Fibre content of enteral feeds for the older child.
BACKGROUND
There is currently a lack of clinical data on fibre requirements in UK children. Subsequently, the ideal fibre profile for enteral formulae designed to meet the requirements of older children is unknown. The present study aimed to investigate the effect of fibre supplementation on gastrointestinal function of children aged 7-12 years (or weight 21-45 kg) receiving an age-specific high-energy enteral feed.


METHODS
In this double-blind randomised crossover study, 25 home enterally tube-fed children with a range of medical conditions (including cystic fibrosis, neurological conditions, liver transplant and bone marrow transplant) were given a 1.5 kcal mL(-1) formula with or without added dietary fibre (1.13 g per 100 mL). Each formula was taken for 6 weeks, followed by 6 months on the second randomly assigned formula. Anthropometry, blood biochemistry, stool characteristics, tolerance and oral dietary intake were assessed.


RESULTS
Despite a higher median fibre intake on the fibre-containing formula (84% versus 26% of recommended intake; P = 0.003), most children did not meet existing international recommendations for fibre as a result of small feed volumes (median 800 mL day(-1); 9 g fibre day(-1)). There was some evidence of reduced constipation, laxative reliance and abdominal pain on the fibre-containing formula.


CONCLUSIONS
Given the poor fibre intakes and absence of adverse effects, the use of fibre-containing formulae should become standard practice for the majority of children on enteral feeds. Larger trials in children are required to further evaluate the effect of amount and blend of fibre in enteral formulae for older children. However, it is likely that current formulae require higher levels of fibre.
Evans
S
S
Dietetic Department, Birmingham Children's Hospital, Birmingham, UK. evanss21@onetel.com
Daly
A
A
Davies
P
P
MacDonald
A
A
D015746:Abdominal Pain / Q000150:complications / Q000178:diet therapy; D000293:Adolescent; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003248:Constipation / Q000150:complications / Q000178:diet therapy*; D018592:Cross-Over Studies; D004043:Dietary Fiber / Q000008:administration & dosage* / Q000032:analysis / Q000627:therapeutic use; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated / Q000032:analysis*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D009751:Nutritional Requirements; D006113:United Kingdom
D004043:Dietary Fiber; D054368:Laxatives