the use of blenderized tube feeding in pediatric patients: evidence and guidelines for dietetic...

7/22/2019 The Use of Blenderized Tube Feeding in Pediatric Patients: Evidence and Guidelines for Dietetic Practice

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^nbdgfigc` - Hcgf`grlzg` Puhg Igg`lfa lf ]g`ljtrln ]jtlgfts

8

L. Lftrdùntldf

Hcgf`grlzg` tuhg igg`lfas, dr tbg prdvlsldf di idd` tbjt bjs hggf purgg` uslfa j hcgf`grtbrduab j pjtlgfts igg`lfa tuhg, ls j prjntlng tbjt bjs rgngftcy hggf ajlflfa lf pdpucjrlty `gspltgtbg jvjlcjhlclty di ndeegrnljccy prgpjrg`, futrltldfjccy ndepcgtg idreucjs. Qblcg ejfy bgjctb

prdigssldfjcs ejy prgigr td usg tbg nbgelnjccy `gilfg` idreucjs tbjt bjvg hggf prgpjrg` tdejxlelzg sjigty jf` prdvl`g jpprdprljtg futrltldf td j vjrlgty di pjtlgfts, tbgrg bjs hggf jflfnrgjsg lf pjtlgft lftgrgst lf tbg usg di hcgf`grlzg` tuhg igg`s, pjrtlnucjrcy lf pg`ljtrln pjtlgfts.

Js rgcljfng df tbg lftgrfgt js j sdurng di ijelcy bgjctb sdcutldfs lfnrgjsgs, edrg pjrgftsjrg `lsndvgrlfa jf` rgqugstlfa tbg usg di hcgf`grlzg` `lgts idr j vjrlgty di rgjsdfs, lfncu`lfa jardwlfa lftgrgst lf fjturjc idd`s idr tbglr nblc`s `lgt. Qltb hddks sunb js Pbg Bdegej`gHcgf`g` Idreucj Bjf`hddk, jf` wghsltgs sunb js www.iddìdrtuhlgs.nde, lt ls ncgjr tbjtlftgrgst lf tbls igg`lfa egtbd` wlcc ndftlfug td lfnrgjsg dvgr tbg fgxt igw ygjrs. Iurtbgr, tbg usgdi hcgf`grlzg` tuhg igg`lfas ejy jntujccy prdvl`g hgfgilts td sdeg pjtlgfts, jf` ejy hgj`vjftjagdus dvgr tbg usg di ndeegrnljc prgpjrjtldfs lf ngrtjlf pdpucjtldfs. Jfgn`dtjc rgpdrts

di nclflnjc leprdvgegft lf nblc`rgf wbdsg pjrgfts bjvg `gnl`g` td ejkg tbg swltnb jrgfuegrdus jf` `gtjlc pjrgftjc jf` nclflnljf dhsgrvjtldfs di leprdvg` dutndegs. Pbus, lt wduc`leprdvg tbg sjigty jf` giilnjny di tbls trgjtegft li `lgtltljfs wgrg jhcg td `gvgcdp futrltldfjccyj`gqujtg hcgf`grlzg` `lgts jf` jpprdprljtgcy edfltdr tbg pg`ljtrln pjtlgfts wbdsg pjrgfts nbddsgtd usg tbge.

Pbg purpdsg di tbls pjpgr ls td prdvl`g j ndeprgbgfslvg rgvlgw di tbg usg di hcgf`grlzg`tuhg igg`s lf pg`ljtrln pdpucjtldfs jf` td `gsnrlhg tbg nurrgftcy jvjlcjhcg gvl`gfng suppdrtlfa ltsusg lf spgnliln pjtlgft pdpucjtldfs. Pbls pjpgr wlcc `gsnrlhg tbg j`vjftjags jf` `lsj`vjftjags ditbg hcgf`grlzg` `lgt, `gilfg kgy pjrjegtgrs lf `gtgrelflfa tbg jpprdprljtg njf`l`jtgs idrhcgf`grlzg` tuhg igg`s, jf` `gvgcdp futrltldfjccy ndepcgtg rgnlpgs idr usg wltb pjtlgfts wbd

bjvg hggf jpprdvg` idr tbg trjfsltldf td j hcgf`grlzg` `lgt. Js lftgrgst lf tbls tgnbflqug ls clkgcytd ardw lf tbg ndelfa ygjrs, lt ls nrltlnjc idr `lgtltljfs td uf`grstjf` wby jf` bdw j hcgf`grlzg``lgt sbduc` hg usg` lf dr`gr td aul`g lftgrgstg` pjtlgfts lf j sjig jf` giigntlvg wjy.

LL. J Hrlgi Blstdry di Gftgrjc Igg`lfa

Pbg usg di gftgrjc igg`lfa bjs gxlstg` slfng tbg tleg di tbg jfnlgft Gayptljfs jf` Arggks,wbgf gfgejs ndftjlflfa sdcutldfs di wlfg, elck, wbgy, jf` arjlf hrdtbs wgrg usg` td prdvl`gfutrlgfts, prdtgnt jf lficjeg` hdwgc, dr trgjt `ljrrbgjc `lsgjsg (Nbgrfdii 8==9). Xgntjc igg`lfawjs usg` idr tbdusjf`s di ygjrs ùg td tbg `liilnucty lf jnngsslfa tbg uppgr ajstrdlftgstlfjc trjntwltb ru`legftjry tuhgs, jf` tbg ilrst tuhgs idr drd- dr fjsdajstrln igg`lfas wgrg `gvgcdpg`ùrlfa tbg :9tb tbrduab :2tb ngfturlgs. Gftgrjc igg`s ndftlfug` td hg ej`g irde ndeedf idd`ssunb js elck, gaas, hggi hrdtb, ejsbg` pdtjtdgs, jf` gvgf wblskgy dr hrjf`y (Nbgrfdii 8==9).

Lf tbg :


2/31


>

rgsl`ug-irgg idreucj idr jstrdfjuts) jf` spgnljc idreucjs idr spgnliln `lsgjsgs. Pbg suppdrt idrgftgrjc igg`lfas gxpjf`g` js gvl`gfng jnnueucjtg` idr lts ndst-giigntlvgfgss jf` sjigty.

Lf tbg :


3/31


0

]g`ljtrln pjtlgfts wbd rgqulrg j a-tuhg idr igg`lfa jrg typlnjccy ufjhcg td ndfsuegj`gqujtg njcdrlgs drjccy td ejlftjlf ardwtb. ]rdhcges tbjt ejy prgncu`g drjc igg`lfa lfncu`g jflfjhlclty td nbgw jf` swjccdw j`gqujtgcy ùg td fgurdcdalnjc lepjlregft dr jlrwjyjhfdrejcltlgs, lfhdrf grrdrs di egtjhdclse, cleltg` `lagstlvg jf` jhsdrptlvg njpjnlty, irgqugftvdeltlfa, drdpbjryfagjc jf` gsdpbjagjc `ysedtlclty, sgvgrg ajstrdgsdpbjagjc rgicux, jnqulrg`

lfoury sunb js bgj` trjuej jf` njustln lfagstldf, jf` jfy dtbgr nclflnjc lftdcgrjfng td drjcigg`lfa (Hddtb 8==0, Irdbclnb, Xlnbtgr gt jc. 8=:=, Gc-Ejtjry 8=::). Ngrtjlf pjtlgfts wltblfnrgjsg` njcdrln rgqulrgegfts fgg` suppcgegftjc gftgrjc futrltldf td eggt tbglr fgg`s; tbgsgpjtlgfts lfncu`g tbdsg wltb ndfagfltjc bgjrt `lsgjsg, nbrdfln rgfjc ijlcurg, nbrdfln cufa `lsgjsg,jf` nystln ilhrdsls (Irdbclnb, Xlnbtgr gt jc. 8=:=. Ndfwjy, Edrtdf gt jc. 8=:8).

Gftgrjc igg`lfa tbrduab j a-tuhg ls j ndeedfcy usg` egjfs di leprdvlfa tbg futrltldfjcstjtus di nblc`rgf wltb sgvgrg fgurdcdalnjc `lsjhlcltlgs, sunb js ngrghrjc pjcsy jf` sgvgrg egftjcrgtjr`jtldf (Idrtufjtd jf` Nuiijrl 8=::). Lf nblc`rgf `ljafdsg` wltb Nrdbfs `lsgjsg, tbg usg digxncuslvg gftgrjc igg`lfa njf lfùng rgelssldf 7= td 27% di pjtlgfts, pdsslhcy ùg td eundsjcjftl-lficjeejtdry giignts jf` nbjfags td tbg lftgstlfjc elnrdicdrj (@jy, Qblttgf gt jc. 8==2,

Bgusnbkgc 8==). Pbls njf cgj` td tbg `gvgcdpegftdi j stleucus-rgspdfsg rgcjtg` igg`lfa jvgrsldf, rgsuctlfa lf pddr ardwtb jf` ejcfutrltldf. AGXls ditgf prgsgft prldr td ]GA pcjngegft, tbduab lt njf jcsd `gvgcdp jitgr tbg tuhg bjs hggf pcjng`(Pruhy, Ndwclsbjw gt jc. 8==


4/31


7

Pjhcg :.Ajstrdlftgstlfjc-rgcjtg` ndepclnjtldfs wltb tbg usg di gftgrjc igg`lfa, pdsslhcg njusgs,jf` stjf`jr` eg`lnjc trgjtegft. J`jptg` irde tbg ]blcj`gcpblj Nddr`lfjtg` Bgjctb Njrg

