetyowati S, Lestari LA, Setyopranoto I. Potential of local food-based enteral nutrition to improve patient’s nutrition status in hospital in Yogyakarta, Indonesia. J Food Nutr Res 2019; 7: 568-72.
[http://dx.doi.org/10.12691/jfnr-7-8-3]
[28]
Chen XY, Zhou J, Luo LP, et al. Black rice anthocyanins suppress metastasis of breast cancer cells by targeting RAS/RAF/MAPK pathway. BioMed Res Int 2015; 2015: 1-11.
[http://dx.doi.org/10.1155/2015/414250] [PMID: 26649302]
[29]
Diaconeasa Z, Ayvaz H, Ruginǎ D, et al. Melanoma inhibition by anthocyanins is associated with the reduction of oxidative stress biomarkers and changes in mitochondrial membrane potential. Plant Foods Hum Nutr 2017; 72(4): 404-10.
[http://dx.doi.org/10.1007/s11130-017-0638-x] [PMID: 29129015]
[30]
Mine Y. Egg proteins and peptides in human health--chemistry, bioactivity and production. Curr Pharm Des 2007; 13(9): 875-84.
[http://dx.doi.org/10.2174/138161207780414278] [PMID: 17430187]
[31]
Bumrungpert A, Pavadhgul P, Nunthanawanich P, Sirikanchanarod A, Adulbhan A. Whey protein supplementation improves nutritional status, glutathione levels, and immune function in cancer patients: A randomized, double-blind controlled trial. J Med Food 2018; 21(6): 612-6.
[http://dx.doi.org/10.1089/jmf.2017.4080] [PMID: 29565716]
[32]
Cereda E, Turri A, Klersy C, et al. Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cancer Med 2019; 8(16): 6923-32.
[http://dx.doi.org/10.1002/cam4.2517] [PMID: 31568698]
[33]
Mazzuca F, Roberto M, Arrivi G, et al. Clinical impact of highly purified, whey proteins in patients affected with colorectal cancer undergoing chemotherapy: Preliminary results of a placebo-controlled study. Integr Cancer Ther 2019; 18.
[http://dx.doi.org/10.1177/1534735419866920] [PMID: 31370717]
[34]
Teixeira FJ, Santos HO, Howell SL, Pimentel GD. Whey protein in cancer therapy: A narrative review. Pharmacol Res 2019; 144: 245-56.
[http://dx.doi.org/10.1016/j.phrs.2019.04.019] [PMID: 31005617]
[35]
Cardeno A, Sanchez-Hidalgo M, Alarcon-de-la-Lastra C. An up-date of olive oil phenols in inflammation and cancer: molecular mechanisms and clinical implications. Curr Med Chem 2013; 20(37): 4758-76.
[http://dx.doi.org/10.2174/09298673113209990159] [PMID: 23834184]
[36]
Gorzynik-Debicka M, Przychodzen P, Cappello F, et al. Potential health benefits of olive oil and plant polyphenols. Int J Mol Sci 2018; 19(3): 686.
[http://dx.doi.org/10.3390/ijms19030686] [PMID: 29495598]
[37]
DeGarmo EP, Canada JR, Sullivan WG. Engineering economy. (7th ed.), New York: New York Macmillan Pub. Coy. Inc. 1984.
[38]
Hayati R. Efendi, Rahmadana F. Determination of the best treatment of the harvesting, physicochemical properties, organoleptic test using the effectiveness index method on the Aceh local rice genotype M7. IOP Conf Ser Earth Environ Sci 2020; 425(1): 012012.
[http://dx.doi.org/10.1088/1755-1315/425/1/012012]
[39]
Ticoalu G, Maligan J. The utilization of purple sweet potato (Ipomoea batatas) as an anthocyanin contained beverage using enzimatic hydrolisis process. Jurnal Pangan dan Agroindustri 2016; 4: 46-55.
[40]
Ha E, Zemel MB. Functional properties of whey, whey components, and essential amino acids: mechanisms underlying health benefits for active people (review). J Nutr Biochem 2003; 14(5): 251-8.
[http://dx.doi.org/10.1016/S0955-2863(03)00030-5] [PMID: 12832028]
[41]
Menendez J, Lupu R. Mediterranean dietary traditions for the molecular treatment of human cancer: Anti-oncogenic actions of the main olive oil’s monounsaturated fatty acid oleic acid (18:1n-9). Curr Pharm Biotechnol 2006; 7(6): 495-502.
[http://dx.doi.org/10.2174/138920106779116900] [PMID: 17168666]
[42]
Vieira SA, McClements DJ, Decker EA. Challenges of utilizing healthy fats in foods. Adv Nutr 2015; 6(3): 309S-17S.
