2015 N2U Syllabus & Presentations

EoE Dietary Pointers (Syllabus pg 83-94): Sally Schwartz, Valeria Cohran

• Even with SFED, elemental supplements helpful
• Drink elemental beverages from covered glass with straw (improves palatability)
• Cross-contamination –big issue
• Label reading critical

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IBD EEN Pointers (Syllabus pg 95-102): Rebecca Pipkorn, Justine Turner

• Polymeric formulas –most palatable and least expensive. Oral EEN is used costly/not covered
• EEN particularly helpful with microperforation/flare-up presentation and with infections (eg. TB)
• EEN induces mucosal healing and improved symptoms

References:

• Levin et al. Inflamm Bowel Dis. 2014;20:278-285.
• Johnson et al. Gut 2006;55:356-361.
• Sigall-Boneh et al. Inflamm Bowel Dis. 2014;20:1353-1360.
• Wilschanski et al. Gut 1996;38543–548.
• Critich et al. J Pediatr Gastroenterol Nutr. 2012;54: 298–305. NASPGHAN Guidelines

Conclusions:

• Enteral therapy offers an alternative to steroids in patients with CD
• Has potential to improve growth and IBD symptoms
• Avoids the side effects of steroids
• Need further research:

1. – Unclear of the mechanism
2. – Unclear of the best protocol
3. – No standard protocol for reintroduction of food

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Cystic Fibrosis (Syllabus pg 34-50) Justine Turner

Case in point: 10 yo with CF and poor growth, hx/o DIOS, poor intake, and distention.  Family had refused tube feedings previously.

Key point: Long-term survival is linked to nutritional status

• Zemel et al. J Pediatr. 2000; 137(3):374-380.
• Stallings et al. J Am Diet Assoc. 2008; 108(5):832-839.
• McPhail et al. J Pediatr. 2008; 153(6):752-757.
• Sharma et al. Thorax 2001; 56:746-750.

Other Caveats:

• Intervene early
• Breast milk (often with supplements) is optimal for infants
• Poor oral intake àcould need periactin and/or supplemental feeds
• Discussion re: pros/cons of Gtubes (pg 47 in syllabus)
• Psychology support

Nutrition Goals

• – Normal growth and optimal nutritional status
• – Ages 0-2 year: Weight for length >50th percentile
• – Ages 2-20 year: BMI percentile at or above 50th percentile
• – BMI for males:23
• – BMI for females: 22

Nutritional assessment at every visit & review:

• – Weight, length/height, weight for length, BMI, head circumference in infants
• – Nutritional education & dietary counseling
• – Review PERT
• – Review need for micronutrient supplementation: fat soluble vitamins (A, D, E, K), Ca, Fe, Zn, Na (salt), essential fatty acids

PERT (Pancreatic enzyme replacement therapy):

• Infants 2000-4000 U lipase with 120 mL breast milk or formula– Mouth care for infants (and breast feeding mother)
• Children 500-2500 U lipase/kg per meal (≤10000 U/kg/day or ≤ 4000 U/g fat/day); half meal dose with snacks
• Ideally taken with meals and orally
• Microspheres preferred formulation
• Acid blockade (used to optimize enzyme activity)
• Gold standard to assess adequacy is 72h fecal fat collection

Cystic Fibrosis Related Diabetes

• Rare before 10 years of age
• Increases mortality risk 6-fold
• Weight loss and pulmonary decline begin 2-4 years prior to
• diagnosis of CFRD

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