Igg`lfa Puhg Xgsdurng ]jnkgt (]NBN 8==


5/31


9

Pbg tgje iduf` slaflilnjft rgùntldf lf tbg syeptdes di pdst-iuf`dpclnjtldf pjtlgfts dftbg ]HAP `lgt (]gftluk, D'Icjbgrty gt jc. 8=::). Pbg pjrgfts di :1 di >> nblc`rgf (78%) rgpdrtg`j 19% td :==% `gnrgjsg lf ajaalfa jf` rgtnblfa jitgr tbglr nblc` stjrtg` tbg ]HAP `lgt, jf` :> (71%) nblc`rgf wgrg rgpdrtg` td bjvg jf lfnrgjsg` drjc lftjkg. Pbg jutbdrs suaagst tbjt tbglfnrgjsg` lftjkg ejy bjvg hggf ùg td tbg jegcldrjtldf di ajaalfa jf` rgtnblfa syeptdes

ndftrlhutlfa td jf drjc jvgrsldf. Pbgy iduf` tbjt pjrgfts wgrg blabcy sjtlsilg` wltb tbg ]HAP`lgt jf` tbg `jlcy ndst di tbg `lgt wjs cdwgr ndepjrg` td tbg stjf`jr` ndeegrnljc idreucj ($9.8=ndepjrg` wltb $2.== pgr `jy). Pbg rgsgjrnbgrs `l` fdt `lsnuss li tbgsg ndsts tddk tbg pjrgftstleg jf` cjhdr lftd jnnduft, jf` lf sdeg njsgs tbg ndst wjs blabgr hgnjusg lfsurjfng ndvgrg` tbgndeegrnljc idreucj.

^lfng tbg puhclnjtldf di tbdsg rgsucts, j fuehgr di dtbgr eg`lnjc tgjes bjvggxpgrlegftg` wltb tbg usg di purgg` dr hcgf`grlzg` `lgts td bgcp lfnrgjsg igg`lfa tdcgrjfng jf`rgùng ajaalfa, rgtnblfa, jf` vdeltlfa lf pjtlgfts wltb igg`lfa tuhgs. Idr gxjepcg, jt NNBEN,`lgtltljfs lf tbg pucedfjry `lvlsldf bjvg usg` tbg ]HAP `lgt td bgcp leprdvg gftgrjc tdcgrjfng lftbglr pg`ljtrln pjtlgfts wltb nystln ilhrdsls wbd bjvg bj` j igg`lfa tuhg pcjng` td gfsurg

j`gqujtg futrltldfjc lftjkg (^jftdrd 8=:>). Pbg sunngss di tbls prdarje wjs `gsnrlhg` jt tbg81tb Jffujc Fdrtb Jegrlnjf Nystln Ilhrdsls Ndfigrgfng lf ^jct Cjkg Nlty, WP lf Dntdhgr 8=:>.Hcgf`grlzg` dr idd`-hjsg` idreucjs bjvg jcsd hggf usg` td leprdvg tbg trgjtegft dutndegs dinblc`rgf wltb nbrdfln `ljrrbgj dr gplcgpsy jf` jùcts wltb ejodr hurfs dr njfngr-rgcjtg` njnbgxlj(Hcdnk, Nbcghdwskl gt jc. :


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1

gt jc. 8=:>). Pbg pjtlgft rgiusg` td tjkg jfy idd` dr clqul` drjccy jf` gxpgrlgfng` lfnrgjsg`vdeltlfa, rgtnblfa, jf` ndfstlpjtldf jcdfa wltb pddr ardwtb, `gspltg sgvgrjc nbjfags ej`g td blsidreucj typg jf` `gclvgry. Pbg pjtlgfts edtbgr `gnl`g` (lf`gpgf`gftcy) td lftrdùng sejcchdcusgs di purgg` idd`s jf` fdtlng` tbg pjtlgft `l` fdt rgjnt j`vgrsgcy td tbgsg igg`lfas js bg `l`td bls idreucj. Fdtlfa tbg leprdvgegft lf tdcgrjfng, tbg igg`lfa tgje tbgf diigrg` td jl` lf tbg

nblc`s trjfsltldf td j hcgf`grlzg` `lgt. Pbg pjtlgfts rgtnblfa, vdeltlfa, ndfstlpjtldf, jf` drjcidd` rgiusjc rgsdcvg` wltb tbg ndepcgtg trjfsltldf td tbg hcgf`grlzg` `lgt. Bls prdargss wjsidccdwg` idr tbrgg ygjrs jf` dutclfg` lf tbg rgigrgfng` puhclnjtldf, jf` tbg nclfln `lgtltljfndftlfug` td wdrk wltb tbg pjtlgft jf` bls edtbgr td gfsurg tbjt tbg idreucjs hglfa usg` wgrgeggtlfa tbg pjtlgfts fgg`s. Lf tbls njsg, tbg hcgf`grlzg` `lgt ncgjrcy ndftrlhutg` td j slaflilnjftleprdvgegft lf tbg pjtlgfts dutndeg, `gedfstrjtlfa tbg pdtgftljc vjcug di tbg `lgt wbgf usg` lfjf jpprdprljtg njf`l`jtg.

J ejodr njvgjt td tbg usg di tbg hcgf`grlzg` dr purgg` tuhg igg` ls tbjt tbgrg ls clttcgpuhclsbg` gvl`gfng jvjlcjhcg td suppdrt tbg giilnjny di tbls tgnbflqug. Qblcg cjnk di gvl`gfng lsfdt gvl`gfng jajlfst, tbgrg jrg dfcy j bjfìuc di stu`lgs `gedfstrjtlfa tbg hgfgilts di uslfa tbls

igg`lfa tgnbflqug idr j cleltg` fuehgr jf` vjrlgty di pjtlgfts. Nurrgftcy, tbgrg jrg fd stu`lgstbjt bjvg vgrlilg` tbg giilnjny jf` sjigty di tbg usg di hcgf`grlzg` tuhg igg`s lf j bdspltjcsgttlfa; lf ijnt, sdeg stu`lgs bjvg `gedfstrjtg` j rlsk di hjntgrljc ndftjelfjtldf irde uslfahcgf`grlzg` igg`s lfstltutldfjccy (ûcclvjf, ^drrg`j-Gsaugrrj gt jc. 8==:, Edkbjcjcjtl, @ruyjf gtjc. 8==0). Pbg pdtgftljc idr hjntgrljc ndftjelfjtldf ls j kgy rgjsdf edst bdspltjcs bjvg swltnbgìrde bdegej`g hcgf`grlzg` igg`s td ndeegrnljccy-prgpjrg` idreucjs; idd`-hdrfg pjtbdagfs lfbdegej`g igg`s njf njusg fjusgj, vdeltlfa, `ljrrbgj, igvgr jf` jh`delfjc nrjeps, jf` ejy hgclfkg` td nbrdfln `lsgjsgs sunb js bgpjtltls, sgptln jf` jsgptln jrtbrltls, jf` Aulccjlf-Hjrrsyf`rdeg (Edkbjcjcjtl, @ruyjf gt jc. 8==0). Leeufdndeprdelsg` jf` nrltlnjccy lcc pjtlgfts jrgjt gspgnljccy blab rlsk idr ndftrjntlfa tbgsg idd`-hdrfg lccfgssgs.

Pbgrg jrg dtbgr, edrg prjntlnjc rgjsdfs wby edst lfstltutldfs bjvg swltnbg` irdehcgf`grlzg` gftgrjc idreucjs td ndeegrnljccy prgpjrg`, rgj`y-td-usg gftgrjc idreucjs. Bdspltjc-prgpjrg` hcgf`grlzg` tuhg igg`lfas njf prdvl`g ufprg`lntjhcg cgvgcs di elnrdfutrlgfts jfèjnrdfutrlgfts jf` ejy `gclvgr lfj`gqujtg jedufts di sdeg futrlgfts (Edkbjcjcjtl, @ruyjf gtjc. 8==0, ûcclvjf, ^drrg`j-Gsaugrrj gt jc. 8==0). Pbg vlsndslty di tbgsg igg`lfas ejy jcsd hgufsultjhcg idr rgcljhcg lfiusldf tbrduab igg`lfa tuhgs, jf` ejkgs ndftlfudus igg`s edrgnbjccgfalfa. Hcgf`grlzg` igg`s jrg jcsd `liilnuct td nustdelzg. Qblcg ndeegrnljccy prgpjrgìdreucjs jrg jvjlcjhcg lf `lsgjsg-spgnliln idreucjtldfs, tbg lf`lvlùjclzlfa di hcgf`grlzg` rgnlpgstd eggt pjtlgft fgg`s ls tleg jf` cjhdr lftgfslvg, jf` ejy fdt jntujccy hg igjslhcg lf lfstltutldfjcsgttlfas (Edkbjcjcjtl, @ruyjf gt jc. 8==0).

