Improvements in anthropometric measures and gastrointestinal tolerance in patients with cystic fibrosis by using a digestive enzyme cartridge with overnight enteral nutrition

Abstract

Background: Patients with cystic fibrosis (CF) and pancreatic insufficiency are at risk for suboptimal fat absorption, inability to maintain weight, poor growth, and increased gastrointestinal (GI) symptoms due to malabsorption. Enteral nutrition (EN) is used to supplement caloric intake and requires pancreatic enzyme replacement for effective digestion. We evaluated the relationship between long-term use of an in-line digestive enzyme cartridge with EN and changes in anthropometric measures and GI symptoms in patients with CF.Methods: This is a single-center, retrospective case review of patients with CF using a digestive enzyme cartridge with EN. Data were collected from the patient medical records and included weight, height, body mass index, EN regimen, and reported GI symptoms.Results: Thirteen pediatric and five adult patients with a mean age of 12.6 years used a digestive enzyme cartridge with EN for a period of 3-27 months. Most patients (n = 14) had been using oral digestive enzymes with EN before using the digestive enzyme cartridge, whereas four started from the onset of EN. The indications to convert from oral enzymes to the digestive enzyme cartridge included poor growth (72.2%) and poor tolerance of EN (69.2%). There was a reduction in reported GI symptoms after initiating use of the digestive enzyme cartridge.After 12 months of digestive cartridge use, there were improvements in anthropometrics.Conclusions: This real-world experience with prolonged use of a digestive enzyme cartridge with EN demonstrated improved clinical outcomes and a reduction in GI symptoms in patients with CF.

Association of in‐line digestive enzyme cartridge with enteral feeds on improvement in anthropometrics among pediatric patients with cystic fibrosis

“…The findings of this study are consistent with previous findings, strongly supporting the clinical benefit for patients receiving nocturnal feedings to use the in-line lipase cartridge as the most appropriate source of PERT therapy to help bolster growth. 11,14 Height significantly increased after the use of in-line lipase cartridge. Adequate linear growth is observed early in the life of people with CF, and poor linear growth early in life is associated with stunted height in adults with CF.…”

“…11 Another similar study performed by Hendrix et al in 2022, saw an initial jump in patients' BMI followed by a return to baseline, which suggests an increase in weight over height. 14 Unfortunately, because of the nature of the study, the effect of exacerbations or complications of patients' underlying diagnoses on anthropometric changes were not analyzed. Anthropometric data collected for analysis were the measurements at every 3-month, standard-of-care visit.…”

Validation of an omega-3 substrate challenge absorption test as an indicator of global fat lipolysis

“…An evidence-based review found “insufficient evidence to make a recommendation regarding the association of specific PERT dosing and CFA or growth” [ 21 ]. Although not contemporaneously studied, use of an in-line lipase cartridge, which has been shown to be associated with improvements in plasma DHA and EPA absorption relative to placebo, has been shown to lead to improved BMI and GI symptoms when used over one year [ 22 ]. Use of this in-line lipase cartridge was also associated with increases in red blood cell (RBC) membrane DHA and EPA over 90 days [ 19 ].…”

Evolving nutritional needs, obesity, and overweight status in cystic fibrosis

“…Feeding by gastrostomy continues to be utilized as a tool to address malnutrition when present. The addition of digestive enzyme cartridge uses in tandem with overnight enteral nutrition was associated with improvement in both anthropometrics in children and adults, as well as reduced GI symptoms [17]. While malnutrition may continue to decrease with further care development, these studies highlight refinement in available tools.…”