Random forest model evaluation results.

ObjectiveThis study aimed to investigate the impact of different energy levels and ingredient ratios on the nasogastric tube patency of pureed diets, optimizing the formulations to meet the nutritional requirements of elderly nasogastric feeding patients while minimizing tube blockage risk.MethodsThe study followed the guidelines of the “Chinese Resident’s Balanced Diet Pyramid” and formulated five different energy levels of pureed diets (900 kcal, 1200 kcal, 1500 kcal, 1800 kcal, and 2100 kcal) using natural food groups. The diets consisted of seven major food categories: cereals and tubers, vegetables, meats, milk, oil, salt, and fruits. The liquid formulations for the above energy levels were prepared according to the concentration standards for special medical purpose foods (FSMPs). The maximum injection force required for nasogastric feeding was measured via a texture analyzer. The nutritional components of the pureed diets at different energy levels and ingredient ratios were evaluated via West China Hospital Nutrition Software. Spearman correlation analysis, multiple regression analysis, and random forest models were used to explore the relationships between energy levels, nutritional components, ingredients, maximum injection force, and tube patency.ResultsThe study revealed that as the energy density increased, the maximum injection force of the pureed diets significantly increased (p p ρ = 0.736) and dietary fiber (ρ = 0.668) contents were significantly positively correlated with the maximum injection force (p p p > 0.05). All nutritional components (energy (ρ = 0.629), carbohydrates (ρ = 0.621), protein (ρ = 0.582), fat (ρ = 0.547), and dietary fiber (ρ = 0.544)) were significantly positively correlated with tube blockage (p p ρ = 0.742) and meats (ρ = 0.766) were significantly positively correlated with the maximum injection force (p ρ = 0.7886) and sweet potato (ρ = 0.506) were significantly positively correlated (p ρ = −0.411) and milk (ρ = −0.690) were significantly negatively correlated (P ρ = 0.615) and meats (ρ = 0.628) were significantly positively correlated with the risk of tube blockage at all energy levels (p ρ = 0.660) and beef (ρ = 0.153) significantly increasing the risk of blockage, whereas rice flour (ρ = −0.350) and milk (ρ = −0.557) were significantly negatively correlated with the risk of blockage (P ConclusionThis study explores the impact of nutritional components and ingredient characteristics on tube patency and blockage risk in nasogastric pureed diets, revealing key optimization pathways for pureed diet formulations. The energy density and ingredient selection of pureed diets significantly affect tube patency. High-energy diets provide higher nutritional density but significantly increase the injection force and blockage risk. Diet formulations should be optimized by reducing high-viscosity and high-hardness ingredients such as rice and beef, using rice flour to replace rice, and milk as the liquid component. For high-energy demands, the carbohydrate and dietary fiber contents should be controlled to reduce the injection force requirements and blockage risk. The study also developed a five-dimensional blockage risk warning model based on energy, protein, fat, carbohydrate, and dietary fiber (AUC = 0.91), classifying low-, medium-, and high-risk levels. Low-risk patients (energy≤1400 kcal/d, carbohydrates≤200 g/d, protein≤70 g/d) are recommended to use homemade formulas, whereas high-risk patients (energy≥1601 kcal/d, carbohydrates≥241 g/d, protein≥86 g/d) should use FSMP for full feeding to balance nutritional supply and tube patency. The findings of this study provide both theoretical and practical guidance for optimizing diets for dysphagia patients, emphasizing that adjusting formulations can effectively balance nutritional supply and tube patency, reduce blockage risk, and prevent malnutrition in homemade pureed feed. This has significant implications for reducing nasogastric complications and ensuring the safety of medical procedures.

研究目的：本研究旨在探究不同能量水平与配料比例对匀浆膳食（pureed diets）鼻胃管通畅性（nasogastric tube patency）的影响，优化配方以满足老年鼻胃喂养（nasogastric feeding）患者的营养需求，同时最大程度降低堵管风险（tube blockage risk）。
研究方法：本研究遵循《中国居民平衡膳食宝塔（Chinese Resident’s Balanced Diet Pyramid）》指南，采用天然食物类别制备了5种不同能量水平的匀浆膳食（900 kcal、1200 kcal、1500 kcal、1800 kcal及2100 kcal）。膳食涵盖七大食物类别：谷薯类、蔬菜类、肉类、乳类、油脂类、食盐类及水果类。上述各能量水平的液体制剂均按照特殊医学用途配方食品（FSMPs）的浓度标准制备。通过质构分析仪（texture analyzer）测定鼻胃喂养所需的最大注射力。采用华西医院营养软件（West China Hospital Nutrition Software）评估不同能量水平与配料比例的匀浆膳食的营养成分。运用斯皮尔曼相关性分析（Spearman correlation analysis）、多元回归分析（multiple regression analysis）及随机森林模型（random forest models），探究能量水平、营养成分、配料、最大注射力与鼻胃管通畅性之间的关联。
研究结果：本研究发现，随着能量密度（energy density）升高，匀浆膳食的最大注射力显著升高（p<0.001, ρ=0.736），且膳食纤维含量与最大注射力呈显著正相关（p<0.001, ρ=0.668）。所有营养成分[能量（ρ=0.629）、碳水化合物（ρ=0.621）、蛋白质（ρ=0.582）、脂肪（ρ=0.547）及膳食纤维（ρ=0.544）]均与堵管风险呈显著正相关（p<0.001）。肉类（ρ=0.766）与最大注射力呈显著正相关（p<0.001）；红薯（ρ=0.506）亦呈显著正相关（p<0.05）。食盐（ρ=−0.411）与乳类（ρ=−0.690）与最大注射力呈显著负相关（p<0.001）。能量（ρ=0.615）与肉类（ρ=0.628）在所有能量水平下均与堵管风险呈显著正相关（p<0.001）；牛肉（ρ=0.153）会显著升高堵管风险，而米粉（ρ=−0.350）与乳类（ρ=−0.557）则与堵管风险呈显著负相关（p<0.001）。
研究结论：本研究探究了营养成分与配料特性对鼻胃匀浆膳食管通畅性及堵管风险的影响，揭示了匀浆膳食配方的关键优化路径。匀浆膳食的能量密度与配料选择显著影响鼻胃管通畅性：高能量膳食可提供更高的营养密度，但会显著升高注射力与堵管风险。配方优化应通过减少大米、牛肉等高粘度、高硬度配料，使用米粉替代大米，并以乳类作为液体成分实现。针对高能量需求场景，需控制碳水化合物与膳食纤维含量，以降低注射力需求与堵管风险。本研究还基于能量、蛋白质、脂肪、碳水化合物及膳食纤维构建了五维度堵管风险预警模型（AUC=0.91），可将堵管风险划分为低、中、高三个等级。建议低危患者[每日能量≤1400 kcal、碳水化合物≤200 g、蛋白质≤70 g]采用自制配方，而高危患者[每日能量≥1601 kcal、碳水化合物≥241 g、蛋白质≥86 g]应使用特殊医学用途配方食品进行全量喂养，以平衡营养供给与鼻胃管通畅性。本研究结果为吞咽困难患者（dysphagia patients）的膳食优化提供了理论与实践指导，强调调整配方可有效平衡营养供给与鼻胃管通畅性，降低自制匀浆喂养的堵管风险并预防营养不良，这对减少鼻胃管并发症、保障医疗操作安全具有重要意义。