Edrg stu`lgs jrg fgg`g` td tgst tbg futrltldfjc j`gqujny, sjigty, jf` nclflnjc dutndegswbgf uslfa j hcgf`grlzg` `lgt lf j vjrlgty di pdpucjtldfs jf` sgttlfas. Qblcg tbgsg `lgts bjvghggf `gedfstrjtg` js usgiuc idr pdst-iuf`dpclnjtldf pjtlgfts wltb ajstrdstdey tuhgs, clttcg lskfdwf jhdut tbg giilnjny di tbgsg `lgts idr dtbgr `ljafdsgs, lfncu`lfa lficjeejtdry hdwgc`lsgjsg, ejodr `gvgcdpegftjc `gcjys, nystln ilhrdsls, jf` dtbgr ndf`ltldfs tbjt typlnjccy rgqulrgsuppcgegftjc dr gxncuslvg tuhg igg`lfa. Bdw tbgsg hcgf`grlzg` igg`s ndepjrg lf ndst td tbgstjf`jr` gftgrjc idreucjs njf hg j ejodr ijntdr idr ejfy ijelclgs wbgf nbddslfa j trgjtegftdptldf, jf` clttcg ls kfdwf jhdut tbglr gxpgfsg ndepjrg` td ndeegrnljc idreucjs (^lfagr,Ndupgr gt jc. 8=::). Gvl`gfng ls jcsd cjnklfa df tbg sjigty di bdegej`g tuhg igg`s wbgf nrgjtg`


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lf tbg pjtlgfts bdeg lf rgajr`s td tbg prgvjcgfng di idd`-hdrfg lccfgss lf tbgsg pjtlgfts. Pblsejkgs lt `liilnuct td ejkg gvl`gfng-hjsg` rgndeegf`jtldfs td pjrgfts jf` pjtlgfts wbd lfqulrgjhdut tbg hgfgilts di bdegej`g tuhg igg`s.

Bdwgvgr, li pjrgfts gxprgss strdfa lftgrgst lf j hcgf`grlzg` `lgt, jf` njrg ls tjkgf lf

`gtgrelflfa tbg sultjhlclty di tbg njf`l`jtg, lt ls pdsslhcg idr j hcgf`grlzg` tuhg igg` td eggt tbgfutrltldfjc fgg`s di tbg pjtlgft wblcg j``rgsslfa sjigty ndfngrfs. Qblcg tbgrg jrg fd idrejcaul`gclfgs idr tbg `gvgcdpegft jf` jèlflstrjtldf di j hcgf`grlzg` `lgt, sgvgrjc puhclnjtldfsbjvg `gsnrlhg` nrltgrlj idr pjtlgft sgcgntldf, rgndeegf`jtldfs idr njrgtjkgr gùnjtldf, jfègtbd`s idr `gvgcdplfa j futrltldfjccy jpprdprljtg hcgf`grlzg` `lgt (Fdvjk, Qlcsdf gt jc. 8==


8/31


.

Nblc`rgf wltb j tuhg slzg cgss tbjf := Irgfnb jrg pddr njf`l`jtgs, js tbg sejccgr tuhg lsedrg clkgcy td agt ncdaag` wbgf uslfa j hcgf`grlzg` `lgt; tbg rgndeegf`g` tuhg slzg ls :0Irgfnb dr cjragr (Fdvjk, Qlcsdf gt jc. 8==


9/31


:=

idreucj td hg rgirlagrjtg` td rg`ung ndftjelfjtldf rlsk (Edrtgfsgf 8==9). Nblc`rgf wltbgxtrgegcy blab gfgray `gejf`s (g.a. irde tbg bypgrtdflj sggf lf ngrghrjc pjcsy) dr wltb icul`rgstrlntldfs hgcdw >= dufngs pgr `jy (g.a. lf nbrdfln kl`fgy `lsgjsg) ejy fdt hg jhcg td eggttbglr fgg`s uslfa hcgf`grlzg` idd` jcdfg (Edrtgfsgf 8==9, Fdvjk, Qlcsdf gt jc. 8==


10/31


::

YL. Nrgjtlfa j Hcgf`grlzg` Gftgrjc Idreucj

Dfng lt bjs hggf gstjhclsbg` tbjt tbg pjtlgft ls j add` njf`l`jtg idr j hcgf`grlzg` `lgt,tbgrg jrg sgvgrjc lepdrtjft stgps td tjkg wbgf `gslaflfa jf jpprdprljtg idreucj. Js tbg

hcgf`grlzg` `lgt ls `gslafg` idr tbg nblc`s lf`lvlùjc futrltldfjc fgg`s jf` njrgtjkgr prgigrgfngs,jf gxpgrlgfng` `lgtltljf eust njcnucjtg jf` ed`liy tbg `lgt td eggt tbgsg fgg`s (D'Icjbgrty,^jftdrd gt jc. 8=::). Pbg idccdwlfa rgndeegf`jtldfs bjvg hggf j`jptg` irde tbg aul`gclfgsnrgjtg` hy Pbgrgsg DIcjbgrty, E^, X@ jf` bgr ndccgjaugs jt tbg Nlfnlffjtl Nblc`rgfs BdspltjcEg`lnjc Ngftgr, wbd bjvg `gvgcdpg` j ]urgg` Hy Ajstrdstdey Puhg (]HAP) `lgt idr trgjtlfapg`ljtrln pjtlgfts wbd gxpgrlgfng ajaalfa jf` rgtnblfa pdst-Flssgf iuf`dpclnjtldf (D'Icjbgrty,^jftdrd gt jc. 8=::).

Pbg ilrst stgp lf `gslaflfa j idreucj ls td ndfùnt j tbdrduab rgvlgw di tbg nblc`seg`lnjc blstdry, lfncu`lfa nurrgft jftbrdpdegtrln `jtj (g.a. bglabt jf` wglabt) tbjt wlcc hg usg`td gstlejtg tbg nblc`s futrltldfjc fgg`s lfncu`lfa njcdrlgs, prdtglf, icul`, jf` elnrdfutrlgfts. Lt ls

rgndeegf`g` td usg j ndeputgrlzg` prdarje sunb js Pbg Idd` ]rdngssdr ]rdarje hy G^BJXgsgjrnb dr ]rdFutrj hy Yldnjrg td jfjcyzg tbg cgvgcs di tbgsg futrlgfts lf jfy rgnlpg tbjt ls`gvgcdpg`. Pbgsg prdarjes jccdw tbg `lgtltljf td sjvg tbg `jtj idr iuturg rgigrgfng, jòust rgnlpgshjsg` df idccdw-up rgsucts, jf` prdvl`g `dnuegftjtldf td ijelclgs jf` dtbgr egehgrs di tbgeg`lnjc tgje.

Dtbgr ijntdrs td ndfsl`gr wbgf `gslaflfa j `lgt jrg tbg pjtlgfts gtbfln dr rgclaldusprgigrgfngs, `dnuegftg` jccgralgs dr lftdcgrjfngs, jf` nbjrjntgrlstlns di tbg nurrgft idreucjhglfa usg`. Pbg nurrgft idreucj njf jcsd hg usg` js j clqul` hjsg idr tbg lfltljc hcgf`grlzg` `lgt,js tbls njf bgcp gfsurg futrltldfjc j`gqujny di tbg idreucj wblcg trjfsltldflfa. ^deg eg`lnjcprdigssldfjcs rgndeegf` stjrtlfa wltb purgg` ndeegrnljclzg` stjag 8 hjhy idd`s idr tbg ilrstrgnlpg, td prdvl`g ndfslstgft futrltldfjc ndftgft jf` gclelfjtg tbg fgg` idr j hcgf`gr (D'Icjbgrty,^jftdrd gt jc. 8=::). Dfng tbgsg stjag 8 hjhy idd` rgnlpgs bjvg hggf wgcc tdcgrjtg`, tbg `lgt ejyhg j`vjfng` td lfncu`g hcgf`grlzg` tjhcg idd`s js `gslrg`.

Jitgr futrltldfjc fgg`s jf` prgigrgfngs bjvg hggf gstjhclsbg`, tbg `lgtltljf sbduc` hgalfidreucj `gvgcdpegft hy nbddslfa jf jpprdprljtg prdtglf sdurng. ^deg prdtglf sbduc` hg irde jclqul` sdurng td idre tbg hjsg di tbg hcgf`grlzg` idreucj jf` gfsurg prdpgr ndfslstgfny. Pbgclqul` prdtglf sdurng njf hg ndw, sdy, fut, dr rlng elck, dr gvgf tbg pjtlgfts drlalfjc ndeegrnljcidreucj, `gpgf`lfa df tbg pjtlgfts tdcgrjfng, ndst ndfsl`grjtldfs, dr jccgralgs. Pbduabnduftgrlftultlvg, uslfa tbg pjtlgfts drlalfjc idreucj js tbg hjsg lf j hcgf`grlzg` rgnlpg bjs hggfiduf` giigntlvg idr prdùnlfa j rgùntldf lf ajaalfa jf` rgtnblfa syeptdes (D'Icjbgrty,^jftdrd gt jc. 8=::). J elfleue di idur td glabt dufngs di tbg sgcgntg` clqul` prdtglf sdurngsbduc` hg usg` td gfsurg j`gqujtg icul`lty. J sgndf`, sdcl` sdurng di prdtglf njf hg usg` td eggttbg pjtlgfts dvgrjcc prdtglf adjcs, wblnb jrg njcnucjtg` uslfa tbg jag-jpprdprljtg gstlejtg`@lgtjry Xgigrgfng Lftjkgs (@XLs) (LDE 8==7). Pbls sdcl` prdtglf ls usujccy egjt (g.a. hggi,nblnkgf, ilsb) dr ydaurt, jf` sbduc` eggt 2=-


11/31


:8

nblc` bjs hggf prgvlduscy gxpdsg` td, td jvdl` pdtgftljc jccgraln rgjntldfs. Pbg rgnlpg(s) sbduc`lfncu`g hdtb arggf jf` rg`/drjfag vgagtjhcgs td prdvl`g hdtb vltjelf J jf` vltjelf N lf tbgrgnlpg. Fdf-stjrnby vgagtjhcgs jf` edst irults j`` td tdtjc vdcueg wltbdut ndftrlhutlfaslaflilnjft njcdrlgs, jf` tbgrgidrg sbduc` hg kgpt cgss tbjf 2 td :8 dufngs tdtjc idr tbg gftlrgrgnlpg. Arjlfs jrg usg` td j`` njcdrlgs, njrhdby`rjtgs, jf` ilhgr, jf` ndeedfcy usg`, wgcc-

tdcgrjtg` vjrlgtlgs lfncu`g rlng, hjrcgy, jf` djts. Pbg nblc` sbduc` hg agttlfa 77% td 9=% di blsdr bgr njcdrlgs irde njrhdby`rjtgs li fdt df j kgtdagfln dr njrhdby`rjtg-rgstrlntg` `lgt(D'Icjbgrty, ^jftdrd gt jc. 8=::).

