CF Guidelines - Nutritional & Oral Supplementation

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CF Guidelines - Nutrition & Oral Supplementation

Oral Nutritional Support in CF:
	The aim of nutritional therapy for CF is to promote normal growth and development throughout childhood and on into adulthood.

Nutritional Requirements:
	The nutritional requirements of patients with CF vary widely. Requirements are increase by poorly controlled fat absorption and increased energy expenditure. It is recommended that the diet of a CF patient should be 120% - 150% of the estimated average requirement - EAR - for energy. Although there has been limited research about protein requirements, it is generally accepted that protein intake should also be higher then the norm. This is to compensate for excessive los of nitrogen in faeces and sputum and to also ensure that there is adequate level in the system for growth. Fat restrictions are not recommended. Fat provides a useful source of energy and it is suggested that 35% - 45% of energy come from fat sources. A non CF patients healthy diet should be 25% - 30% but 100% of EAR.

Dietary Advice:
	Principally, dietary requirements should be met by the patients diet. Patients should be reviewed by a CF dietician regularly to monitor growth and nutritional status. Advice should be on an individual basis. A high calorie and high protein diet should be promoted. If there is weight loss or poor weight gain, further advice should be provided to maximise calorie intake.

	Dietary advice may include:
	-	Food fortification with cream, butter, oil, dried milk, jam and sugar etc.
	-	Promotion of full fat milk and dairy products.
	-	Avoidance of low fat food and drink products.
	-	Promotion of energy dense foods such as crisps, chocolate, cheese etc.
	-	Nourishing drinks.

Oral Nutritional Supplements:
	If a patient fails to meet their requirements through oral diet and are failing to grow and develop, loosing weight or have a low BMI, oral nutritional supplements should be considered. Supplementation with high energy milk based oral supplements has been demonstrated to be an effective way of improving nutritional status and weight of patients with CF.(Skypala et el, 1998) However, a Cochrane review concluded that they did not provide any more benefit in moderately malnourished children with CF than the use of dietary advice and monitoring. Whilst they may be used, they should not be considered as essential. (Smyth & Walters, 2000) There is no conclusion for there short term use for weight gain, or for use in the long term management in adult CF patients or those with advanced lung disease. (Smyth & Walters, 2007) There is an extensive range of supplements available to suit individual age and taste. The table below gives some examples of the variety available on prescription.

	Do not require enzymes. Check with manufacturers data for suitability of use of supplements with young children.

	Supplements should be taken in addition to the patients normal diet to increase their daily energy intake and should not be used to replace meals. Consideration of timing and quantity is required to ensure appetite and intake of normal food is not reduced. The best way to take them is as snakes between meals, after meals or just before bed time.

Nutritional Intervention:
	The table below shows the different stages of nutritional intervention - (CF Trust, 2002).


References:
1,	Leeds Teaching Hospital NHS Trust. Cystic Fibrosis in Children and Adults. The Leeds Method of Management, 2008.
2,	Royal Brompton & Harefield NHS Trust. Clinical guidelines: Children with CF. http://www.rbht.nhs.uk/healthprofessionals/clinical-depts/paediatrics/childrencf/introduction
3,	Skypala I.J, Ashworth F.A, Hodson M.E, Leonard C.H, Knox A, Hiller E.J, Wolfe S.P, Littlewood J.M, Morton A, Conwat S, Patchell C, Weller P, McCarthy H, Redmond A, Dodge J. Oral nutritional supplements to promote weight gain in Cystic Fibrosis patients. Journal of Human Nutrition and Dietetics, 1998: 11: 95-104
4,	Smith R, Walters S. Oral calorie supplements for Cystic Fibrosis. The Cochrane Database of Systematic Reviews, 2000.

	Dowloadable PDF File - PDF File
			Document approved - 2011
			Document due for review - December 2013

	Acknowledgements: The Peninsula CF team acknowledges the use of guidelines produced by The CF Trust, Manchester, Papworth, Leeds and Brompton CF teams during development of these local Peninsula protocols and guidelines.

Disclaimer: While efforts have been made to ensure that all the information published on this web site is correct, the authors take no responsibility for the accuracy of information, or for harm arising as a consequence of errors contained within this web site. If you have concerns regarding treatment, drugs or doses then consult your local CF consultant.