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Background: The effectiveness of dietary therapy to induce remission of eosinophilic esophagitis (EoE) has been evaluated over the last decades and summarized in meta-analyses. Choosing the dietary modality, identifying the most suitable patients, and implementing specific prerequisites are essential to ensure long-term success. Summary: Impractical exclusive elemental diets provided the highest remission rates in EoE; however, they are not recommended due to their numerous disadvantages and detrimental effects on patient quality of life. Allergy testing-guided diets for EoE are limited; their insufficient effectiveness and low reproducibility are due to poor accuracy of skin or serum test results in identifying EoE food triggers. Initial experiences with a six-food elimination diet have provided evidence of high and predictive effectiveness rates and paved the way for less restrictive and more efficient step-up approaches, including four-food, two-food, and most recently, milk elimination diets. Dietary treatment for EoE is challenging for patients and families and requires certain skills to ensure success in the short and long term. Key Messages: The selection of appropriate patients is essential to ensure the success of and long-term adherence to dietary treatment of EoE. As normal triggers for EoE are commonly found in the staple diet, it is important to ensure adequate nutritional substitutes to avoid nutrient deficiency risks when long-lasting feeding difficulties or extensive restrictions are present. Specialized facilities in dietary therapy should adopt patient-centered and personalized approaches in order to provide timely monitoring and support for complex cases.

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Enteral nutrition is a cornerstone of nutrition support therapy in patients of all ages and across the care continuum. Safe delivery of enteral nutrition to patients is paramount. This review article will focus on current topics in enteral nutrition safety primarily in children including safety with home-made blenderized feeds, recent infant and enteral formula shortages largely due to formula contamination at the manufacturer level, and concerns with importing infant formulas.

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The four-tiered NOVA food classification defines foods based on their degree of processing and ranges from native unprocessed foods to so-called "ultra-processed" foods. Recent publications have suggested that foods classified as ultra-processed are unhealthy and contribute to the obesity epidemic. It is important to distinguish between formulation and processing of a food. In most cases it is the formulation more than the processing that results in foods that are not recommended as part of a healthy diet. Such "ultra-formulated" foods are unhealthy because they are high in added sugar and other caloric sweeteners, refined flours saturated fats and salt to increase palatability. The understanding that processing and formulation are distinct will assist health professionals in identifying the types of foods that are unhealthy and contribute to overconsumption and obesity. It furthermore will help to destigmatize food technology and promote discussions amongst health professionals, food scientists, corporate scientists, government officials and the general public. Novel food processing techniques are urgently needed in times of population growth, climate change and war-induced food shortages.

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BACKGROUND: Studies have shown an increase in the number of patients who use enteral nutrition at home and the benefits of this type of nutrition care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations. METHODS: This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies that microbiologically analyzed homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies. RESULTS: Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n = 73) of the HEPs, 81.96% (n = 50) of the BEPs, and 44.87% (n = 35) of the CEFs. The presence of 10 different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples. CONCLUSION: The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling.

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INTRODUCTION: Dietary and pharmacological (proton pump inhibitors, swallowed topical corticosteroids) therapies are effective for induction of clinical and histological remission of eosinophilic esophagitis. However, data evaluating their long-term efficacy and safety is limited. AREAS COVERED: Since eosinophilic esophagitis is chronic, clinical, endoscopic, and histological features usually recur when successful treatments are stopped. In untreated patients, persistent esophageal eosinophilic inflammation may progress to fibrostenosis over time, giving place to strictures and narrow-caliber esophagi. This article comprehensively reviews available data on long-term maintenance of eosinophilic esophagitis with pharmacological and dietary treatment. It also discusses limitations re: available literature and outlines data gaps on adherence to therapy and monitoring disease activity in the long-term. EXPERT OPINION: Evidence indicates that long-term maintenance therapy may decrease the risk of esophageal stricture, food bolus impaction, and need for dilation in patients with eosinophilic esophagitis. Further knowledge on eosinophilic esophagitis phenotypes is needed to ascertain who will benefit best from sustained therapy. Unanswered questions include an adequate definition for sustained remission, best strategies for maintenance drugs and diets, enhancement of treatment adherence, and proper monitoring for long-term surveillance.

