Peptide: the missing piece for improved tolerance

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THE VICIOUS CYCLE OF MALNUTRITION AND MALABSORPTION

Children with compromised gastrointestinal (GI) function are at increased risk of malnutrition1 which can lead to malabsorption,2 but this is reversible by appropriate child centric nutritional treatment.3

However, condition-associated GI intolerance may bring about intolerance to nutritional interventions as a result of:4

Impaired
motility

Inadequate
digestion

Reduced
absorption

Side effects
of additional
medication

Chronic conditions that can increase the risk of GI intolerance and may require nutritional support include:

  • Cancer: Malnutrition occurs in up to 48% of children with cancer5
  • GI disorders: Growth failure is seen in up to 40% of children with inflammatory bowel disease as a result of poor nutrition6
  • Cerebral Palsy: Undernourishment is found in around 20% of children with cerebral palsy7
  • Neurodisabilities: 89% of autistic children display difficulty with eating8
  • Cystic Fibrosis: Up to 30% of children diagnosed with CF initially present with symptoms of malnutrition or failure to thrive9

In what is referred to as the vicious cycle of malnutrition and malabsorption, compromised immunity and infection can lead to physiological changes including bi-directional interplay between GI function and malnutrition2 which can have lasting effects on growth and development.1

Figure adapted from Selimoglu MA, 2020.2

PHYSIOLOGICAL CHANGES

PANCREATIC INSUFFICIENCY

Decreased secretion of pancreatic enzymes such as lipase, trypsin, chymotrypsin, and amylase can occur in severely malnourished children.10

Insufficient enzyme secretion can disrupt the critical process of breaking down food into absorbable forms as the body struggles to extract essential nutrients.2

VILLOUS ATROPHY

Malnutrition can affect gut integrity, by causing atrophy of the villi.11

This damage reduces the surface area available for nutrient absorption which can cause malabsorption and diarrhoea.11,12




DEFECTIVE CARRIERS

Malnutrition can reduce intestinal motility, so it takes longer to transport substances through the digestive system, even with the presence of diarrhoea.10

Disruptions to the lymphatic system or lack of blood flow can contribute to these transport abnormalities13 and can subsequently lead to malabsorption.14

 THE POWER OF PEPTIDES

Peptide-based feeds, designed specifically to meet the unique nutritional needs of malnourished children with compromised GI function, are associated with several benefits compared to amino acid-based or whole protein-based feeds, including:4,15-17

Improve GI tolerance and
absorption

Reduce diarrhoea and
bacterial translocation

Reduce inflammation

Maintain and restore gut
integrity

Additionally, peptide transporters can regulate peptide levels during different metabolic states, enhancing the absorption of dietary nitrogen in di- and tripeptide form.15,18

 WATCH THE SHORT PEPTIDE MODE OF ACTION VIDEO

Where a whole protein feed is not tolerated, introducing a peptide-based feed can help alleviate GI symptoms and improve the quality of life for children and their families.19

Resources Icon

PAEDIASURE PEPTIDE

PaediaSure Peptide has been specially formulated for children at risk of malnutrition with GI symptoms. Optimised for young, growing bodies, it addresses the distinct requirements of children's physical and cognitive growth at every stage.

  • Nutritionally complete

  • Lowest osmolality for improved tolerance20

  • 50% of fats as MCTs

  • Suitable for vegetarian,* halal and kosher diets

  • Great tasting vanilla flavour,‡§ preferred by children when taken orally.21

peptide

In a crowded field of nutrition options, finding the right product can be challenging.

PaediaSure Peptide stands out from the crowd with its unique formulation and benefits, helping you make an informed prescription choice that meets the highest standards for your patient's health and growth.

PER 200 ML SERVING
PAEDIASURE PEPTIDE
PEPTAMEN® JUNIOR 1.522
PEPTAMEN® JUNIOR POWDER**23
ENERGY
200 kcal302 kcal204 kcal
PROTEIN
6 g9 g6 g
PROTEIN: ENERGY RATIO
12%12%12%
FATS AS MCTS
50%60%53%
FIBRE
0 g1.4 g0 g
OSMOLARITY
272 (mOsm/l)465 (mOsm/l)322 (mOsm/l)
OSMOLALITY
320 (mOsm/Kg)560 (mOsm/Kg)370 (mOsm/Kg)

RELATED RESOURCES

PEPTIDE CASE STUDY CEREBRAL PALSY

Born prematurely at 24 weeks, Lucas is one of a twin that has faced significant health challenges from birth, including a Level 5 Cerebral Palsy diagnosis, chronic lung disease, hydrocephalus, visual impairment, hearing loss, and epilepsy.