[http://dx.doi.org/10.3945/an.114.006965] [PMID: 25979504]
[43]
Freitas R, Campos MM. Protective effects of omega-3 fatty acids in cancer-related complications. Nutrients 2019; 11(5): 945.
[http://dx.doi.org/10.3390/nu11050945] [PMID: 31035457]
[44]
Olson E, Kavlich S. National dysphagia diet: Standardization for optimal care. Chicago, IL: American Dietetic Association 2002.
[45]
Ferrie S, Daniells S, Gagnon S, et al. Enteral nutrition manual for adults in health care facilities. Dietitian Association Australia, Nutrition Support Interest Group 2018.
[46]
De Luis DA, Izaola O, Cuellar L, Terroba MC, Martin T, Ventosa M. A randomized double-blind clinical trial with two different doses of arginine enhanced enteral nutrition in postsurgical cancer patients. Eur Rev Med Pharmacol Sci 2010; 14(11): 941-5.
[PMID: 21284343]
[47]
Farreras N, Artigas V, Cardona D, Rius X, Trias M, Gonzalez JA. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr 2005; 24(1): 55-65.
[http://dx.doi.org/10.1016/j.clnu.2004.07.002] [PMID: 15681102]
[48]
Klek S, Scislo L, Walewska E, Choruz R, Galas A. Enriched enteral nutrition may improve short-term survival in stage IV gastric cancer patients: A randomized, controlled trial. Nutrition 2017; 36: 46-53.
[http://dx.doi.org/10.1016/j.nut.2016.03.016] [PMID: 28336107]
[49]
Casas-Rodera P, Gomez-Candela C, Benítez S, et al. Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: A prospective, randomized clinical trial. Nutr Hosp 2008; 23(2): 105-10.http://www.redalyc.org/articulo.oa?id=309226725011
[PMID: 18449445]
[50]
Susetyowati S, Sholikhati AS, Cahyaningrum DK, Rachmawati AI. Provision of local food based nutrition support to adenocarcinoma rectosigmoid pre-surgical patient. Malaysian J Med Heal Sci 2022; 18: 362-4.
[51]
Li X, Zhou J, Chu C, et al. Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy. Head Neck 2019; 41(10): 3525-34.
[http://dx.doi.org/10.1002/hed.25861] [PMID: 31301097]
[52]
Brown B, Roehl K, Betz M. Enteral nutrition formula selection: Current evidence and implications for practice. Nutr Clin Pract 2015; 30(1): 72-85.
[http://dx.doi.org/10.1177/0884533614561791] [PMID: 25516537]
[53]
Hawa II, Murbawani EA. The effect of administration of enteral formula based on yellow pumpkin (Cucurbita moschata) on postprandial blood glucose levels in diabetic mellitus rats. Journal of Nutrition College 2015; 4(4): 387-93. http://ejournal-s1.undip.ac.id/index.php/jnc
[http://dx.doi.org/10.14710/jnc.v4i4.10115]
[54]
Escuro A. Blenderized tube feeding: Suggested guidelines to clinicians. Pract Gastroenterol 2014; 136: 58-66.
[55]
Djali M, Huda S, Andriani L. Physicochemical characteristics of non-fat yogurt with whey protein concentrate and xanthan gum addition. Agritech 2018; 38: 178-86.
[http://dx.doi.org/10.22146/agritech.22451]
[56]
Nusa MI, Suarti B, Marbun RA. Addition of tempe and old fermentation to the quality of albumin flour egg. Agrium 2017; 20: 211-21.
[57]
Rauf R, Utami A. Nutrition value and viscosity of polymeric enteral nutrition products based on purple sweet potato flour with variation of maltodextrin levels. Indonesian J Nutr 2020; 8(2): 119-25.
[http://dx.doi.org/10.14710/jgi.8.2.119-125]
[58]
Lee JH, Paik HD. Anticancer and immunomodulatory activity of egg proteins and peptides: A review. Poult Sci 2019; 98(12): 6505-16.
[http://dx.doi.org/10.3382/ps/pez381] [PMID: 31237321]
[59]
Solak BB, Akin N. Health benefits of whey protein: A review. J Food Sci Eng 2012; 2: 129-37.
[60]
Escrich E, Solanas M, Moral R, Escrich R, Solanas M. Modulatory effects and molecular mechanisms of olive oil and other dietary lipids in breast cancer. Curr Pharm Des 2011; 17(8): 813-30.
[http://dx.doi.org/10.2174/138161211795428902] [PMID: 21443482]
[61]
Sim E, Kim JM, Lee SM, et al. The effect of omega,3 enriched oral nutrition supplement on nutritional indices and quality of life in gastrointestinal cancer patients: A randomized clinical trial. Asian Pac J Cancer Prev 2022; 23(2): 485-94.
