The environmental footprint of home tube feeding: an Australian audit

This work was presented at the Australasian Society of Parenteral and Enteral Nutrition 2024 by the Tube Dietitian Team.

The below abstract has been published in the conference journal:

Background: Over 7,100 Australians rely on Home Enteral Nutrition (HEN), generating daily plastic equipment and formula waste. Waste production is not traditionally considered in the nutrition assessment. This project aims to quantify the waste, assess its carbon dioxide emissions (CO2e) impact, and evaluate if manufacturers provide accessible recycling guidance on their websites.

Methods: A retrospective audit was conducted on clients of a community-based HEN service. Daily amount of formula (millilitre (ml)) and equipment (kilograms (KG)) discarded (according to manufacturer's disposal directions) per client was extracted (excluding packaging). Results were converted to KG of CO2e using evidence-based conversion tools. Descriptive statistics were performed, and outcomes were statistically analysed (t-test) by delivery method. The occurrence of the words "recycling," "recyclable," and "recycle" on manufacturer websites was counted.

Results:  One hundred clients were included (55% females, 47 (10-97) years of age, 868ml/day (125-1920ml) formula intake, 75% with a neurological condition, 78% with a non-low profile gastrostomy tube). On average, one HEN client produced 0.48kg/day of equipment waste, and 0.17L/day of formula waste, equivalent to 440kg CO2e annually (44% of the average non-HEN Australians total food and plastic waste). Pump/gravity fed clients were found to emit 39% (210kg) more CO2e than syringe fed clients (535kg vs. 325kg, p = 0.051). No company websites were found to have directions on how consumers can recycle their products.

Conclusion: This study shows that HEN clients generate significant waste, contributing about 440kg/client of CO2e annually. The environmental impact is higher for pump/gravity-fed clients, and there is no accessible recycling guidance available on Australian manufacturer websites. These findings highlight the need for clearer recyclability information to reduce the environmental footprint of HEN products. Future research should validate these results and explore actual disposal practices by HEN clients.

Funding source: This research did not receive any funding.

Conflict of interest: The authors declare that they have no conflicts of interest.