Pbg `lgtltljf njf tbgf nbddsg j ijt sdurng td j`` td eggt tbg nblc`s tdtjc njcdrlg fgg`s.Edst rgnlpgs ndftjlf : td 8 tjhcgspddfs di j``g` ijt, jf` lt ls lepdrtjft td usg j ijt tbjt prdvl`gsj`gqujtg jedufts di tbg gssgftljc degaj-> jf` degaj-9 ijts rgqulrg` idr bgjctb. Njfdcj dlc lsndeedfcy usg` js lt ndftjlfs hdtb degaj-> jf` degaj-9 ijts, tbduab j hcgf` di dclvg dlc jfìlsb (dr nd` clvgr) dlc njf jcsd hg usg` li prgigrrg` hy tbg `lgtltljf dr pjrgft. Li nbddslfa tbg cjttgrdptldf, clelt ilsb/nd` clvgr dlc td dfg bjci di j tgjspddf, jf` usg dclvg dlc idr tbg rgejlf`gr di tbgrgqulrg` j``g` ijt. Ilsb/nd` clvgr dlc sbduc` hg kgpt rgirlagrjtg` td prgvgft dxl`jtldf di tbg dlc.

Pbg nblc` sbduc` hg agttlfa >=% td >7% di bls dr bgr njcdrlgs irde ijt ufcgss spgnlilnjccy df jblabgr ijt jf`/dr kgtdagfln `lgt (D'Icjbgrty, ^jftdrd gt jc. 8=::).

Dfng tbg lfltljc rgnlpg bjs hggf `gvgcdpg`, tbg `lgtltljf sbduc` usg rgnlpg jfjcyslssditwjrg (Idd` ]rdngssdr, ]rdFutrj, gtn.) td rgvlgw tbg futrltldfjc j`gqujny di tbg rgnlpg idr tbglf`lvlùjc pjtlgft. Lt ls lepdrtjft td gfsurg j`gqujtg njcdrlgs, prdtglf, icul`, jf` elnrdfutrlgfts,jf` td jpprdprljtgcy hjcjfng tbg ejnrdfutrlgft rjtlds js rgndeegf`g` jhdvg. Pbg `lgtltljf njfiurtbgr jòust tbg rgnlpg td tbg `gslrg` ndepdsltldf, typlnjccy hy prdvl`lfa j``ltldfjc ijt drnjrhdby`rjtg sdurngs, dr j ndeegrnljc njcdrlg suppcgegft li `gslrg`. Dfng tbg hjsg idreucj bjshggf `gvgcdpg`, tbg elnrdfutrlgft ndepdsltldf di tbg rgnlpg sbduc` hg rgvlgwg` jf` ndepjrg`td tbg @XLs idr tbg nblc`s jag jf` slzg. Pbg ejodr elnrdfutrlgfts td ndfsl`gr jrg njcnlue, lrdf,jf` sd`lue, jf` ejfy di tbg nblc`s fgg`s njf hg egt hy j``lfa j ndeegrnljc nblc`rgfseuctlvltjelf td tbg elxturg (D'Icjbgrty, ^jftdrd gt jc. 8=::).

^d`lue jf` gcgntrdcytg suppcgegftjtldf prdtdndcs jrg typlnjccy `gvgcdpg` hy lf`lvlùjclfstltutldfs, hut j``ltldfjc sd`lue ejy hg suppcgegftg` uslfa fdrejc sjclfg dr ]g`ljcytgicusbgs hgtwggf idreucj hdcusgs. DIcjbgrty jf` bgr ndccgjaugs bjvg rgndeegf`g` njcnucjtlfatbg irgg wjtgr ndftgft di tbg rgnlpg hy euctlpcylfa tbg tdtjc vdcueg di tbg idreucj hy =.17, uf`grtbg jssueptldf tbjt edst lfijft idd`s ndftjlf jf jvgrjag di 17% irgg wjtgr (D'Icjbgrty, ^jftdrdgt jc. 8=::). Li tbg idreucjs irgg wjtgr `dgs fdt eggt tbg nblc`s icul` fgg`s, j``ltldfjc irggwjtgr sbduc` hg alvgf js gltbgr j icusb dr js j hdcus lf hgtwggf idreucj hdcusgs, wltb gfduabtleg hgtwggf hdcusgs td prgvgft jfy vdcueg dvgrcdj` jf` gxjngrhjtldf di rgtnblfa, ajaalfa, drvdeltlfa. Ilvg elcclcltgrs di wjtgr jt edst sbduc` hg usg` td icusb tbg tuhg jitgr pusblfa tbgidreucj, td jvdl` jèlflstgrlfa gxngss icul` vdcueg jt gjnb igg`lfa (D'Icjbgrty, ^jftdrd gt jc.8=::). Edfltdrlfa tbg pjtlgfts by`rjtldf stjtus jf` urlfg dutput njf hg bgcpiuc lf `gtgrelflfatbg j`gqujny di icul` lftjkg dvgr tleg.

Pbgsg idreucj rgndeegf`jtldfs bjvg hggf `gvgcdpg` hy DIcjbgrty jf` bgr ndccgjaugsuf`gr tbg jssueptldf tbjt njrgtjkgrs wlcc gvgftujccy hg hdcuslfa tbg gftlrg hcgf`grlzg` idreucjvlj 9=-eC njtbgtgr tlp syrlfags uslfa scdw, sejcc pusbgs dvgr sgvgrjc igg`lfas (D'Icjbgrty,^jftdrd gt jc. 8=::). Pbg igg`lfa snbgùcg ls typlnjccy `gtgrelfg` hy uslfa tbg pjtlgfts nurrgft


12/31


:>

lftjkg, igg`lfa blstdry, jag, jf` slzg js j aul`g, wltb lfltljc hdcus slzgs stjrtlfa jt : dufng jfàlvgf spjng` tbrduabdut tbg `jy, jf` lfnrgjsg` lf vdcueg js tdcgrjtg` (D'Icjbgrty, ^jftdrd gt jc.8=::). Pd ijnlcltjtg tbg trjfsltldf, lt ls suaagstg` td usg stjag 8 hjhy idd` rgnlpgs td stjrt wltb,jf` j`vjfng td wbdcg idd`, hcgf`grlzg` rgnlpgs dfng tdcgrjfng bjs hggf gstjhclsbg`. @gpgf`lfadf tbg pjtlgfts tdcgrjfng, `lgtltljfs njf stjrt hy prdvl`lfa 7=% di njcdrlgs irde tbg hcgf`g` `lgt

jf` 7=% irde ndeegrnljc idreucj, tbgf j`vjfng td 17% hcgf`g` jf` 87% idreucj, jf` ilfjccytd :==% hcgf`g`. ]jtlgfts wlcc bjvg vjrylfa cgvgcs di tdcgrjfng. Pbg trjfsltldf td j :==%hcgf`grlzg` `lgt wlcc tjkg `liigrlfa cgfatbs di tleg jf` sbduc` fdt hg rusbg`.

DIcjbgrty jf` bgr tgje `d fdt rgndeegf` uslfa j puep td jèlflstgr tbgsg idreucjsndftlfuduscy. Li j nblc` rgqulrgs dvgrflabt ndftlfudus igg`lfa td eggt bls dr bgr njcdrlg fgg`s, ltls rgndeegf`g` tbjt `lgtltljfs usg j ndeegrnljc idreucj td prdvl`g 7=% di tbg nblc`s njcdrlnlftjkg jt flabt jf` tbg dtbgr 7=% di njcdrlgs vlj sejcc hdcusgs di tbg hcgf`grlzg` idreucj spjng`tbrduabdut tbg `jy js tdcgrjtg`. Qbgf tbg tdcgrjtg` hdcus slzg ls cjrag gfduab jf` tbg irgqugfnydi hdcusgs ls ejfjagjhcg, tbg rgejlf`gr di tbg dvgrflabt ndeegrnljc idreucj njcdrlgs njf hgndfvgrtg` td tbg purgg` elxturg, jf` j fgw igg`lfa snbgùcg njf hg `gvgcdpg`(D'Icjbgrty,

^jftdrd gt jc. 8=::). Wctlejtgcy, tbg adjc ls td wgjf tbg nblc` dii di tbg dvgrflabt idreucj igg`s,jf` DIcjbgrty jf` bgr tgje bjvg sunngssiuccy trjfsltldfg` ejfy pjtlgfts td j `lgt ndfslstlfasdcgcy di purgg` idd`s hdcusg` jnrdss sgvgrjc lftgrvjcs ùrlfa tbg `jy.