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Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Left untreated, EoE progresses to fibrous remodeling and stricture formation that impairs quality of life. Therefore, EoE requires either repeated treatments or maintenance therapy. Current guidelines recommend swallowed topical corticosteroids (STCs), proton-pump inhibitors (PPIs), or dietary intervention as initial options to induce and maintain long-term disease remission. Impractical exclusive elemental diets and suboptimal allergy testing-directed food avoidance paved the way for empirical elimination diets. These are moderately effective and highly reproducible in inducing EoE remission and allow for identification of specific food triggers. Step-up strategies, including two- and four-food rather than six-food elimination diets, should be considered as initial approaches for dietary treatment in patients of all ages, as they reduce the need for endoscopic procedures, shorten diagnostic processing time, and avoid unnecessary restrictions. Formulations of STC originally designed for asthma therapy are suboptimal for EoE treatment, with new effervescent orodispersible tablets and viscose formulations designed to coat the esophageal mucosa providing increased effectiveness at reduced doses. The anti-inflammatory effects of PPI in EoE are independent from gastric acid secretion inhibition; despite evidence from observational research, PPIs are the most commonly prescribed first-line therapy for EoE due to their accessibility, low cost, and safety profile. Double doses of PPI only induce remission in half of EoE patients, irrespective of the drug used or patients' age. Inflammatory rather than stricturing EoE phenotype and treatment duration up to 12 weeks increase chances of achieving EoE remission. Most responders effectively maintain long-term remission with standard PPI doses. Finally, endoscopic dilation should be considered in patients with reduced esophageal caliber or persistent dysphagia despite histological remission. This article provides a state-of-the-art review and updated discussion of current therapies and newly developed options for EoE.

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RESUMEN Una nutrición adecuada es fundamental para el crecimiento y desarrollo óptimo de la infancia. En Chile, el Programa de Alimentación Escolar tiene como propósito disminuir la brecha asociada con el acceso a la cantidad y calidad de los alimentos en la población de estudiantes vulnerables. El objetivo de este estudio fue determinar el grado de aceptabilidad de los almuerzos que el Programa ofrece a los estudiantes y sus pérdidas económicas asociadas. Se realizó un estudio descriptivo transversal en 528 estudiantes primarios y secundarios de 5 colegios públicos de la comuna de Coquimbo, quienes evaluaron 6 almuerzos mediante la escala sensorial hedónica de 9 puntos, encuesta de características organolépticas, test de ordenación y determinación de porcentaje de ingesta para establecer pérdidas económicas. Se realizó muestreo probabilístico estratificado, ANOVA para análisis de la escala hedónica y porcentaje de ingesta, tablas de contingencia, Chi cuadrado para características organolépticas (p<0,05). Se encontró que la carne de res con fideos tuvo la mayor preferencia y las más bajas aceptaciones fueron frijoles con fideos y pastel de pescado con puré de papas (p<0,05). Las preparaciones con menor aceptabilidad representaron el 82,2% de las pérdidas económicas, principalmente frijoles. Los resultados confirman una baja ingesta de pescado y verduras, que las características de sabor por bajo contenido de sal afectan las preferencias y que existe una relación directa entre la ingesta y la pérdida económica.

ABSTRACT Adequate nutrition is a fundamental factor for optimal early childhood growth and development. In Chile, the School Nutritional Program aims to diminish the gap associated with access to the quantity and quality of food. The objective of this study was to determine the degree of acceptability of prepared lunches that are given to students by the School Nutritional Program and its association with economic losses. A descriptive cross-sectional study was carried out among 528 primary and secondary students from 5 public schools in the Coquimbo commune, who evaluated 6 lunches using the 9-point hedonic sensory scale, a survey of organoleptic characteristics, a ranking test and determination of the intake percentage to establish economic losses. Stratified probability sampling was performed, ANOVA for analysis of the hedonic scale and percentage of intake, contingency tables, Chi square tests were used for organoleptic characteristics (p<0.05). The thin sliced beef with noodles was found to have the highest preference and the lowest ranked meals were beans with noodles and fish cake with mashed potatoes (p<0.05). Preparations with lower acceptability represented 82.2% of economic losses and were mainly beans. The results confirm a low intake of fish and vegetables, that taste characteristics due to low salt content affect preferences and that there was a direct relationship between intake and economic loss.

