Background Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires and perceptions of highly motivated caregivers. With wider use in practice, new and increasing literature has emerged on clinical outcomes that may support this practice for health professionals.

Objective To identify, appraise and synthesise the best available evidence on the benefits and complications of the BD versus commercial feeds for enteral tube feeding in young people.

Methods A systematic review was carried out from December 2020 to June 2021 in line with PRISMA- P guidance and registered with PROSPERO (CRD42021229453). Searches were conducted of PubMed, Embase, CINAHL, Scopus and Cochrane in accordance with a PICO approach without limitation on year of publication. The search strategy included blended diet OR blenderized diet OR blended OR blenderized OR Pureed OR real food OR liquidized OR liquidised AND enteral OR tube OR gastrostomy OR PEG OR G-tube OR nasogastric OR NG. Inclusion criteria for the review were (1) English language, (2) studies including children, (3) original research from interventional and observational studies and (4) examination of outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) studies that focus on management of feeding, preparations or attitudes and (3) studies that compare commercial blends only. Data was synthesised using a formal narrative synthesis approach in keeping with the four-element framework by Popay et al, using the Mixed Methods Appraisal Tool (MMAT) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) in appraisal.

Results 629 database results were identified. Following screening, 53 were sought for retrieval. Full text article review revealed 6 eligible for inclusion involving 226 participants (age range 9 months - 26 years). Study type varied and included cohort, prospective interventional and retrospective. 5 studies reported differences in GI symptoms (n=181). 3 studies reported changes in medication use (n=78). 5 studies reported on growth outcomes (n=148). 3 studies specifically reported complications or adverse events (n=9). The studies varied to an extent that deems them collectively unsuitable for meta-analysis or other pooled quantitative statistical analysis. However, the available literature indicates towards positive outcomes, particularly in the area of gastrointestinal symptom control with few reports of mild adverse events in the included studies.

Conclusion There is a paucity of data in this area and much heterogeneity in included studies. This is an important and highly clinically relevant topic and more primary research, ideally using core outcome sets to standardise reporting, is required to answer the key questions.