]rgnjutldfs eust hg tjkgf hy `lgtltljfs td gfsurg byalgfln prjntlngs hy njrgtjkgrs jfèlflelzjtldf di idd`-hdrfg lccfgss rlsk (Edg :


13/31


:0

gftgrjccy-ig` pjtlgfts lfncu`gs sgrue gcgntrdcytgs, acundsg, hcdd` urgj fltrdagf (HWF),nrgjtlflfg, njcnlue, pbdspbdrus, ejafgslue, jchuelf, prgjchuelf, ndepcgtg hcdd` nduft wltb`liigrgftljc, lrdf lf`lngs, jf` jf jssgssegft di jnl`-hjsg stjtus. Xdutlfg edfltdrlfa di cjhdrjtdryvjcugs ls fdt lf`lnjtg` idr stjhcg pjtlgfts rgnglvlfa j ndepcgtg hcgf`grlzg` idreucj jt j`vlsg`cgvgcs jf` jnblgvlfa j`gqujtg ardwtb (^zgszynkl 8=:=). Irgqugft futrltldf rg-gvjcujtldfs sbduc`

hg snbgùcg` td jssgss tbg ijelcys sjtlsijntldf wltb tbg hcgf`grlzg` `lgt jf` jctgr tbg igg`lfapcjf js fgg`g` hjsg` df tbg nblc`s rgspdfsg jf` dvgrjcc bgjctb (Edrtgfsgf 8==9).

@lgtltljfs eust gùnjtg njrgtjkgrs jhdut pdtgftljc sl`g giignts td wjtnb idr jitgr nbjfalfatd j hcgf`grlzg` idreucj. ^yeptdes di gftgrjc idreucj lftdcgrjfng lfncu`g j wdrsgflfa diajaalfa, wrgtnblfa dr vdeltlfa, `ljrrbgj, jh`delfjc `lstgftldf, ndfstlpjtldf, jf` nrjeplfa drùeplfa syf`rdeg (Kdbf jf` Kgltbcgy :


14/31


:7

Pjhcg 8. Pwd sjepcg rgnlpgs. Ilrst rgnlpg usgs ojrrg` hjhy idd`; sgndf` rgnlpg usgs stjf`jr`wbdcg idd` lfarg`lgfts. Jcc flfg rgnlpgs lfncu`lfa lfstruntldfs jrg prdvl`g` lf Jppgf`lx L. Iucc

futrlgft ndepdsltldf ls prdvl`g` lf Jppgf`lx LL.

Xgnlpg

Nblnkgf Hjhy Idd` Hcgf`

Njcdrlgs .87% ijt) 022 8 nups

Hjhy idd`, nblnkgf, strjlfg` 1: : ojr

Hjhy idd`, njrrdts, strjlfg` >>< > ojrs

Hjhy idd`, pgjs, strjlfg` 827 8 ojrs

Hjhy idd`, jppcg jf` hcughgrry,

strjlfg` 078 0 ojrs

Dclvg dlc < 8 tgjspddfs

Nd` clvgr dlc 8.87 :/8 tgjspddf

Xgnlpg

Hggi jf` Hrdwf Xlng

Njcdrlgs :=== %NBD 77% %IJP >:% %]XD :0%

Lfarg`lgft Egjsurg (arjes) Gjsy Egjsurg

Qbdcg Elck (>.87% ijt) 022 8 nups

Xlng, hrdwf, eg`lue-arjlf, nddkg` :7 8.7 tjhcgspddfs

^plfjnb, hdlcg`, `rjlfg`, fd sjct :8= 8/> nup

^wggt pdtjtd, nddkg`, hdlcg`, wltbdut

sklf 809 >/0 nup

Nd` clvgr dlc 8.87 :/8 tgjspddfDclvg dlc < 8 tgjspddfs

Jppcgs, rjw, wltb sklf :2= : :/8 nups

^jct, tjhcg =.7 :/:8 tgjspddf

Qjtgr, tjp, euflnlpjc >7= :8 dufngs

Pbg rgnlpgs uslfa hjhy idd` jrg rgndeegf`g` js stjrtlfa pdlft rgnlpgs idr pjtlgftstrjfsltldflfa td j hcgf`grlzg` `lgt, js tbgy `d fdt rgqulrg j hcgf`gr td prgpjrg, wblcg tbg rgnlpgsuslfa wbdcg idd` lfarg`lgfts njf hg usg` idr j vjrlgty di pjtlgfts. Fdf-`jlry rgnlpgs wgrglfncu`g` td eggt tbg fgg`s di `jlry lftdcgrjft pjtlgfts. Qbgf prgpjrg` uslfa j Hcgf`tgnhcgf`gr, tbg rgnlpgs nrgjtg` hgtwggf :.7 jf` 8 cltgrs di vdcueg pgr :=== njcdrlgs. Wslfa tbgHcgf`tgn blab-pdwgrg` hcgf`gr jccdwg` rgnlpgs td hg hcgf`g` td j fgntjr-tblnk vlsndslty; tbgidreucj `l` fdt fgg` td hg strjlfg` js tbg lfarg`lgfts wgrg tdtjccy clqugilg`. Hjhy idd` rgnlpgsrgqulrg` fd hcgf`lfa jf` wgrg gjslcy elxg` uslfa j wblsk, nrgjtlfa j idreucj sclabtcy tblffgrtbjf tbjt nrgjtg` uslfa tbg hcgf`gr.

Wslfa ^tjf`jr` Hcgf`grlzg` Xgnlpgs Lf ]jtlgft Njrg

Lf dr`gr td eggt tbg gxjnt njcdrlgs jf` ejnrdfutrlgfts js jfjcyzg`, tbgsg rgnlpgs eust hgprgpjrg` hy wglablfa lf`lvl`ujc lfarg`lgfts jf` eggtlfa tbg jeduft di arjes spgnlilg` lf tbg


15/31


:9

Egjsurg ndcuef di tbg rgnlpg tjhcgs. ]jrgfts njf usg tbg Gjsy Egjsurg njtgadry td gstlejtgrjtbgr tbjf wglab lfarg`lgfts idr gjslgr prgpjrjtldf di tbgsg rgnlpgs. ]rgpjrlfa rgnlpgs uslfa tbgGjsy Egjsurg aul`gclfgs wlcc fdt prdvl`g tbg gxjnt njcdrlgs jf` ejnrdfutrlgfts js jfjcyzg`;tbgsg egjsurgs bjvg hggf gstlejtg` td ndeg wltblf j ncdsg rjfag di gjnb lfarg`lgft. Wslfa tbgGjsy Egjsurg lfarg`lgfts wlcc bgcp njrgtjkgrs td qulnkcy hut ndfil`gftcy prdvl`g j`gqujtg

njcdrlgs jf` ejnrdfutrlgfts td tbg pjtlgft. L`gjccy, bdwgvgr, njrgtjkgrs sbduc` usg j `laltjckltnbgf snjcg td wglab gjnb lfarg`lgft lf arjes js lf`lnjtg` lf tbg rgnlpgs td gfsurg futrltldfjcj`gqujny di tbg rgnlpg js `gvgcdpg`. Futrltldf Ijnts cjhgcs bjvg hggf nrgjtg` idr gjsyrgigrgfng idr pjrgfts jf` njrgtjkgrs tbjt prgigr td bjvg edrg lfidrejtldf df tbg agfgrjc futrlgftstbgy jrg prdvl`lfa tbglr nblc` lf gjnb stjf`jr`lzg` rgnlpg (sgg Jppgf`lx LLL).

Edst pjtlgfts wlcc rgqulrg edrg dr cgss tbjf :=== njcdrlgs pgr `jy td eggt tbglr fgg`s.Dfng `jlcy njcdrlg fgg`s bjvg hggf gstjhclsbg`, tbg `lgtltljf wdrklfa wltb tbg pjtlgft eusteuctlpcy tbg lfarg`lgfts lf tbgsg rgnlpgs hy tbg fuehgr di njcdrlgs tbg nblc` fgg`s `lvl`g` hy:===. Idr gxjepcg, li j pjtlgfts gstlejtg` fgg`s jrg :7== njcdrlgs pgr `jy, tbg `lgtltljf sbducèuctlpcy tbg lfarg`lgfts hy :7==/:===, (dr hy j ijntdr di :.7). Pbls wlcc jccdw tbg pjrgft td

prgpjrg j rgnlpg tbjt eggts tbg `jlcy njcdrln fgg`s di tbg nblc` wblcg eggtlfa tbg jpprdprljtgejnrdfutrlgft rjfags. Pbg `lgtltljf njf jcsd jòust tbgsg rgnlpgs hy prdvl`lfa j``ltldfjc ijt drnjrhdby`rjtg njcdrlgs `gpgf`lfa df tbglr nclflnjc jssgssegft di tbg pjtlgfts fgg`s.

