title: Whey- vs casein-based enteral formula and gastrointestinal function in children with cerebral palsy.
abstract: OBJECTIVE
  Children with severe cerebral palsy (CP) commonly have gastrointestinal (GI) dysfunction. Whey-based enteral formulas have been postulated to reduce gastroesophageal reflux (GOR) and accelerate gastric emptying (GE). The authors investigated whether whey-based (vs casein-based) enteral formulas reduce GOR and accelerate GE in children who have severe CP with a gastrostomy and fundoplication.
  
  
  METHODS
  Thirteen children received a casein-based formula for 1 week and either a 50% whey whole protein (50% WWP) or a 100% whey partially hydrolyzed protein (100% WPHP) formula for 1 week. Reflux episodes, gastric half-emptying time (GE t(1/2)), and reported pain and GI symptoms were measured.
  
  
  RESULTS
  Whey formulas emptied significantly faster than casein (median [interquartile range (IQR)] GE t(1/2), 33.9 [25.3-166.2] min vs 56.6 [46-191] min; P = .033). Reflux parameters were unchanged. GI symptoms were lower in children who received 50% WWP (visual analog symptom score, median [IQR], 0 [0-11.8]) vs 100% WPHP (13.0 [2.5-24.8]) (P = .035).
  
  
  CONCLUSIONS
  This pilot study shows that in children who have severe CP with a gastrostomy and fundoplication, GE of the whey-based enteral formula is significantly faster than casein. The acceleration in GE does not alter GOR frequency, and there appears to be no effect of whey vs casein in reducing acid, nonacid, and total reflux episodes. The results indicate that enteral formula selection may be particularly important for children with severe CP and delayed GE.
authors.affiliation: Department of Gastroenterology, Women's and Children's Hospital, Women's & Children's Health Service, North Adelaide, SA, Australia. karina.savage@health.sa.gov.au
authors.forename: Karina
authors.initials: K
authors.lastname: Savage
authors.forename: Stamatiki
authors.initials: S
authors.lastname: Kritas
authors.forename: Andrea
authors.initials: A
authors.lastname: Schwarzer
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Davidson
authors.forename: Taher
authors.initials: T
authors.lastname: Omari
mesh_terms: D000293:Adolescent; D002364:Caseins / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D018662:Fundoplication; D005746:Gastric Emptying / Q000187:drug effects; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control*; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008894:Milk Proteins / Q000008:administration & dosage*; D010865:Pilot Projects; D000067816:Whey Proteins
chemical_list: D002364:Caseins; D008894:Milk Proteins; D000067816:Whey Proteins