Oral protein calorie supplementation for children with chronic disease

Abstract

Background Poor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009. Objectives To examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems. Search methods Trials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted. Most recent search of the Group's Trials Register: 24 February 2015. Selection criteria Randomised or quasi‐randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease. Data collection and analysis We independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials. Main results Four studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases. Authors' conclusions Oral protein calor...

Patient, parent and professional perception of the use of maintenance enteral nutrition in Paediatric Crohn's Disease

“…Appetite assessment was subjectively measured only, potentially incurring a risk of recall bias. Although local patient perspective on MEN cannot be directly compared with national perspective, nor with dietetic perception, the experience of families in our study is similar to that reported by other patients with chronic disease consuming oral nutritional supplements and by clinical dietitians internationally . A lower response rate in our study (53% children and 62% parents) compared with a similar patient questionnaire by Svolvos (71% response rate) may relate to the longer study period of up to two years between MEN treatment and questionnaire, compared to one year post EEN in his study .…”

“…A Cochrane review reported that oral nutritional supplementation is not well tolerated in paediatric chronic disease due to physical side effects of nausea, bloating and food displacement . Adherence to a MEN regimen may, therefore, be affected, however adherence rates are only measured subjectively in paediatric CD studies on MEN and the impact of daily MEN upon patients’ quality of life is not assessed.…”

Bovine Colostrum Against Chemotherapy‐Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double‐Blind, Placebo‐Controlled Trial

“…This may be attributable to differences in palatability of the colostrum supplement and the placebo. Previous studies of nutrition interventions in children with chronic diseases rarely assessed compliance, and studies in adults show similar difficulties in maintaining adherence to oral nutrition interventions . The reasons for decreased adherence to oral supplements could relate to factors such as chemotherapy‐related taste changes, nausea, and pain on swallowing or issues of palatability.…”

“…Previous studies of nutrition interventions in children with chronic diseases rarely assessed compliance, and studies in adults show similar difficulties in maintaining adherence to oral nutrition interventions. 46,47 The reasons for decreased adherence to oral supplements could relate to factors such as chemotherapy-related taste changes, nausea, and pain on swallowing or issues of palatability. Optimization of taste, composition, and texture of supplementary products is critical, together with appropriate support and instructions to parents and chemotherapy-treated pediatric patients in nutrition trials.…”

What role for oral nutritional supplements in primary care?

“…19 Some systematic reviews have included only inpatients, 20,21 some have included mixed primary and secondary care patients 14 and in some the setting was unclear. 22,23 …”