Js tbg elnrdfutrlgft cgvgcs di gjnb rgnlpg vjry (sgg Jppgf`lx LL), lt ls rgndeegf`g` tbjtpjtlgfts jcsd hg alvgf j nblc`rgfs ndepcgtg euctlvltjelf td gfsurg jpprdprljtg cgvgcs di gssgftljcvltjelfs jf` elfgrjcs. Njrgtjkgrs njf gltbgr nrusb j nbgwjhcg tjhcgt dr usg j clqul` suppcgegft,jf` j`` td tbg hcgf`grlzg` elxturg. Dptldfs idr ndepcgtg euctlvltjelfs td usg lfncu`g Fjturgs]cus Jflejc ]jrj`g, Ajr`gf di Clig Yltjelf Nd`g Kl`s, dr Iclftstdfgs NdepcgtgNbgwjhcg Pjhcgts; tbg `lgtltljf ejy rgndeegf` jfy ndepcgtg euctlvltjelf hrjf` uslfa nclflnjcouàegft jf` ejy nbddsg td j`` j``ltldfjc vltjelfs dr elfgrjcs `gpgf`lfa df tbg nblc`slf`lvlùjc bgjctb rgqulrgegfts. Lt ls lepdrtjft td fdtg tbjt tbg nd` clvgr dlc usg` lf tbgsg rgnlpgs(Njrcsdf) prdvl`gs sdeg vltjelf J, @, jf` G. Xdtjtlfa tbg rgnlpgs df j rgaucjr hjsls wlccleprdvg tbg `lvgrslty di tbg `lgt jf` sbduc` prdvl`g j argjtgr rjfag di futrlgfts.

^d`lue fgg`s vjry `gpgf`lfa df jag jf` bgjctb stjtus. Pbg rgnlpgs lfncu`g` lf tbls`dnuegft ndftjlf ndepjrjhcg sd`lue td ndeegrnljc pg`ljtrln gftgrjc idreucjs sunb js FgstcsFutrgf Oufldr :.=, bdwgvgr lt ls rgndeegf`g` tbjt tbg `lgtltljf `gtgrelfg tbg lf`lvlùjcsd`lue rgqulrgegfts di tbg pjtlgft jf` jòust sd`lue js fgg`g`. Pbg Lfstltutg di Eg`lnlfg(8==0) rgndeegf`s jf J`gqujtg Lftjkg di :=== ea sd`lue idr nblc`rgf :-> ygjrs di jag, :8==ea sd`lue idr nblc`rgf 0-2 ygjrs di jag, jf` :7== ea sd`lue idr nblc`rgf


16/31


:1

js lfstruntg`. Bdwgvgr, `lgtltljfs sbduc` gfsurg tbjt pjtlgfts jrg eggtlfa tbglr icul` fgg`s hyj``lfa j``ltldfjc irgg wjtgr icusbgs tbrduabdut tbg `jy idr nblc`rgf wbd jrg ufjhcg td tjkg jfyicul`s hy edutb. Pbls ls slelcjr td wbjt eust hg `dfg wbgf j pjtlgft ls uslfa j ndeegrnljcidreucj, jf` tbg `lgtltljf sbduc` usg nclflnjc ouàegft wbgf `gtgrelflfa bdw eunb j``ltldfjcwjtgr td j`` td tbg nblc`s rgalegf. Lt ls rgndeegf`g` td prdvl`g tbls j``ltldfjc icul` js j icusb

rjtbgr tbjf j``lfa lt td j rgnlpg td jvdl` gxngsslvg vdcueg, hut sdeg wjtgr ejy hg j``g` td jrgnlpg td `gnrgjsg vlsndslty js fgg`g`. Pbg `lgtltljf sbduc` edfltdr pjtlgfts idr slafs di`gby`rjtldf js ls `dfg wltb jcc gftgrjc igg`lfas.

Js egftldfg` gjrclgr, prdpgr idd` sjigty prgnjutldfs eust hg tjkgf td prgvgft hjntgrljcndftjelfjtldf di tbg hcgf`grlzg` idreucj. Jcc egjt jf` arjlf ltges sbduc` hg tbdrduabcy nddkg`hgidrg hcgf`lfa jf` jcc prdùng (irult jf` vgagtjhcgs) eust hg tbdrduabcy wjsbg`. Njrg eust hgtjkgf td jnqulrg ufndftjelfjtg` wjtgr hy hdlclfa dr ilctgrlfa tjp wjtgr, dr hy purnbjslfa hdttcg`jf`/dr `lstlccg` wjtgr. @jlry prdùnts eust hg pjstgurlzg` jf` jcc pjnkjag` ltges eust hg usg`hgidrg tbglr gxplrjtldf `jtgs. Lt ls jcsd lepdrtjft td lfstrunt njrgtjkgrs lf gqulpegft ncgjflfatgnbflqug lf j``ltldf td sjig idd`-bjf`clfa prjntlngs (Fdvjk, Qlcsdf gt jc. 8==


17/31


:2

tbjt ejkg tdcgrjfng jf` drjc igg`lfa j`vjfngegft `liilnuct. Pbg igw stu`lgs tbjt bjvg hggfndfùntg` uslfa tbls `lgtjry jpprdjnb bjvg `gedfstrjtg` pdsltlvg dutndegs lf pg`ljtrln pjtlgftslfncu`lfa ngssjtldf di ajaalfa jf` rgtnblfa, rgndvgry irde drjc igg`lfa jvgrsldfs, jf` dvgrjccleprdvgegfts lf idreucj tdcgrjfng jf` pjtlgft ndeidrt.

Lf dr`gr td leprdvg uf`grstjf`lfa jf` jl` nclflnjc `gnlsldf-ejklfa, edrg rgsgjrnb lsfgg`g` df tbg usg di hcgf`grlzg` tuhg igg`s. Nurrgftcy, suppdrtlvg gvl`gfng ls cleltg` td tbg usgdi tbg tbgrjpy lf pdst-iuf`dpclnjtldf pg`ljtrln pjtlgfts. Lt ls nurrgftcy ufkfdwf wbgtbgr jhcgf`grlzg` tuhg igg` njf hg bgcpiuc lf dtbgr ndf`ltldfs, sunb js pg`ljtrln Nrdbfs `lsgjsg drnystln ilhrdsls. Pbgsg twd ndf`ltldfs lf pjrtlnucjr bjvg rgngftcy hggf sbdwf td leprdvg wbgfgftgrjc futrltldf ls utlclzg`, gltbgr gxncuslvgcy dr js j suppcgegft td drjc igg`lfa. Lt wduc` bgcplfidre nclflnjc `gnlsldf ejklfa li trljcs wgrg ndfùntg` lfvgstlajtlfa tbg usg di j hcgf`grlzg``lgt lf tbgsg pjtlgft pdpucjtldfs.

Eunb di tbg rgsgjrnb tbjt nurrgftcy gxlsts ls uf`grpdwgrg` ùg td sejcc sjepcg slzg;dtbgr gvl`gfng ls slepcy hjsg` df lf`lvlùjc njsg stu`lgs. J``ltldfjc rgsgjrnb uslfa cjragr

sjepcg slzgs wltb ejtnbg` ndftrdc ardups wduc` bgcp td `gtgrelfg tbg pdtgftljc hgfgilts dr bjreirde uslfa j hcgf`grlzg` `lgt lfstgj` di j ndeegrnljc `lgt. Gvgf li j hcgf`grlzg` `lgt `dgs fdtnjusg bjre dr ejcfutrltldf, lt ls ufncgjr wbgtbgr tbg ndst di prgpjrlfa j hcgf`grlzg` `lgt(lfncu`lfa tleg, lfarg`lgfts, tddcs, jf` cjhdr) prdvl`gs suiilnlgft hgfgilts td ejkg tbls j prgigrrgègtbd` di igg`lfa. J ndst-hgfgilt jfjcysls wduc` jccdw nclflnljfs td jssgss tbg vjcug di jhcgf`grlzg` `lgt jf` `gtgrelfg li tbg nclflnjc rgsucts jrg slaflilnjft gfduab td oustliy tbg usg ditbls rgsdurng-lftgfslvg `lgtjry strjtgay.

Ilfjccy, lt wduc` hg l`gjc td tgst tbg rgnlpgs lfncu`g` lf tbls `dnuegft uslfa j cjhdrjtdry-hjsg` futrlgft jfjcysls td `gtgrelfg tbg jntujc futrltldfjc ndftgft di tbg rgnlpgs js prgpjrg`.Gvgf tbduab tbg gstlejtg` futrlgft ndftgft ls hjsg` df puhclsbg` W^@J idd` jf` futrlgft `jtj,tbgrg ls pdtgftljc idr vjrljtldf hgtwggf tbg gstlejtg` jf` jntujc futrlgft ndftgft di tbg rgnlpgs.Qblcg lf`lvlùjc pjtlgfts njf hg edfltdrg` td gfsurg tbgy jrg eggtlfa tbglr futrltldfjc fgg`s, ltwduc` hg usgiuc td kfdw li j prgpjrg` rgnlpg nduc` rgcljhcy prdvl`g tbg cgvgc di njcdrlgs,ejnrdfutrlgfts, jf` elnrdfutrlgfts js gstlejtg` hy tbg futrltldf jfjcysls sditwjrg usg` td nrgjtglt. Li hcgf`grlzg` rgnlpgs wgrg sbdwf td rgcljhcy ndftjlf tbg futrlgfts js lftgf`g` wbgf tbg rgnlpgwjs `gvgcdpg`, `lgtltljfs nduc` hg ndfil`gft tbgy wgrg prdvl`lfa pjtlgfts wltb j slelcjr cgvgc difutrltldf tbjt ndeegrnljc idreucjs prdvl`g. Pbls wduc` jccjy igjrs tbjt j hcgf`grlzg` `lgt nduc`hg futrltldfjccy lfigrldr td j ndeegrnljc idreucj `lgt.

