Tolerance and acceptability of a new oral nutritional supplement in cystic fibrosis

Abstract

It has been shown that nutrient deficiencies which are secondary to malabsorption and pulmonary disease in cystic fibrosis (CF) can be treated effectively with oral nutritional supplements, but inconvenience and taste aversion present obstacles to success. The Cystic Fibrosis Foundation has supported the development of an oral nutritional supplement, Calories Plus™, a product specifically formulated to provide 450 calories, 25 g fat, 13 g linoleic acid, 2500 IU vitamin A, and 15 IU vitamin E per serving reconstituted in water. We tested tolerance and acceptability, and evaluated the effect of the supplement on short-term nutritional status and dietary intake in patients with CF. Subjects were their own controls for this 3-month study and were recruited during regular visits to the University of Wisconsin Hospital and Clinics in Madison, Wisconsin. Patients ≥ 4 yr were selected if they met one of the following criteria: weight < 89% reference weight, weight loss > 5% usual body weight, decrease of 1 growth channel in weight-for-age or weight-for-height, a plateau in weight gain for ≥ 3 months, or adequate growth/weight maintenance reliant upon the use of another nutritional supplement. All subjects were receiving pancreatic enzyme therapy and were not participating in other research protocols. Of the 23 subjects enrolled, 19 completed the study (8 over 18 yr; 11 under 18 yr). Subjects consumed Calories Plus™ at a maximum of 30% their estimated daily energy requirements. Tolerance and acceptability questionnaires and 3-day food records were completed monthly. Anthropometric measurements and plasma levels of retinol, α-tocopherol, and serum albumin were obtained at 0 and 3 months. Data were analyzed using Minitab and Statistical Analysis Software (SAS). A significance level of 0.05 was used for all tests. Of the 16 who had previously used oral nutritional supplements, 9 preferred the taste of Calories Plus™. Mean compliance was 70% of recommended intake. All subjects tolerated Calories Plus™ although 12 reported mild symptoms of fullness, nausea, and/or bloating which were resolved upon distributing intake throughout the day. Difficulty in reconstitution was the most commonly reported problem. There were no significant changes in plasma retinol, α-tocopherol, and serum albumin. Normal food intake was not significantly suppressed. Linoleic acid intake increased significantly (p = 0.0003). Weight also increased significantly (p = 0.01). We conclude that Calories Plus™ would be a beneficial addition to the supplementation choices available to patients with CF. This study was supported by a grant from the Cystic Fibrosis Foundation.