Home enteral nutrition. Demographics and utilization in the United States.

Enteral nutrition is the act of receiving nutrients through the gut, either orally or through an enteral access device. It has long been used in the hospital and nursing home setting. The number of patients receiving home enteral nutrition (HEN) in the United States has progressively increased, yet the absolute numbers remain difficult to determine. The use of enteral nutrition has a long history. In 1790, Hunter was first reported to use a mixture of jellies, milk, eggs, sugar and wine through a whale bone covered with eel skin attached to a bladder pump [1]. Einhorn [2] in 1910 provided medical practitioners with guidelines for gastric and intestinal enteral feedings. In the 1950s, attention was placed on the development of enteral formulas. Pareira et al. [3] and Meade Johnson (Evansville, Ind., USA) developed an early enteral formula consisting of milk, milk solids, calcium caseinate, dextrose, maltodextrose, vitamins and minerals. At the same time at Henry Ford Hospital, Barron et al. [4] reported on the use of tube feedings made in the kitchen by blenderizing and straining table food. In the late 1950s and early 1960s a large study on the use of an elemental-based diet was conducted by the Vivonex Corporation (Mountain View, Calif., USA) and the National Institutes of Health. These diets were shown to provide adequate nutrition and maintain a patient’s well-being [5]. The last 3 decades have shown an explosion in the enteral formula industry with the development of many enteral products, some disease-specific. This has provided some specificity in a clinician’s ability to use enteral nutrition as a disease-specific tool, but has complicated the home care industry by the sheer volume of enteral formula choices available to patients and their providers. HEN has become a growing segment of the total home care arena in the United States. In 1992 it was estimated that there were approximately 73,000 HEN patients with an average yearly expenditure of USD 136 million [6]. Today’s expenditure estimates are very difficult to obtain, not only from the Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 45–58, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.