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INTRODUCTION: Eosinophilic esophagitis (EoE) is a non-Immunoglobulin E-mediated food allergy that currently represents the main cause of dysphagia and food impaction in children and young adults. Diet remains the only therapy targeting the cause of the disease. Relevant advances in recent years allow novel approaches to dietary therapy in EoE. AREAS COVERED: An up-to-date review on dietary therapy for EoE is provided, as a potential first-line anti-inflammatory therapy able to induce and maintain remission in a significant proportion of patients. Unpractical elemental diets and suboptimal food allergy testing-directed food restrictions paved the way for empiric elimination diets, which currently are to be considered as the most effective drug-free treatment for EoE. After largely restrictive empiric six-food elimination diets, most efficient step-up approaches now include four-food and two-food elimination diets. The potential of milk-elimination is also discussed. EXPERT COMMENTARY: An empiric elimination diet step-up strategy should be currently considered as the initial approach for dietary treatment in EoE patients of all ages. Compared to a top-down strategy, step-up diets reduce the need for endoscopic procedures, shorten diagnostic process times, and avoid unnecessary restrictions. Furthermore, early identification of responders with few food triggers may select best candidates for maintenance dietary therapy.

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Enteral feeding is considered the preferred method for providing a complete or supplemental source of nutrition to patients. Enteral formulas (EFs) are traditionally assessed from general information provided by the manufacturer such as caloric density, percentage of macronutrients, and micronutrients to meet the Recommended Dietary Allowance. Sometimes labeling information highlights particular ingredients to indicate specific properties at a metabolic or nutrition level. However, it is necessary to review the quality and composition of any enteral formula, since the basic components are responsible for tolerance and nutrition efficacy, and this should not be overshadowed by the benefit of a single constituent. Intolerance to EF is commonly attributed to individual patient response or to the means of administration. The objective of this review is to highlight the importance of appraising EFs with regard to composition and effect on the gastrointestinal tract.

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Formulated chicken nuggets which are low in fat and, high in dietary fiber and free from phosphate were developed by adding various levels of a konjac flour/xanthan gum (KF/XG) (3:1) mixture (0.2-1.5 %, w/w) and shiitake powder (SP) (1-4 %, w/w). A central composite rotatable design was used to investigate the influence of variables on the physical and sensory properties of nuggets and to optimize the formulated nugget formulation. The addition of the KF/XG mixture and SP was effective in improving nugget firmness and increasing hedonic scores for color, taste, flavor and overall acceptability. The nugget became darker with more SP was added. Optimal nuggets with 0.39 % KF/XG mixture and 1.84 % SP had reduced fat, higher dietary fiber and amino acids. After frozen (-18 ± 2 °C) storage, optimal formulated nuggets showed slower decreased in moisture, hardness and chewiness compared to standard nuggets. Konjac flour and SP also lowered lipid oxidation in frozen formulated nuggets. A slight change in sensory score was observed in both nuggets were microbiologically safe after frozen storage for 75 days.

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Many new enteral nutrition (EN) formulas have been created over the past several decades with a variety of intended uses. Although each is intended to promote improved outcomes, research is often unclear and, in many cases, conflicting. It is important to note that EN products are considered medical foods by the U.S. Food and Drug Administration and therefore do not have to complete premarket review or approval and are not regulated to the same extent as pharmaceuticals. While standard EN formulas are designed to meet the basic macro- and micronutrient requirements of individuals who cannot meet nutrition needs orally, specialty EN products have been developed to exhibit pharmacologic properties, such as immune-enhancing formulas containing arginine, glutamine, nucleotides, and ω-3 fatty acids. With the vast number of products available, rising costs of healthcare, and the drive toward evidence-based practice, it is imperative that clinicians carefully consider research regarding use of specialty formulas, paying close attention to the quality, patient population, clinical end points, and cost to patient and/or facility.

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