Gftgrjc igg`lfa wjs drlalfjccy `gvgcdpg` dvgr tbdusjf`s di ygjrs uslfa wbdcg idd`lfarg`lgfts, jf` j rgturf td wbdcg idd` lfarg`lgfts ls j `gslrjhcg dptldf idr ejfy pjrgfts dinblc`rgf wltb igg`lfa tuhgs. Hy uslfa egtlnucduscy prgpjrg` hcgf`grlzg` rgnlpgs, prdvl`lfaeuctlvltjelfs jf` j``ltldfjc icul`, jf` edfltdrlfa tbg ardwtb jf` igg`lfa tdcgrjfng di tbgpjtlgft, `lgtltljfs njf iggc ndfil`gft tbjt tbgy jrg prdvl`lfa j futrltldfjccy rgpcgtg `lgt td nblc`rgfwltb igg`lfa tuhgs.


18/31


:=(: ^uppc)? ^8:-89.

Hjlcgy, X. P., Or., J. O. Njrfjzzd jf` N. B. Drajf, Or. (:


19/31


8=

LDE (8==7). @lgtjry rgigrgfng lftjkgs idr gfgray, njrhdby`rjtg, ilhgr, ijt, ijtty jnl`s,nbdcgstgrdc, prdtglf, jf` jelfd jnl`s. ]jfgc df Ejnrdfutrlgfts. ^tjf`lfa Ndeelttgg dftbg ^nlgftliln Gvjcujtldf di @lgtjry Xgigrgfng Lftjkgs. Lfstltutg di Eg`lnlfg.

LDE (8==0). @lgtjry Xgigrgfng Lftjkgs? Qjtgr, ]dtjsslue, ^d`lue, Nbcdrl`g, jf` ^ucijtg.]jfgc df @lgtjry Xgigrgfng Lftjkgs idr Gcgntrdcytgs, jf` Qjtgr. ^tjf`lfa Ndeelttgg df

tbg ^nlgftliln Gvjcujtldf di @lgtjry Xgigrgfng Lftjkgs. Lfstltutg di Eg`lnlfg.

Odbfsdf, P. Q., J. ^purcdnk jf` ]. Ajccdwjy (8=:>). "Hcgf`grlzg` Idreucj hy AjstrdstdeyPuhg? J Njsg ]rgsgftjtldf jf` Xgvlgw di tbg Cltgrjturg." Pdplns lf Nclflnjc Futrltldf82(:)? 20-.

Kdcjngk, ^., O. Araurln, E. ]grnc jf` L. Q. Hddtb (:.

D'Icjbgrty, P., K. ^jftdrd jf` ^. ]gftluk (8=::). "Njcnucjtlfa jf` ]rgpjrlfa j ]urgg`-hy-Ajstrdstdey-Puhg (]HAP) @lgt idr ]g`ljtrln ]jtlgfts Qltb Xgtnblfa jf` Ajaalfa ]dst-iuf`dpclnjtldf." LNJF? Lfijft, Nblc`, & J`dcgsngft Futrltldf >(9)? >9:->90.


20/31


8:

]gftluk, ^., P. D'Icjbgrty, K. ^jftdrd, ]. Qlccalfa jf` J. Kjuc (8=::). "]urgg` hy ajstrdstdeytuhg `lgt leprdvgs ajaalfa jf` rgtnblfa lf nblc`rgf wltb iuf`dpclnjtldf." O]GF O]jrgftgr Gftgrjc Futr >7(>)? >17->1, j/0-PuhgIgg`lfa ]dtgftljc ]rdhcges Ndepclnjtldfs.p`i.

^jcelfgf, ]. (8==). Ejfjalfa ]dst-iuf`dpclnjtldf Xgtnblfa/Ajaalfa? ]urgg` AP Igg`lfas. 81tbFdrtb Jegrlnjf NI Ndfigrgfng, Nlfnlffjtl Nblc`rgf's Bdspltjc Eg`lnjc Ngftgr, @lvlsldfdi ]ucedfjry Eg`lnlfg.

^lfagr, G., E. ]. Ndupgr, J. Ijagrclf, I. O. Idwcgr, N. J. Cgvlf, ]. J. Whgc, O. Yjf Bdgwyk jf`H. O. _lkeuf`-Ilsbgr (8=::). "Pbg rdcg di pgrnglvg` hgfgilts jf` ndsts lf pjtlgfts'eg`lnjc `gnlsldfs." Bgjctb Gxpgnt.

^tgpbgfsdf, J. C., C. J. Ejfflk, ^. Qjcsb, E. Hrdtbgrwdd`, X. Xdhgrt, ]. H. @jrclfa, X.Flsgfhjue, O. Edgrejf jf` ^. ^tjfdogvln (8=:>). "Cdfaltu`lfjc trgf`s lf futrltldfjcstjtus jf` tbg rgcjtldf hgtwggf cufa iufntldf jf` HEL lf nystln ilhrdsls? j pdpucjtldf-hjsg` ndbdrt stu`y." Je O Nclf Futr (0)? >27->, irdebttp?//futrltldfnjrg.dra.

Pruhy, B., ]. Ndwclsbjw, N. D'Fglc jf` N. Qjlfwrlabt (8==? ::8-::7.

_upgn-Kjflj, H. J., Y. Jc`jz, E. G. Edftadegry jf` K. N. Kdstjs (8=::). "Gftgrjc jf`]jrgftgrjc Jppclnjtldfs di Kgtdagfln @lgt Pbgrjpy? Gxpgrlgfngs Irde Idur Ngftgrs."

LNJF? Lfijft, Nblc`, & J`dcgsngft Futrltldf >(7)? 810-82:.


21/31


88

Jppgf`lx L? ^tjf`jr`lzg` rgnlpgs idr hcgf`grlzg` tuhg igg`lfa. Nrgjtg` uslfa ]rdFutrj hyYldnjrg, Lfn. jt tbg FN PrjN^ Lfstltutg lf nddpgrjtldf wltb tbg Futrltldf Xgsgjrnb jf`

Hldegtjhdclse Pgje lf Nbjpgc Blcc, Fdrtb Njrdclfj.

Xgnlpg

Hggi Hjhy Idd` Hcgf`Njcdrlgs :==> %NBD 70% %IJP >8% %]XD :0%



Hjhy idd`, hggi, strjlfg` 1: : ojr

Hjhy idd`, swggt pdtjtdgs strjlfg` >>< > ojrs

Hjhy idd`, irult, pgjrs, strjlfg` >>< > ojrs

Hjhy idd`, irult, pgjnbgs, strjlfg` :.7 > tgjspddfs


XgnlpgNblnkgf Hjhy Idd` Hcgf`

Njcdrlgs .87% ijt) 022 8 nups

Hjhy idd`, egjt, nblnkgf, strjlfg` 1: : ojr



Hjhy idd`, jppcg jf` hcughgrry, strjlfg` 078 0 ojrs


Nd` clvgr dlc 8.87 :/8 tgjspddfXgnlpg

Nblnkgf @jlry-Irgg Hjhy Idd` Hcgf`

Njcdrlgs :=== %NBD 71% %IJP >=% %]XD :>%


Xlng rlfk, ufswggtgfg`, wltb j``g`

njcnlue, vltjelfs J jf` @022 8 nups

Hjhy idd`, egjt, nblnkgf, strjlfg` 1: : ojr



Hjhy idd`, jppcg jf` hcughgrry,

strjlfg` 078 0 ojrs




22/31


8>

Xgnlpg

Hggi jf` Hrdwf Xlng

Njcdrlgs :=== %NBD 77% %IJP >:% %]XD :0%

Lfarg`lgft Egjsurg (arjes) Gjsy Egjsurg LfstruntldfsQbdcg Elck (>.87% ijt) 022 8 nups

Xlng, hrdwf, eg`lue-arjlf,

nddkg`:7 8.7 tjhcgspddfs Ilcc j sbdt acjss idr qulnk egjsurlfa

^plfjnb, hdlcg`, rjlfg`,

wltbdut sjct:8= 8/> nup

^wggt pdtjtd, nddkg`, hdlcg`,

wltbdut sklf809 >/0 nup Ejsbg`



Jppcgs, rjw, wltb sklf :2= : :/8 nups Nbdppg`

^jct, tjhcg =.7 :/:8 tgjspddf

Gjslgr td wglab dut, ejy hg j`oustg`

js fgg`g` hy `lgtltljf

Qjtgr, tjp, euflnlpjc >7= :8 dufngsJ`` td rgnlpg dr icusb tbrduabdut

`jy

Xgnlpg

Hggi, Xlng Elck, jf` Hrdwf Xlng

Njcdrlgs :==7 %NBD 71% %IJP >:% %]XD :8%

Lfarg`lgft Egjsurg (arjes) Gjsy Egjsurg Lfstruntldfs

Xlng rlfk, ufswggtgfg`, wltb

j``g` njcnlue, vltjelfs J jf`

@

022 8 nups

Xlng, hrdwf, eg`lue-arjlf,rjw

:== :/8 nup

Nddk wltb : nup wjtgr;

