Systematic inflammation
MANAGING MALNUTRITION IN CHILDREN WITH CHRONIC RESPIRATORY DISEASE
ON THIS PAGE
CAUSES OF DISEASE-RELATED MALNUTRITION IN CHILDREN WITH CHRONIC RESPIRATORY DISEASE
BURDEN OF DISEASE-RELATED MALNUTRITION FOR CHILDREN WITH CHRONIC RESPIRATORY DISEASE
IMPORTANCE OF NUTRITIONAL ASSESSMENT AND EARLY IDENTIFICATION
THE ROLE OF MEDICAL NUTRITION FOR CHILDREN WITH RESPIRATORY DISEASE RELATED PRODUCTS NUTRITIONAL RESOURCES
Children with chronic respiratory diseases such as cystic fibrosis (CF), bronchiectasis and childhood interstitial lung disease often suffer from malnutrition as a result of inflammation, anorexia, and gastrointestinal (GI) disorders. They may also suffer from reduced physical activity levels due to their condition.1
Malnutrition can impact the progression of respiratory disease and illness, as well as respiratory muscle function and disease severity. Adequate nutritional intake is associated with better outcomes for children with chronic respiratory disease.1,2
Malnutrition risk (either over or underweight) in children, is common across a variety of respiratory conditions:
Up to 57%
of children with cystic
fibrosis3
Up to 57%
of children with
bronchiectasis4
Up to 44%
of children with asthma5
Children with respiratory disease are often at increased risk of disease-related malnutrition and reduced fat-free mass. There can be many reasons for this, depending on the condition, but causes include:1,2
Systematic inflammation
Decreased appetite
Associated GI disorders
Impaired physical activity
following exacerbation
Maldigestion and poor
absorption
Increased energy
expenditure
Malnutrition in children with chronic respiratory disease can impact disease progression and the child’s overall health and development:1,2,6
Reduced immunity
and increased risk
of infection
Abnormal
respiratory
function
Increased
exacerbations/disease
severity
Poor weight gain
and growth
GI symptoms such as
bloating, constipation
and diarrhoea
Increased
hospitalisation
Regular nutritional assessment should be part of the care of all children with chronic diseases, with maintenance of optimal growth as one of the treatment goals.7
Methods used for nutritional intervention may include weight, body composition and energy expenditure assessments.7
A validated nutrition screening tool for use in hospitalised children from 2 weeks to 16 years of age.
A validated, easy-to-use digital nutritional awareness tool that supports HCPs in completing a nutrition-focussed consultation.
MUAC Z-score tapes are a simple, inexpensive and easy way to measure malnutrition risk in children.
Nutritional intervention has the potential to reduce respiratory illness-related morbidity and mortality, supporting improvements in:1
Weight and body
composition
Respiratory symptoms
and pulmonary function
Frequency of hospital
admissions
Acute exacerbation
occurrence
Calorie and protein requirements should be based on the phase of the disease, the child’s current nutritional status and their age. Infants and young children may need more calories and protein to maintain adequate growth and development.
Goals of nutritional support should always be considered, which may include:2
• Adequate calorie intake
• Adequate protein intake to prevent muscle loss
• Correction of disease exacerbation
• Optimised exercise tolerance
• Growth normalisation
If the patient is experiencing GI symptoms, a peptide-based formula may be the most appropriate intervention. Peptide-based formulas provide protein in shorter parts (peptides) that are absorbed more rapidly by the body. Compared to whole protein feeds, peptide-based feeds have been associated with improved GI symptoms, improved tolerance and a reduced risk of diarrhoea in malnourished children with compromised GI function.8
PaediaSure® Plus
PaediaSure Plus is suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. PaediaSure Plus provides 1.5 kcal/ml and is available both as a 500 ml Ready to Hang tube feed and as a 200 ml oral nutritional supplement.
PaediaSure® Compact
PaediaSure Compact is a 125 ml oral nutritional supplement suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. It has been specifically developed for children who may benefit from a smaller volume, as an alternative to ready-to-drink supplements which are 200 ml in volume. Each bottle provides 301 kcal (2.4 kcal/ml) and 8.4 g of protein. The milkshake style oral nutritional supplement is ready-to-drink and available in three delicious flavours: banana, strawberry and vanilla.
PaediaSure® Peptide
PaediaSure Peptide is suitable for the dietary management of children weighing 8-30 kg with malabsorption or children who experience symptoms of poor feed tolerance.
PaediaSure Peptide is 1.0 kcal/ml, with 100% proteins broken down to peptides*, 50% fat as medium-chain triglycerides (MCT) and clinically lactose free. PaediaSure Peptide is available both as a 500 ml Ready to Hang tube feed and as a 200 ml bottle. It is available in vanilla flavour and is best served chilled.
*Peptides are partially broken down proteins, which makes them easier to digest and absorb in the gut than whole proteins.
In this webinar, Chris Smith, RD, BSc (Hons), MBDA, and Sally Harris, PhD, ClinPsyD, MSc, BSc, CPsychol AFBPsS, will identify the emerging evidence in paediatric cystic fibrosis influencing nutritional management, review the nutritional needs and management of children with cystic fibrosis in line with new therapies.
In this course, Helen McCarthy will define paediatric malnutrition and its prevalence in the UK, review the role of paediatric malnutrition screening tools in practice, and evaluate the paediatric malnutrition screening tools currently available for identifying malnutrition.
References:
1. Alsharkawy A et al. Egyptian Pediatric Association Gazette 2021;69:42.
2. Knebusch N et al. Nutrients 2023;14:4142.
3. Cirstea O et al. Archives of Disease in Childhood 2017;102:A164.
4. Goyal V & Chang AB. Clin Chest Med 2022;43:71-88
5. Petrovic V et al. Medicinski Pregled 2020;73:9-10.
6. Cystic Fibrosis Trust. Cystic Fibrosis FAQs. https://www.cysticfibrosis.org.uk/what-is-cystic-fibrosis/faqs Last accessed March 2024.
7. Moráis-López A. An Pediatr (Barc) 2020;92(4):190-191.
8. Selimoglu MA et al. Frontiers in Pediatrics. 2021;9:2296-2360
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ENSURE PLUS
1 x 220 ml
Flavor: Apple
1,5 kcal / ml
Nutrition Information
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| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
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