Evaluation of the Mineral, Physical and Chemical Properties of Enteral Tube Feeds Powder Administered in Jos University Teaching Hospital, Jos Plateau State, Nigeria

For many people, the simple act of eating is a routine biological function, a way to fuel the body and sustain life. But for patients in hospitals who cannot chew or swallow due to illness, injury, or surgery, this fundamental process becomes impossible. When the mouth cannot do its job, doctors must turn to alternative methods to deliver nutrients directly into the digestive system. One common approach is tube feeding, where liquid nutrition is pumped through a thin tube inserted into the stomach or intestine. While many hospitals use commercially manufactured formulas that are precisely engineered to contain specific amounts of vitamins, minerals, and energy, some healthcare systems, particularly in developing regions, rely on feeds prepared right inside the hospital. These are often made by blending whole foods like grains, legumes, and nuts into a smooth liquid. The idea is that these whole-food mixtures are affordable, culturally familiar, and potentially easier for patients to tolerate than processed products. However, because these hospital-made feeds are not produced in a factory with strict quality controls, their nutritional content can vary wildly depending on the ingredients used and how they are prepared. This uncertainty raises a critical question: do these homemade mixtures actually provide the balanced nutrition that a sick person needs to recover?

A team of researchers set out to answer this question by examining the specific feeds used at the Jos University Teaching Hospital in Nigeria. They focused on three different types of powder that staff mixed with water to create the liquid meals for patients. The first mixture, called Dietrend, was made from a blend of maize, soybeans, and groundnuts. The second, known as JOT-M-MIX, swapped the maize for millet but kept the soybeans and groundnuts. The third option, Bran Mix, was a combination of leftover bran from the first mixture and a small grain called acha, also known as fonio. The researchers wanted to know exactly what was inside these powders, not just in terms of calories, but in terms of the essential minerals that keep the body functioning, as well as how thick the liquid was and how it behaved chemically when mixed with water.

To find the answers, the scientists took sealed samples of these three powders to a laboratory in the United Kingdom for detailed analysis. They used advanced equipment to measure the concentration of nearly thirty different mineral elements in each sample, looking for things like calcium, iron, magnesium, and zinc. They also tested the physical properties of the feeds, specifically measuring how thick or runny the liquid was at two different temperatures: one hot, similar to when it is first prepared, and one warm, similar to body temperature. They also checked the osmolality, a measure of how many dissolved particles are in the liquid, which can affect how easily the body absorbs the nutrients and whether the feed might cause stomach upset.

The results revealed that while these hospital-prepared feeds contained a wide variety of minerals, they were far from uniform. The researchers found that the JOT-M-MIX and Bran Mix powders generally contained significantly higher levels of important minerals like magnesium, phosphorus, calcium, iron, and zinc compared to the Dietrend powder. For instance, the magnesium content in the Bran Mix was notably higher than in the other two. However, the Dietrend powder had higher levels of certain other elements, such as radium, though the amounts were very small. The study identified about thirty different mineral elements across the samples, but the amounts varied so much between the three types that one could not assume they were nutritionally equivalent. This variability suggests that the specific choice of grain and the ratio in which ingredients are mixed play a huge role in the final nutritional value of the meal.

Beyond the minerals, the physical characteristics of the feeds showed even starker differences. When the researchers measured the thickness of the liquids, the Dietrend mixture was significantly thicker than the other two. At a temperature of 100 degrees Celsius, the Dietrend liquid was so thick that its viscosity, or resistance to flow, was measured at 1644.00 centipoise, whereas the JOT-M-MIX and Bran Mix were much thinner, with values around 289 and 180 centipoise respectively. This difference remained even when the liquids cooled to body temperature, with the Dietrend mixture remaining much thicker. This is a crucial finding because if a liquid is too thick, it can clog the narrow tubes used for feeding, making it difficult to deliver the full amount of food to the patient. Additionally, the chemical tests showed that the JOT-M-MIX and Bran Mix had higher osmolality than the Dietrend, meaning they had a higher concentration of dissolved particles, which could influence how well a patient's body tolerates the feed.

The study concludes that while these locally prepared feeds can provide a source of nutrition, they lack the consistency found in commercial products. The fact that the mineral content and physical properties changed so drastically between the three formulations means that a patient receiving one type of feed might be getting a very different nutritional profile than a patient receiving another, even if they are in the same hospital. The researchers suggest that this is not necessarily a failure of the whole-food approach, but rather a signal that these hospital recipes need better standardization. By carefully measuring ingredients and perhaps adjusting the mixtures to ensure they contain enough essential minerals and flow easily through tubes, hospitals could improve the quality of care. The findings highlight that in settings where commercial options are scarce, optimizing these homemade feeds through science-based adjustments could be a vital step toward ensuring that every patient receives the reliable, adequate nutrition they need to heal.