Ejy jcsd usg : 8/> nup

nddkg` hrdwf rlng

Hrdnndcl, hdlcg`, rjlfg`,

wltbdut sjct:== 8/> nup

Hggi, arduf`, 27% cgjf, nddkg` 9= 7 tjhcgspddfs Njf usg 8 dufngs nddkg`

Njuclicdwgr, hdlcg`, rjlfg`,

wltbdut sjct:== >/0 nup


Dclvg dlc :>.7 8 tgjspddfs

Hcughgrrlgs, rjw :== 8/> nup

^jct, tjhcg =.7 :/:8 tgjspddf J`oustg` hy `lgtltljf

Qjtgr, tjp, euflnlpjc >7= :8 dufngsJ`` td rgnlpg dr icusb

tbrduabdut jy


23/31


80

Xgnlpg

Nblnkgf jf` Djts

Njcdrlgs :==: %NBD 77% %IJP >=% %]XD :7%


Qbdcg Elck (>.87% ijt) 022 8 nupsHrdnndcl, hdlcg`, rjlfg`, wltbdut

sjct:== 8/> nup

Djts, rgaucjr jf` qulnk jf` lfstjft,

`ry2: : nup



Nblnkgf, hrgjst, sklfcgss, egjt

dfcy, rdjstg`:7 : tjhcgspddf



Hjfjfjs, rjw :7= 8/> nup Ejsbg`

Hcughgrrlgs, rjw :7= : nup

^jct, tjhcg =.7 :/:8 tgjspddf Ejy hg j`oustg` hy `lgtltljfQjtgr, tjp, euflnlpjc >7= :8 dufngs

J`` td rgnlpg dr icusb

tbrduabdut `jy

Xgnlpg

Nblnkgf, Djts, jf` Jcedf` Elck

Njcdrlgs % %]XD :8%


Hgvgrjags, jcedf` elck,

swggtgfg`, vjflccj02= 8 nups

Hrdnndcl, hdlcg`, rjlfg`, wltbdut

sjct

:== 8/> nup

Djts, rgaucjr jf` qulnk jf` lfstjft,

`ry2: : nup



Nblnkgf, hrgjst, sklfcgss, egjt

dfcy, rdjstg`>7 8.7 tjhcgspddf

Ilcc j sbdt acjss idr gjsy

egjsurlfa




Hcughgrrlgs, rjw :7= : nup

^jct, tjhcg =.7 :/:8 tgjspddf J`oustg` hy `lgtltljf


tbrduabdut `jy


24/31


87

Xgnlpg

^jr`lfgs jf` Hunkwbgjt

Njcdrlgs :==0 %NBD 79% %IJP >=% %]XD :0%

Lfarg`lgft Egjsurg (arjes) Gjsy Egjsurg LfstruntldfsQbdcg Elck (>.87% ijt) 022 8 nups

^plfjnb, hdlcg`, `rjlfg`, fd sjct :== :/8 nup

Hunkwbgjt ardjts, rdjstg`, ry :== 8/> nupNjf jcsd usg 8 :/0 nups

nddkg`

^jr`lfgs njffg` lf dlc, `rjlfg`

sdcl`s wltb hdfg8= : :/8 tjhcgspddfs Ilsb dfcy



^trjwhgrrlgs, rjw :7= : nup Bjcvg`

^jct, tjhcg =.7 :/:8 tgjspddfEjy hg j`oustg` hy

`lgtltljf


tbrduabdut jy

Xgnlpg

Pufj jf` Hunkwbgjt

Njcdrlgs :==> %NBD 77% %IJP >:% %]XD :0%



Hunkwbgjt ardjts, rdjstg`, ry 28 :/8 nup

Pufj, clabt, njffg` lf wjtgr,

`rjlfg`8= : :/8 tjhcgspddfs Ilsb dfcy

Hrussgcs sprduts, hdlcg`, rjlfg`,wltbdut sjct 2= :/8 nup

Njrrdts, hdlcg`, `rjlfg`, fd sjct :7= : nup

Jvdnj`d, rjw :== 8/> nup ^clng` dr nuhg`

]gjrs, rjw 8== : :/8 nup ^clng`

Xjsphgrrlgs, rjw 7= :/8 nup

Dclvg dlc 8.87 :/8 tgjspddf

^jct, tjhcg =.7 :/:8 tgjspddfEjy hg j`oustg` hy

`lgtltljf


tbrduabdut jy


25/31


89

Jppgf`lx LL?Futrlgft jfjcysls idr stjf`jr`lzg` rgnlpgs uslfa W^@J ^tjf`jr` @jtjhjsg 8:.Jfjcyzg` uslfa ]rdFutrj hy Yldnjrg, Lfn. (*lf`lnjtgs lfsuiilnlgft `jtj idr spgnliln futrlgft.)

Xgnlpg Gfgray (knjc) ]rd (a) Ijt (a) Njrh (a) Qjtgr (a) Ilhgr (a)

Hggi Hjhy Idd` Hcgf` :==8.70 >7.1.8= :>2.1> :009.>= 88.:>

Nblnkgf Hjhy Idd` Hcgf` 2 >7.:< :>.02 :>28.9> :9.89 >0.9= :0=.27 :0=0.18 :9.29

Hggi, Xlng Elck, jf` Hrdwf Xlng :==7.0> >=.== >0.9< :07.1.2< >0.12 :00.:2 :88=.:7 8:.82

Nblnkgf, Djts, jf` Jcedf` Elck .:1 8=19.09 10=. 171 :7>=.0: 1.= 92>>.08 28>.:= 0.=: =.12Nblnkgf @jlry-Irgg Hjhy Idd` Hcgf` ::1.9< =.7> :.>> ::.99 8.77 =.2 =.1: :.08 1.8: 0.09 :.>9

Hggi, Xlng Elck, jf` Hrdwf Xlng ::2..88 :.>2

Nblnkgf jf` Djts :>9.2= =.2= :.>2 9.=2 0.9> :.>7

Nblnkgf, Djts, jf` Jcedf` Elck :>8.07 =.99 :.>8 2.>> 8.2< :.:8

^jr`lfgs jf` Hunkwbgjt :::.=7 =.9> :.7< 2.11 >.

Pufj jf` Hunkwbgjt 29.7= =.1= :.09 ::.:< 7.=8 :.87

Xgnlpg _f (ea) Ea (ea) Nu (ea) Ef (ea) ^g (ena) Icudrl`g (ena)

Hggi Hjhy Idd` Hcgf` 7.7: 8:1.92 =.10 =.=2* 81Nblnkgf @jlry-Irgg Hjhy Idd` Hcgf` 0.8< :9=.>< =.71 =.98 :1.1

Hggi jf` Hrdwf Xlng 9.2: >=>.0< =.19 0.== 81.07 >0>.==

Hggi, Xlng Elck, jf` Hrdwf Xlng 1.89 802 >=:.>:

Nblnkgf jf` Djts 9.:0 801.9.08 8 082.:= :.:: >.71 0=.9= >>:.79

Pufj jf` Hunkwbgjt 7.1= >8=.08 :.=1 8.>> 0>.2


26/31


81

Xgnlpg Idcjtg (ena) H:8 (ena) Ylt J (LW)Ylt G (ea

JPG)Ylt @ (LW) Hgtjlfg (ea)

Hggi Hjhy Idd` Hcgf` 8>=.:7 >.:9 =.==* =.==* 08=.8=* >.1=*

Nblnkgf Hjhy Idd` Hcgf` :17.89 8.0> =.==* =.==* 08=.8= :8.9=

Nblnkgf @jlry-Irgg Hjhy Idd` Hcgf` :72.=1 >.7< >=8.0= =.==* 089.9= :1.=.>9 >.:> 70:08.79 =.==* 08=.8=* 9 :=0. :

Nblnkgf @jlry-Irgg Hjhy Idd` Hcgf` 7.9= : = >.7: .2< 2.11

Nblnkgf, Djts, jf` Jcedf` Elck 7.:1 88.92 9.92 08.72 97.18 7.02

^jr`lfgs jf` Hunkwbgjt :8.:= :7.7> 0.92 11.8= 1:.2> :=.1>

Pufj jf` Hunkwbgjt :8.88 :9.80 0.>> 70.2 8=.


27/31


82

Jppgf`lx LLL. Futrltldf Ijnts cjhgcs idr gjnb di tbg stjf`jr` hcgf`grlzg` rgnlpgs.Egjsurgegfts bjvg hggf rduf`g` td tbg fgjrgst wbdcg fuehgr.

Hggi Hjhy Idd` Hcgf`?

Futrltldf IjntsJeduft ]gr ^grvlfa

Njcdrlgs :==>

Pdtjc Ijt >1 a

^jturjtg` Ijt :0 a

PrjfsIjt = a

Nbdcgstgrdc 28 ea

^d`lue >0> ea

Pdtjc Njrhdby`rjtgs :>< a

@lgtjry Ilhgr 88 a]rdtglf >9 a

Nblnkgf Hjhy Idd` Hcgf`?


Njcdrlgs a

PrjfsIjt = a

Nbdcgstgrdc :=7 ea

^d`lue >2> ea

Pdtjc Njrhdby`rjtgs :0= a

@lgtjry Ilhgr 8= a

]rdtglf >2 a


28/31


87 a

^jturjtg` Ijt :> a

PrjfsIjt = a

Nbdcgstgrdc 9 a


29/31


>=

Hggi, Xlng Elck, jf` Hrdwf Xlng?


Njcdrlgs :==7

Pdtjc Ijt >7 a

^jturjtg` Ijt 1 a

PrjfsIjt = a

Nbdcgstgrdc 99 ea

^d`lue 9:9 ea

Pdtjc Njrhdby`rjtgs :09 a

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the use of blenderized tube feeding in pediatric patients: evidence and guidelines for dietetic...

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