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Oral protein calorie supplementation for children with chronic disease

  • Review
  • Intervention

Authors

  • Vanessa J Poustie,

    Corresponding author
    1. Alder Hey Children's Foundation Trust, Institute of Child Health, University of Liverpool, Liverpool, Merseyside, UK
    • Vanessa J Poustie, Institute of Child Health, University of Liverpool, Alder Hey Children's Foundation Trust, Eaton Road, Liverpool, Merseyside, L12 2AP, UK. v.poustie@liv.ac.uk.

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  • Rosalind L Smyth,

    1. Alder Hey Children's Foundation Trust, Institute of Child Health, University of Liverpool, Liverpool, Merseyside, UK
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  • Ruth M Watling

    1. Alder Hey Children's Foundation Trust, Department of Nutrition and Dietetics, Liverpool, Merseyside, UK
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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. development of inappropriate eating behaviour patterns.

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: April 2008.

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 assessed: 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.

Main results

Three studies (135 children) met the inclusion criteria . All three studies were carried out in children with cystic fibrosis. Few statistical differences were found between treatment and control groups, except change in total energy intake at six and twelve months, mean difference 304.86 kcal/day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal/day (95% confidence interval 42.94 to 485.46) respectively. However, these were based on the analysis of 58 children in one study. No studies were identified assessing the effectiveness of oral protein calorie supplements in children with other chronic diseases.

Authors' conclusions

Oral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We identified a small number of studies assessing these products in children with cystic fibrosis, but were unable to draw any conclusions based on the limited data extracted. We recommend a series of large, randomised controlled trials be undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we suggest these products are used with caution.

摘要

背景

慢性疾病兒童的口服高蛋白質營養補充品

罹患慢性疾病的孩童,經常發生生長及營養狀況不良。口服高蛋白質營養補充品為改善這些孩童生長情形的方式之一。然而這些昂貴的產品,卻可能帶來一些副作用;比如錯誤的進食習慣。

目標

主要了解罹患慢性疾病的孩童,使用口服高蛋白質營養補充品對於改善每日營養攝取、營養需求、存活率、生活品質,與副作用像是:腹瀉、嘔吐、降低胃口、葡萄糖耐受不良、腹脹及進食問題等發生的情形。

搜尋策略

經由比較電子資料庫、handsearching相關期刊和會議論文摘要,RCTs出版物提到對罹患慢性疾病的孩童使用口服高蛋白質營養補充品的資料。並聯繫銷售產品的公司。最近一次進入Group's Trials Register檢索的日期為2004年11月。

選擇標準

採隨機或半隨機對照試驗研究,以比較使用口服高蛋白質營養補充品至少一個月,在現有的常規治療下增加熱量的攝取,其中可能包括建議從食物或非特定的介入措施,以改善罹患慢性疾病兒童的營養攝入。

資料收集與分析

主要評估內容包括:營養與生長、身體組成的測量、熱量及營養攝取(全來自口服高蛋白質營養補充品及食物)、進食習慣、順從性、特定的副作用、疾病嚴重度及致死率。

主要結論

本評論共有兩篇共33名受試者符合標準,兩篇研究對象皆為罹患囊狀纖維化的病童。研究與對照組之間有些統計上的差異,排除三個月內總脂肪攝入量的變化,加權平均差為69.20克/天(在95%的信心區間下為11.05至127.35)。然而這僅是根據單一個小型研究的結果。沒有研究確定慢性疾病兒童口服高蛋白質營養補充品的評估成效。

作者結論

口服高蛋白質營養補充品廣泛使用於改善一些慢性疾病兒童的營養狀況。我們評估了一些針對罹患囊狀纖維化的病童使用這些產品的小型研究,但無法根據這些萃取出來的有限資料得出任何結論。我們建議進行一系列大型採隨機採樣的研究,以著手進行罹患慢性疾病病童使用這些產品的探討。在取得進一步的數據之前,我們建議仍需謹慎使用這些產品。

翻譯人

本摘要由臺灣大學附設醫院蕭雅慧翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於口服高蛋白質營養補充品,以改善一些慢性疾病、生長遲緩及營養不足;像是罹患慢性疾病像是囊狀纖維化的病童的情況,目前還沒有明確的證據。這也有可能是由於缺乏食慾、消化不良和其他與疾病相關的營養需求所致。口服高蛋白質營養補充品;像是全脂牛奶或果汁飲料,已廣泛用於改善營養狀況和增加體重。 副作用可能包括這些補充品會取代那些從正常的食物攝取的蛋白質和熱量,這可能產生對飲食習慣的負面影響,及導致腹脹、嘔吐和腹瀉。這篇評論項審查認為沒有足夠證據支持使用這些補充劑。

Plain language summary

The use of oral protein calorie supplements in children with chronic disease

A lack of growth and poor nutrition are common in children with chronic diseases like cystic fibrosis and kidney disease. This may be due to reduced appetite, food not being absorbed properly and the need for extra calories caused by their disease. Oral protein calorie supplements are widely used to improve nutritional status and weight gain. These can take the form of whole protein milk or juice drinks. Adverse effects include the risk that the protein and calories in the supplement may replace those from normal food intake. This may have a negative effect on eating behaviours. It can also cause bloating, vomiting and diarrhoea due to potential for rapid ingestion of high calorie liquid. The review includes three studies with 135 children, all of whom had cystic fibrosis. We found insufficient evidence to support the use of these supplements. Until further data are available, we suggest these products are used with caution.

Laienverständliche Zusammenfassung

Der Gebrauch von hochkalorischer Eiweiss-Zusatznahrung bei Kindern mit chronischer Erkrankung

Wachstumsstörungen und ein schlechter Ernährungszustand kommen häufig vor bei Kindern mit chronischen Erkrankungen, wie z.B. zystische Fibrose (Mukoviszidose) und Nierenkrankheiten. Der Grund dafür können schlechter Appetit, schlechte Nahrungsaufnahme oder ein erhöhter Kalorienbedarf aufgrund der Erkrankung sein. Hochkalorische Eiweiss-Zusatznahrungen werden häufig benutzt, um den Ernährungszustand zu verbessern und das Gewicht zu erhöhen. Diese können als Eiweiss-Vollmilch oder Saftgetränk gegeben werden. Eine unerwünschte Wirkung ist, dass Eiweisse und Kalorien aus der Zusatznahrung möglicherweise dieselben aus der normalen Ernährung ersetzen. Das kann das Essverhalten negativ beeinflussen. Außerdem kann die schnelle Aufnahme von kalorienreichen Flüssigkeiten Blähungen, Erbrechen und Durchfall verursachen. Diese Übersicht schloss drei Studien mit 135 Kindern ein, die an zystischer Fibrose erkrankt waren. Wir fanden unzureichende Evidenz, um die Verwendung dieser Zusatznahrung zu unterstützen. Bis weitere Daten verfügbar sind, empfehlen wir, diese Produkte mit Vorsicht zu gebrauchen.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz