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Tolerance of an Enteral Formula with Insoluble and Prebiotic Fiber in Children with Compromised Gastrointestinal Function

https://doi.org/10.1016/j.jada.2010.08.011Get rights and content

Abstract

The effects of adding fiber to the tolerance of a peptide-based formula have not been studied. The objective of this study was to evaluate the tolerance of a peptide-based formula with insoluble and prebiotic fiber in children with compromised gut function. During January 2005 to June 2006, a 6-week randomized, double-blind, cross-over clinical study was conducted to compare stool frequency, stool consistency, and tolerance (abdominal pain, abdominal distension, vomiting, weight gain, and intake) between a formula with or without 3.5 g fructo-oligosaccharides and 3.8 g insoluble fiber/L. Fourteen children with gastrointestinal dysmotility (n=9), Crohn's disease (n=3), or mild short bowel syndrome (n=2) were randomized to receive one of two formulas for 2 weeks followed by a 5-day washout period and then the second diet for another 2 weeks. Means and standard deviations of daily stool frequency and consistency were calculated and compared using intent-to-treat analysis. Linear mixed models were applied to each outcome variable. Stool frequency did not differ by formula. Stool consistency did differ with more soft “mushy” stools (less hard stools) occurring with use of fiber (P<0.001) and more watery stools occurring with control formula (P<0.01). The extremes of stool consistency were normalized with the fiber formula. No significant differences were observed in vomiting, abdominal pain, feeding intakes, or weight gain between the two formulas. This study showed that a peptide-based formula containing fiber was as well-tolerated as a fiber-free formula in a small population of children with gastrointestinal impairments. Longer-term effects of the fiber formula need to be studied.

Section snippets

Methods

The study was conducted using a prospective, double-blind, randomized, 2×2 cross-over design during January 2005-June 2006.

Patients

A total of 14 participants were included in the study. All nine patients with neurological impairment had documented delayed gastric emptying by radionuclide scans and were fed exclusively through a gastrostomy tube. Both short bowel syndrome patients had intact colons and ileocecal valves, but about 12 inches of ileum resected during the neonatal period. They were fed orally and through a gastrostomy tube. The three patients with Crohn's disease had stable disease but poor weight gain and were

Conclusions

A 100% whey, peptide–based diet containing insoluble and prebiotic fiber was as well tolerated as a commercially available, fiber-free control diet in a small and heterogeneous population of children with impaired gastrointestinal function and was associated with a substantial improvement in stool consistency, especially in neurologically impaired children. Although participants had varied underlying diagnoses, they were all chronically tube-fed patients with well-established feeding regimens.

V. Khoshoo was consulting physician, Pediatric Gastroenterology and Nutrition, West Jefferson Medical Center, New Orleans, LA.

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V. Khoshoo was consulting physician, Pediatric Gastroenterology and Nutrition, West Jefferson Medical Center, New Orleans, LA.

S. S. Sun is professor and chair, Department of Biostatistics, and director, Biomedical Informatics, Virginia Commonwealth University, School of Medicine, Richmond, VA.

H. Storm is head of Clinical Sciences, Nestlé Nutrition, Florham Park, NJ.

Deceased.

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