The impact of low-energy, partially hydrolysed enteral formula on gastrointestinal symptoms and weight in children with neurological impairment: a multicentre retrospective study

IF 2.9 3区医学 Q3 NUTRITION & DIETETICS

Journal of Human Nutrition and Dietetics Pub Date : 2024-03-27 DOI:10.1111/jhn.13305

Graeme O'Connor, Martha Van Der Linde, Zoltan Hartfiel Capriles

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引用次数: 0

Abstract

Background

Neurological impairment (NI) relates to disorders of the central nervous system. The specific aetiology of NI varies but includes genetic, congenital abnormalities or brain injury. In children with severe NI, feeding impairments can lead to undernutrition, and some children require a feeding tube. Although tube feeding improves overall nutritional status, it has also been associated with excess body fat. Commercially available enteral formulas that are low in energy, hydrolysed and nutritionally adequate for protein and micronutrients are available to mitigate gastrointestinal symptoms and obesity.

Methods

This is a retrospective multicentre study of children who attended NI clinics between January 2022 and July 2023. Data were collected before and 1 month after receiving a low-energy, partially hydrolysed enteral formula (0.6 kcal/mL) on demographic data (age, sex, ethnicity and NI diagnosis), anthropometric measurements (weight, height, weight-for-age Z-score, height-for-age Z-score, body mass index [BMI] Z-score) and feed regimen (feed volume, total fluids and type of formula/supplements).

Results

Dietitians collected data on 28 children, the median age was 7 years (interquartile range [IQR] 3, 8). The most frequently recorded NI was cerebral palsy, in 13 of 28 children (48%). Before the formula switch, the most frequently reported gastrointestinal symptom was constipation, in 13 of 28 children. Within 1 month of switching to a low-energy, hydrolysed formula, 10 of the 13 (77%) children reported an improvement in constipation. Before the formula switch, all 28 children were experiencing excessive weight gain. After the formula was switched to low-energy, hydrolysed formula, dietitians reported that 20 of the 28 (76%) children's weight either stabilised or reduced after 1 month. There was no statistically significant difference in weight-for-age Z-score or BMI Z-scores postswitch of formula (p-value 0.1 and 0.09, respectively). Fibre intake increased significantly from 3.3 to 8.1 g/day (p-value < 0.01) after formula switch. The number of children whose feed regimens were simplified after switching to a low-energy, partially hydrolysed formula was 24 of 28 (91%).

Conclusions

Children with an NI who have gastrointestinal symptoms may benefit from a low-energy, hydrolysed enteral formula to maximise feed tolerance and promote healthy weight gain. In addition, changing to a low-energy, hydrolysed formula may simplify feed regimens by eliminating the need for additional electrolytes, multivitamins and fluid boluses. Healthcare professionals should be knowledgeable about the effectiveness and availability of a low-energy, hydrolysed formula.

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低能量、部分水解肠内配方对神经系统受损儿童胃肠道症状和体重的影响：一项多中心回顾性研究。

背景：神经损伤（NI）与中枢神经系统疾病有关。神经损伤的具体病因各不相同，但包括遗传、先天畸形或脑损伤。在患有严重 NI 的儿童中，喂养障碍会导致营养不良，有些儿童需要使用喂养管。虽然插管喂养可改善整体营养状况，但也与体内脂肪过多有关。市售的肠内配方奶能量低、水解、蛋白质和微量元素营养充足，可减轻胃肠道症状和肥胖：这是一项回顾性多中心研究，研究对象为 2022 年 1 月至 2023 年 7 月期间在 NI 诊所就诊的儿童。在接受低能量、部分水解肠内配方（0.6 千卡/毫升）之前和之后 1 个月，收集有关人口统计学数据（年龄、性别、种族和 NI 诊断）、人体测量（体重、身高、体重年龄 Z 值、身高年龄 Z 值、体重指数 [BMI] Z 值）和喂养方案（喂养量、总液体和配方/补充剂类型）的数据：营养师收集了 28 名儿童的数据，中位年龄为 7 岁（四分位数间距 [IQR] 3，8）。记录最多的非传染性疾病是脑瘫，28 名儿童中有 13 名（占 48%）。在更换配方奶粉之前，最常出现的胃肠道症状是便秘，28 名儿童中有 13 名出现了这种症状。在改用低能量水解配方奶粉后的 1 个月内，13 名儿童中有 10 名（77%）表示便秘情况有所改善。在更换配方奶粉之前，所有 28 名儿童的体重都增长过快。在改用低能量水解配方奶粉后，营养师报告说，28 名儿童中有 20 名（76%）的体重在 1 个月后趋于稳定或有所下降。换用配方奶粉后，体重-年龄 Z 值或体重指数 Z 值没有明显的统计学差异（P 值分别为 0.1 和 0.09）。纤维摄入量从每天 3.3 克大幅增加到 8.1 克（p 值结论）：有胃肠道症状的 NI 患儿可能会从低能量水解肠内配方奶粉中获益，从而最大限度地提高饲料耐受性并促进体重健康增长。此外，改用低能量水解配方可简化喂养方案，无需额外添加电解质、多种维生素和补充液体。医疗保健专业人员应了解低能量水解配方奶粉的有效性和可用性。

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来源期刊

Journal of Human Nutrition and Dietetics 医学-营养学

CiteScore

5.30

自引率

15.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Human Nutrition and Dietetics is an international peer-reviewed journal publishing papers in applied nutrition and dietetics. Papers are therefore welcomed on: - Clinical nutrition and the practice of therapeutic dietetics - Clinical and professional guidelines - Public health nutrition and nutritional epidemiology - Dietary surveys and dietary assessment methodology - Health promotion and intervention studies and their effectiveness - Obesity, weight control and body composition - Research on psychological determinants of healthy and unhealthy eating behaviour. Focus can for example be on attitudes, brain correlates of food reward processing, social influences, impulsivity, cognitive control, cognitive processes, dieting, psychological treatments. - Appetite, Food intake and nutritional status - Nutrigenomics and molecular nutrition - The journal does not publish animal research The journal is published in an online-only format. No printed issue of this title will be produced but authors will still be able to order offprints of their own articles.