PEPTIDE CASE STUDY SHORT BOWEL SYNDROME

Rebecca is a 10-year-old female with a diagnosis of short bowel syndrome and has navigated a complex medical history since birth.

Footnotes:

GI – gastrointestinal; MCT – medium chain triglycerides.

* Vitamin D is synthesised from cholesterol extracted from the grease in wool sheared from live sheep. Most manufacturers use vitamin D from this source, which is approved by the Vegetarian Society.
∆ PaediaSure Peptide has an osmolality of 320 mOsm/kg, compared with Peptamen® Junior Liquid* (osmolality 330 mOsm/kg), Peptamen® Junior Powder (osmolality 370 mOsm/kg), and Peptamen® Junior 1.5 (osmolality 560 mOsm/kg).
‡ Vanilla flavour PaediaSure Peptide was consistently rated ahead of Peptamen Junior Powder on taste, mouth feel and ease of consumption (n=56).
§ Independent taste test research involving 56 children found that PaediaSure Peptide scored 2.7/5 on 1a mean taste score vs. 2.1/5 for reformulated Peptamen Junior Powder vanilla flavour (reconstituted to 1 kcal/ml).
**400g presentation. Nutritional values presented per 1kcal/ml for 200ml serving.

References:

1. Chen L, et al. Journal of The Academy of Nutrition and Dietetics. 2017;117(9):A30.
2. Selimoglu MA, et al. Frontiers in Pediatrics. 2021;9:2296-2360.
3. Pimparkar, BD, et al. Am J Gastroenterol. 1977;67(6):580-8.
4. Ibrahim H et al. Arch Med Sci. 2020;16(3):592-596.
5. Tripodi SI et al. Tumori J 2023;109(1):19–27.
6. Forbes A et al. Clin Nutr. 2017;36(2):321-347.
7. NICE, 2017: Cerebral palsy in under 25s: assessment and management. Available online: https://www.nice.org.uk/researchrecommendation/what-is-the-clinical-and-cost-effectiveness-of-early-interventions-for-optimising-protein-energy-and-micronutrient-nutritional-status-in-children-with-cerebral-palsy. Last accessed February 2023.
8. Beyond Autism, 2022: Autism and Eating. Available online: https://www.beyondautism.org.uk/about-autism/understanding-autism/autism-and-eating/. Last accessed February 2023.
9. Cystic Fibrosis Trust, 2020: UK Cystic Fibrosis Registry. Annual Data Report 2019. Available online: https://www.cysticfibrosis.org.uk/sites/default/files/2020-12/2019%20Registry%20Annual%20Data%20report_Sep%202020.pdf. Last accessed December 2023.
10. Viteri FE, Schneider RE. Medical Clinics of North America. 1974;58(6):1487-1505.
11. Bhutta ZA, et al. Nat Rev Dis Primers. 2017; 21;3:17072.
12. Patwari AK. Indian J Pediatr. 1999;66: 124-134.
13. Ensari A. Pathobiology of Human Disease. 2014:1266–87.
14. Nolan JD, et al. Surgery (Oxford). 2012;30(6):268-274.
15. Brinson RR, et al. Nutr Clin Pract. 1989;4(6):211-12.
16. Philips EM, et al. ECPN. 2005:40-44.
17. Alexander DD, et al. World J Gastrointest Pharmacol Ther. 2016;7:306-19.
18. Broer S. Annu. Rev. Nutr. 2023;43:73-99.
19. Elfadil OM et al. J Parenter Enteral Nutr. 2022;46:626–634.
20. De Brito-Ashurst I, et al. Nutrients. 2021 Jul 10;13(7):2362.
21. Data on file. Abbott Laboratories Ltd. 2013 (PaediaSure Peptide vs. Peptamen Junior Powder).
22. Peptamen® Junior datacard [Accessed November 2024]
23. Peptamen® Junior Powder datacard [Accessed November 2024]

 
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