[http://dx.doi.org/10.31557/APJCP.2022.23.2.485] [PMID: 35225460]
[62]
Ockermann P, Headley L, Lizio R, Hansmann J. A review of the properties of anthocyanins and their influence on factors affecting cardiometabolic and cognitive health. Nutrients 2021; 13(8): 2831.
[http://dx.doi.org/10.3390/nu13082831] [PMID: 34444991]
[63]
Sandoval-Ramírez BA, Catalán Ú, Llaurado E, et al. The health benefits of anthocyanins: An umbrella review of systematic reviews and meta-analyses of observational studies and controlled clinical trials. Nutr Rev 2022; 80(6): 1515-30.
[http://dx.doi.org/10.1093/nutrit/nuab086] [PMID: 34725704]
[64]
Rahmadanti TS, Candra A, Nissa C. Development of a hepatogomax enteral formula for liver disease based on soy flour and goat’s milk flour. Indone J of Nutrit 2020; 9(1): 1-10.
[http://dx.doi.org/10.14710/jgi.9.1.1-10]
[65]
Zahn S, Hoppert K, Ullrich F, Rohm H. Dairy-based emulsions: Viscosity affects fat difference thresholds and sweetness perception. Foods 2013; 2: 521-33.
[http://dx.doi.org/10.3390/foods2040521]
[66]
Pratiwi LE, Noer ER. Analysis of microbiological quality and viscosity testing of enteral formula based on yellow pumpkin (curcubita moschata) and duck eggs. J Nutr Coll 2014; 3(4): 951-7.
[http://dx.doi.org/10.14710/jnc.v3i4.6915]
[67]
Hron B, Rosen R. Viscosity of commercial food based formulas and home prepared blenderized feeds. J Pediatr Gastroenterol Nutr 2020; 70(6): e124-8.
[http://dx.doi.org/10.1097/MPG.0000000000002657] [PMID: 32443040]
[68]
Zhu Y, Hsu WH, Hollis JH. The impact of food viscosity on eating rate, subjective appetite, glycemic response and gastric emptying rate. PLoS One 2013; 8(6): e67482.
[http://dx.doi.org/10.1371/journal.pone.0067482] [PMID: 23818981]
[69]
Bonelli A, Menna P, Minotti G, et al. Safety and tolerability of a novel oral nutritional supplement in healthy volunteers. Clin Nutr 2021; 40(3): 946-55.
[http://dx.doi.org/10.1016/j.clnu.2020.06.022] [PMID: 32675020]
[70]
Henriques GS, Miranda LAVO, Generoso SV, Guedes EG, Jansen AK. Osmolality and pH in handmade enteral diets used in domiciliary enteral nutritional therapy. Food Sci Technol 2017; 37 (Suppl. 1): 109-14.
[http://dx.doi.org/10.1590/1678-457x.33616]
[71]
Hassan-Ghomi M, Nikooyeh B, Motamed SR, Neyestani T. Efficacy of commercial formulas in comparison with home-made formulas for enteral feeding: A critical review. Med J Islam Repub Iran 2017; 31: 55.
[http://dx.doi.org/10.14196/mjiri.31.55] [PMID: 29445684]
[72]
Caccialanza R, Laviano A, Bosetti C, et al. Clinical and economic value of oral nutrition supplements in patients with cancer: A position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. Support Care Cancer 2022; 30(11): 9667-79.
[http://dx.doi.org/10.1007/s00520-022-07269-y] [PMID: 35792925]
[73]
Wang Q, Chen Y, Peng Y, et al. Preferences of oral nutritional supplement therapy among postoperative patients with gastric cancer: Attributes development for a discrete choice experiment. PLoS One 2022; 17(9): e0275209.
[http://dx.doi.org/10.1371/journal.pone.0275209] [PMID: 36174091]
[74]
Gomez G, Botero-Rodríguez F, Misas JD, et al. A nutritionally focused program for community-living older adults resulted in improved health and well-being. Clin Nutr 2022; 41(7): 1549-56.
[http://dx.doi.org/10.1016/j.clnu.2022.05.003] [PMID: 35667271]
[75]
Martin B, Cereda E, Caccialanza R, Pedrazzoli P, Tarricone R, Ciani O. Cost-effectiveness analysis of oral nutritional supplements with nutritional counselling in head and neck cancer patients undergoing radiotherapy. Cost Eff Resour Alloc 2021; 19(1): 35.
[http://dx.doi.org/10.1186/s12962-021-00291-7] [PMID: 34130709]